Faced with the imminent opening of the new competing “Lens/Bois-Bernard” care unit in the Nord - Pas-de-Calais region (4 million inhabitants), a prospective modeling study was carried out in 1999 in response to a request from the Lille University Hospital (LUH), which sought to estimate the positive or negative impact on its recruitment catchment areas and consequently on its 1996 cardiac surgery activity (comprising 2 care units, i.e., 84 beds). In 1996, only 3 care units with the “Clinique du Bois” in Lille showed our regional undersupply of cardiac surgery compared to the national average of 5.96 [1,2].

This paper is focused on the assignment of users to medico-social institutions. The main goal is to study if alternative assignment policies can improve global response to users' demands and assess the performances of each alternative compared to the current practice. We formulated a mathematical model of the user assignment to medico-social structures and professionals, under constraints of resource capacity, professional's skills and user requirement covering (formulated in an individual support project). The alternative assignment policies allow respectively to partially cover the need of users, and to authorize the involvement of several structures and several professionals in the response to the request. This model is solved thanks to a mixed ILP solver, following a lexicographic approach with regard do the partial covering policy. We used real size data gathered in a cluster of institution for disabled children and teenagers. We present and compare computational results over several scenarios, highlighting the improvement provided by alternative assignment policies.

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