Determining Location and Size of Medical Departments in a Hospital Network: A Multiobjective Decision Support Approach

Decisions on the location and size of medical departments in a given hospital network are prime examples of priority setting in health care, which is an issue of growing political importance. As such decisions are regularly characterized by multiple and often conflicting objectives in real-life, this paper integrates the fields of hospital planning and multiobjective decision support. The proposed two-phase solution procedure for our corresponding mathematical programming model does not require a priori preference information. Instead, it seeks efficient solutions by means of multiobjective tabu search in the first phase, while applying clustering in the second phase to allow the decision makers to interactively explore the solution space until the “best” configuration is determined. The real-world applicability of our approach is illustrated through a numerical example based on hospital data from Germany.

[1]  Richard S. Segall,et al.  Some quantitative methods for determining capacities and locations of military emergency medical facilities , 2000 .

[2]  Piotr Czyzżak,et al.  Pareto simulated annealing—a metaheuristic technique for multiple‐objective combinatorial optimization , 1998 .

[3]  P R Loubeau,et al.  Hospital selection by managed care insurers. , 2000, Health care management review.

[4]  Olaug S Lian,et al.  Convergence or divergence? Reforming primary care in Norway and Britain. , 2003, The Milbank quarterly.

[5]  L Berghmans,et al.  Implementation of Health Facilities in a New City , 1984, The Journal of the Operational Research Society.

[6]  Les Mayhew,et al.  Urban Hospital Location , 1987 .

[7]  D. Ross,et al.  Resource allocation and budgetary mechanisms for decentralized health systems: experiences from Balochistan, Pakistan. , 2000, Bulletin of the World Health Organization.

[8]  M. Hansen,et al.  Tabu search for multiobjective combinatorial optimization : TAMOCO , 2000 .

[9]  Joel N. Morse,et al.  Reducing the size of the nondominated set: Pruning by clustering , 1980, Comput. Oper. Res..

[10]  Richard S. Segall,et al.  Deterministic Mathematical Modelling for the Spatial Allocation of Multi-Categorical Resources: with an Application to Real Health Data , 1992 .

[11]  R. Andersen,et al.  A framework for the study of access to medical care. , 1974, Health services research.

[12]  Ralph E. Steuer,et al.  Intra-set point generation and filtering in decision and criterion space , 1980, Comput. Oper. Res..

[13]  T Hindle,et al.  The Relative Accessibility for Health Districts to Regionally Supplied Specialist Services , 1990, Health services management research.

[14]  Ralph E. Steuer,et al.  InterQuad: An interactive quad tree based procedure for solving the discrete alternative multiple criteria problem , 1996 .

[15]  McGuirk Ma,et al.  Spatial patterns of hospital utilization: the impact of distance and time. , 1984 .

[16]  L. Mayhew,et al.  Urban Hospital Location , 1987 .

[17]  V. Smith-Daniels,et al.  Capacity Management in Health Care Services: Review and Future Research Directions* , 1988 .

[18]  A. Mehrez,et al.  On the Implementation of Quantitative Facility Location Models: The Case of a Hospital in a Rural Region , 1996 .

[19]  Robert C. Kohberger,et al.  Cluster Analysis (3rd ed.) , 1994 .

[20]  R. S. Laundy,et al.  Multiple Criteria Optimisation: Theory, Computation and Application , 1989 .

[21]  M A Cohen,et al.  The Determinants of Spatial Distribution of Hospital Utilization in a Region , 1985, Medical care.

[22]  D Parkin,et al.  How important is equality of access to hospital? A case study of patients' and visitors' travel costs. , 1987, The Hospital and health services review.

[23]  H S Brown Income, location, and the demand for health care from public, nonprofit, and for-profit hospitals. , 2001, Journal of health care finance.

[24]  K. Levit,et al.  Inflation spurs health spending in 2000. , 2002, Health affairs.

[25]  Eric R De Winter Are we ignoring population density in health planning? The issues of availability and accessibility. , 1992 .

[26]  G. A. Miller THE PSYCHOLOGICAL REVIEW THE MAGICAL NUMBER SEVEN, PLUS OR MINUS TWO: SOME LIMITS ON OUR CAPACITY FOR PROCESSING INFORMATION 1 , 1956 .

[27]  Xavier Gandibleux,et al.  A survey and annotated bibliography of multiobjective combinatorial optimization , 2000, OR Spectr..

[28]  O. Wigertz,et al.  Distance from the Primary Health Center: A GIS method to study geographical access to health care , 2005, Journal of Medical Systems.

[29]  B Japsen Another record year for dealmaking. Activity among medium-size companies fuels continued drive toward consolidation. , 1996, Modern healthcare.

