A two-step planning method to increase accessibility to medium complexity procedures for public secondary healthcare.

João Flávio De Freitas Almeida,Francisco Carlos Cardoso De Campos

doi:10.1590/1413-81232021269.18382020

João Flávio De Freitas Almeida, Francisco Carlos Cardoso De Campos

Open Access

https://doi.org/10.1590/1413-81232021269.18382020

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Abstract

The specialized care level of the public Brazilian national health system is critical and chronically underfunded. Few studies have evaluated public secondary care planning on a strategic level, so there are open issues yet to examine. This study aims at locating medical centers and sizing equipment based on a two-step optimization process to meet the population's needs. The models consider physicians' propensity for working on a metropolis and the patients' choice on moving the least from their municipalities, therefore, conflicting decisions. The models provide the location of medical centers, the assignment of equipment to such locations, and the additional hours of specialists required to meet official standards of demand. Available equipment with idle capacity should partly satisfy the requirement for exams within the current infrastructure. For the remaining uncovered demand, the second step of the optimization model suggests the acquisition of additional equipment for the elected medical centers to meet established needs. The proposed location of secondary care facilities covers 834 municipalities, corresponding to 97.77% of the estate, with an average patient displacement of 58.73 km (CI95%: 56.18 km - 61.28 km). In general, 39 out of 77 health regions should hire additional hours of medical specialties. Pediatrics and gynecology represent the major gap.

Highlights

The location of healthcare units in a hierarchical system is critical on setting the population access to health services, the size of health units, hospitals, and medical centers have been a topic of political and scientific relevance
This study aims at recognizing and solving a location-allocation problem on public secondary care in Minas Gerais using mathematical programming models
We analyze physicians’ preferences for selecting several candidate municipalities with minimum infrastructure as municipalities with more than 30,000 inhabitants, since this is the number of inhabitants for municipality for installing small-sized hospitals; we develop a MILP model to elect medical centers facilities which minimize the weighted sum of demand and distances between patients and physicians of all specialties

Summary

Introduction

The location of healthcare units in a hierarchical system is critical on setting the population access to health services, the size of health units, hospitals, and medical centers have been a topic of political and scientific relevance. In Brazil, the decreasing economic growth imposes challenges to the deployment of good public healthcare planning. While fast aging communities raise services demand and increase the health system’s federal law[1] establishes even tighter bounds on the public health budget. Leaders have strived on setting priorities in allocating resources. This study aims at recognizing and solving a location-allocation problem on public secondary care in Minas Gerais using mathematical programming models. Health needs are based on demographic projections[2] and the Ministerial Decree[3]

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