Introducing health gains in location-allocation models: A stochastic model for planning the delivery of long-term care

Although the maximization of health is a key objective in health care systems, location-allocation literature has not yet considered this dimension. This study proposes a multi-objective stochastic mathematical programming approach to support the planning of a multi-service network of long-term care (LTC), both in terms of services location and capacity planning. This approach is based on a mixed integer linear programming model with two objectives - the maximization of expected health gains and the minimization of expected costs - with satisficing levels in several dimensions of equity - namely, equity of access, equity of utilization, socioeconomic equity and geographical equity - being imposed as constraints. The augmented e-constraint method is used to explore the trade-off between these conflicting objectives, with uncertainty in the demand and delivery of care being accounted for. The model is applied to analyze the (re)organization of the LTC network currently operating in the Great Lisbon region in Portugal for the 2014-2016 period. Results show that extending the network of LTC is a cost-effective investment.

[1]  John R. Birge,et al.  Introduction to Stochastic programming (2nd edition), Springer verlag, New York , 2011 .

[2]  H. Simon,et al.  Rational choice and the structure of the environment. , 1956, Psychological review.

[3]  Stefan Nickel,et al.  Planning a long-term care network with uncertainty, strategic policy and equity considerations: A stochastic planning approach , 2013 .

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

[5]  Mark Oppe,et al.  EQ-5D value sets : inventory, comparative review, and user guide , 2007 .

[6]  Kenneth Yip,et al.  Fraser Health Uses Mathematical Programming to Plan Its Inpatient Hospital Network , 2009, Interfaces.

[7]  B. Squires Methods for the Economic Evaluation of Health Care Programmes. , 1987 .

[8]  Zaid Chalabi,et al.  Budgetary policies and available actions: a generalisation of decision rules for allocation and research decisions. , 2010, Journal of health economics.

[9]  Stefan Nickel,et al.  Modeling the demand for long-term care services under uncertain information , 2012, Health Care Management Science.

[10]  Mark S. Daskin,et al.  Strategic facility location: A review , 1998, Eur. J. Oper. Res..

[11]  H K Smith,et al.  Bicriteria efficiency/equity hierarchical location models for public service application , 2013, J. Oper. Res. Soc..

[12]  Long Term Care in Health Services , 2008 .

[13]  Feng Lin,et al.  Capacity Planning for Publicly Funded Community Based Long-Term Care Services , 2012 .

[14]  Stefan Nickel,et al.  An integrated approach for planning a long-term care network with uncertainty, strategic policy and equity considerations , 2015, Eur. J. Oper. Res..

[15]  Sara R. Machado,et al.  Portugal. Health system review. , 2011, Health systems in transition.

[16]  N. Devlin,et al.  Comprar EQ-5D Value Sets: Inventory, Comparative Review and User Guide | Szende, Agota | 9781402055102 | Springer , 2007 .

[17]  P. Ferreira,et al.  The valuation of the EQ-5D in Portugal , 2014, Quality of Life Research.

[18]  John R. Birge,et al.  Introduction to Stochastic Programming , 1997 .

[19]  Sally C. Brailsford,et al.  OR in healthcare: A European perspective , 2011, Eur. J. Oper. Res..

[20]  M. Drummond,et al.  Health Care Technology: Effectiveness, Efficiency and Public Policy@@@Methods for the Economic Evaluation of Health Care Programmes , 1988 .

[21]  George Mavrotas,et al.  Effective implementation of the epsilon-constraint method in Multi-Objective Mathematical Programming problems , 2009, Appl. Math. Comput..

[22]  Ana Paula Barbosa-Póvoa,et al.  Location-allocation approaches for hospital network planning under uncertainty , 2015, Eur. J. Oper. Res..

[23]  Meryem Masmoudi,et al.  A multiobjective stochastic program for hospital bed planning , 2012, J. Oper. Res. Soc..

[24]  M. Powell,et al.  Equal Access to Health Care and the British National Health Service , 2003 .

[25]  Robert T. Clemen,et al.  Making Hard Decisions with Decisiontools Suite , 2000 .

[26]  Zaid Chalabi,et al.  Uncertainty and value of information when allocating resources within and between healthcare programmes , 2008, Eur. J. Oper. Res..

[27]  Mark Oppe,et al.  EQ-5D Value Sets , 2007 .