[30]  Arthur J. Keown,et al.  An Integer Goal Programming Model for Capital Budgeting in Hospitals , 1976 .

[31]  N. Patel Locating Rural Social Service Centers in India , 1979 .

[32]  Peter T. Ward,et al.  The effect of location, strategy, and operations technology on hospital performance , 2002 .

[33]  Mehrdad Tamiz,et al.  Multi-objective meta-heuristics: An overview of the current state-of-the-art , 2002, Eur. J. Oper. Res..

[34]  P. Lindquist,et al.  The geographical accessibility of hospitals to the aged: a geographic information systems analysis within Illinois. , 1995, Health services research.

[35]  H C W L Williams,et al.  Market-Area Analysis and Accessibility to Primary Health-Care Centres , 1992 .

[36]  Xavier Gandibleux,et al.  A Tabu Search Procedure to Solve MultiObjective Combinatorial Optimization Problems , 1997 .

[37]  R. Andersen,et al.  Exploring dimensions of access to medical care. , 1983, Health services research.

[38]  R L Bashshur,et al.  Time and Distance: The Journey for Medical Care , 1973, International journal of health services : planning, administration, evaluation.

[39]  E. K. Adams,et al.  Predicting hospital choice for rural Medicare beneficiaries: the role of severity of illness. , 1991, Health services research.

[40]  David K. Smith,et al.  Use of location-allocation models in health service development planning in developing nations , 2000, Eur. J. Oper. Res..

[41]  Erhan Erkut,et al.  Analytical models for locating undesirable facilities , 1989 .

[42]  F. Kianifard Applied Multivariate Data Analysis: Volume II: Categorical and Multivariate Methods , 1994 .

[43]  W. Lynk,et al.  The creation of economic efficiencies in hospital mergers. , 1995, Journal of health economics.

[44]  R. L. Keeney,et al.  Decisions with Multiple Objectives: Preferences and Value Trade-Offs , 1977, IEEE Transactions on Systems, Man, and Cybernetics.

[45]  J Morrissey 'Top 100' hospitals set new success standards. , 1994, Modern healthcare.

[46]  N Webb,et al.  Developing a plan for primary health care facilities in Soweto, South Africa. Part II: Applying locational criteria. , 1996, Health policy and planning.

[47]  Jadranka Skorin-Kapov,et al.  Tabu Search Applied to the Quadratic Assignment Problem , 1990, INFORMS J. Comput..

[48]  S A Finkler,et al.  Determinants of Market Share for a Hospital's Services , 1985, Medical care.

[49]  G Higgs,et al.  Is there a role for GIS in the 'new NHS'? , 2001, Health & place.

[50]  Amedeo Cesta,et al.  Toward interactive scheduling systems for managing medical resources , 2000, Artif. Intell. Medicine.

[51]  Ahmed K. Rifai,et al.  An Application of Goal Programming in Healthcare Planning , 1990 .

[52]  Fred Glover,et al.  Tabu Search - Part II , 1989, INFORMS J. Comput..

[53]  H. Charles Romesburg,et al.  Cluster analysis for researchers , 1984 .

[54]  E. Mackenzie,et al.  A trauma resource allocation model for ambulances and hospitals. , 2000, Health services research.

[55]  R. Stock Distance and the utilization of health facilities in rural Nigeria. , 1983, Social science & medicine.

[56]  Charles S. ReVelle,et al.  The Location of Emergency Service Facilities , 1971, Oper. Res..

[57]  A. Hardy On the number of clusters , 1996 .

[58]  K. Levit,et al.  National health expenditures, 1985 , 1981, Health care financing review.

[59]  R M Davies,et al.  An Interactive Simulation in the Health Service , 1985, The Journal of the Operational Research Society.

[60]  J B Parr,et al.  Health care facility planning: some developmental considerations. , 1980, Socio-economic planning sciences.

[61]  V. Smith-Daniels,et al.  Location and service mix decisions for a managed health care network , 1993 .

[62]  Sydney C. K. Chu,et al.  A modeling framework for hospital location and service allocation , 2000 .

[63]  Vladimir Marianov,et al.  Optimal location of public health centres which provide free and paid services , 2001, J. Oper. Res. Soc..

[64]  Brian Everitt,et al.  Cluster analysis , 1974 .

[65]  W M Gesler,et al.  Normative models and healthcare planning: network-based simulations within a geographic information system environment. , 1997, Health services research.

[66]  Carlos A. Coello Coello,et al.  An updated survey of GA-based multiobjective optimization techniques , 2000, CSUR.

[67]  R. D. Galvão,et al.  A hierarchical model for the location of perinatal facilities in the municipality of Rio de Janeiro , 2002, Eur. J. Oper. Res..