Recursive modeling of ambulatory health care settings

Previous work dealing with the planning of outpatient health care has primarily used either linear programming or simulation. Linear programs are rather severe abstractions of reality. Simulation models are more realistic but are very expensive and do not necessarily identify optimal solutions. This paper discusses a recursive optimization-simulation approach, which takes advantage of the best features of both methods while minimizing the disadvantages of each method used alone. A mixed integer program generates staffing and facility plans, thus reducing the number of alternatives requiring analysis via simulation. The simulation model then evaluates the acceptability of alternative plans, considering detailed information and complex relationships omitted from the optimization model. The method is used in a hypothetical example based on data from a variety of sources. The results from the example demonstrate the value of the recursive method; however, they are not to be used in a general context.