Abstract
BackgroundThe majority of curative health care is organized in hospitals. As in most other countries, the current 94 hospital locations in the Netherlands offer almost all treatments, ranging from rather basic to very complex care. Recent studies show that concentration of care can lead to substantial quality improvements for complex conditions and that dispersion of care for chronic conditions may increase quality of care. In previous studies on allocation of hospital infrastructure, the allocation is usually only based on accessibility and/or efficiency of hospital care. In this paper, we explore the possibilities to include a quality function in the objective function, to give global directions to how the ‘optimal’ hospital infrastructure would be in the Dutch context.MethodsTo create optimal societal value we have used a mathematical mixed integer programming (MIP) model that balances quality, efficiency and accessibility of care for 30 ICD-9 diagnosis groups. Typical aspects that are taken into account are the volume-outcome relationship, the maximum accepted travel times for diagnosis groups that may need emergency treatment and the minimum use of facilities.ResultsThe optimal number of hospital locations per diagnosis group varies from 12-14 locations for diagnosis groups which have a strong volume-outcome relationship, such as neoplasms, to 150 locations for chronic diagnosis groups such as diabetes and chronic obstructive pulmonary disease (COPD).ConclusionsIn conclusion, our study shows a new approach for allocating hospital infrastructure over a country or certain region that includes quality of care in relation to volume per provider that can be used in various countries or regions. In addition, our model shows that within the Dutch context chronic care may be too concentrated and complex and/or acute care may be too dispersed. Our approach can relatively easily be adopted towards other countries or regions and is very suitable to perform a ‘what-if’ analysis.
Highlights
The majority of curative health care is organized in hospitals
The number of locations vary from 12 locations for diagnosis groups like congenital anomalies and 14 locations for neoplasms, which have a high volume-outcome relationship, to 150 locations for chronic diagnosis groups such as diabetes and chronic obstructive pulmonary disease (COPD)
In the new hospital landscape, care for acute diagnosis groups and diagnosis groups with a strong volumeoutcome relationship is provided on less locations than in the current situation
Summary
As in most other countries, the current 94 hospital locations in the Netherlands offer almost all treatments, ranging from rather basic to very complex care. Recent studies show that concentration of care can lead to substantial quality improvements for complex conditions and that dispersion of care for chronic conditions may increase quality of care. In the Netherlands, just as in most other countries, the majority of curative health care is organized in hospitals. Recent studies show that quality of care can be improved by concentration of care [1,2]. Within the concept of concentration, hospitals and physicians focus on the treatment of a selection of specific conditions, treating a Concentration and specialization may increase the efficiency of hospitals. On the other hand a decrease in the number of providers may result in a lower level of competition possibly leading to higher prices of care [9]
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