Organizing hospitals into networks: a hierarchical and multiservice model to define location, supply and referrals in planned hospital systems

Abstract

Health care planners in countries with a system based on a National Health Service (NHS) have to make decisions on where to locate and how to organize hospital services, so as to improve the geographic equity of access in the delivery of care while accounting for efficiency and cost issues. This study proposes a hierarchical multiservice mathematical programming model to inform decisions on the location and supply of hospital services, when the decision maker wants to maximize patients' geographical access to a hospital network. The model considers the multiservice structure of hospital production (with hospitals producing inpatient care, emergency care and external consultations) and the costs associated with reorganizing the hospital network. Moreover, it considers the articulation between different hospital services and between hospital units, and the ascendant and descendent flows related to twoway referrals of patients in the hospital hierarchy. The proposed approach differs from previous literature by accounting simultaneously for these issues and provides crucial information for health care planners on referral networks, on hospital catchment areas, on the location and structure of hospital supply as well as on the costs required to improve access. The results from applying the model are illustrated in an application to the South region of the Portuguese NHS. Three scenarios are portrayed to describe how the model can be used in distinct institutional settings and policy contexts and when there is uncertainty concerning the key parameters of the model.

Location Problems in Healthcare

“…For healthcare services, there may also be regulations on minimum number of patients assigned to a physician because for some specialties (such as mammography interpretation or surgery), regular practice is important to maintain high service quality. See Verter and Lapierre (2002), Güneş and Yaman (2009), Mestre et al (2012), Güneş et al (2014) for examples on how to incorporate such type of constraints.…”

“…Some examples of hierarchical facility location models include Hodgson (1988) for primary care facilities, Smith et al (2009Smith et al ( , 2013 for community health facilities, and Mestre et al (2012) for regional and central hospitals. Typically, these models can be solved by commercial solvers.…”

Optimizing the location-allocation problem of pharmacy warehouses: A case study in Gaziantep

“…Hierarchical models are problems in which the upper level and lower level facilities are considered together [15]. Mestre et al [16], Farahani et al [17] and Teixeira and Antunes [18] can be examined as examples of hierarchical models in healthcare services. A summary of the literature related to the single-level facility location-allocation models are given in Table 2.…”

Inequity averse optimization in operational research

“…Especially in essential public service facility location models, geographic equity of access to the service facilities is considered as one of the main requirements for an applicable solution. The access level can be measured in different terms such as the distance between demand points (customers) and the facilities (as in Batta et al, 2014;Maliszewski et al, 2012;Smith et al, 2013;Bell et al, 2011;Ohsawa et al, 2008;Chanta et al, 2011;Jia et al, 2007;Melachrinoudis & Xanthopulos, 2003;Ohsawa & Tamura, 2003;Mladenovic et al, 2003;López-de-los Mozos et al, 2013;Lejeune & Prasad, 2013) or the time required to access the facility from the demand points as in Mestre et al (2012) and Smith et al (2009). Ogryczak (2009) considers the generic location problem from a multicriteria perspective and formulates a model where each individual access level is minimized (see Table 2).…”