Improving spatial accessibility to regional health systems through facility capacity management

Abstract

In austerity times, the general interest to reduce costs and improve efficiency levels often resulted into local cuts to public expenditure and profound reorganizations of existing service networks, especially in sectors like healthcare. In Italy, a recent reform prescribed the reconfiguration of time-dependent (i.e. emergency) hospital networks with the aim of improving patients’ accessibility conditions. In order to evaluate the impacts determined by this reorganization, we perform a spatial analysis in which we consider the distance from the closest facility as an accessibility measure. Results obtained from the spatial analysis confirm that users effectively benefit from the reorganization process but also that further improvements are possible, especially for the worst served ones. To this end, we also propose solving a mathematical programming model aiming at redistributing the capacities, i.e. the supply of beds, among the hospitals of the network seeking to maximize users’ accessibility. The realized computational experiments show that averagely better and even more equitable accessibility conditions could be obtained by containing the deriving reorganization costs.