Abstract
Centrally planned Beveridge healthcare systems typically rely heavily on local or regional “health authorities” as responsible organisations for the care of geographically defined populations. The frequency of reorganisations in the English NHS suggests that there is no compelling unitary definition of what constitutes a good healthcare geography. In this paper we propose a set of desirable objectives for an administrative healthcare geography, specifically: geographical compactness, co-extensiveness with current local authorities and size and population homogeneity, and we show how these might be operationally measured. Based on these objectives, we represent the problem of how to partition a territory into health authorities as a multi-objective optimisation problem. We use a state-of-the-art multi-objective genetic algorithm customised for the needs of our study to partition the territory of the East England into 14 Primary Care Trusts and 50 GP consortia and study the tradeoffs between objectives which this reveals.
Highlights
One of the more depressing features of health policy in publicly funded systems is the frequency with which reorganisations take place, redefining institutional roles, centralising what was previously decentralised, splitting or consolidating different delivery organisations, and so on [1]
health authorities (HAs)’ boundaries should be roughly coextensive with other geographically defined entities with which they have dealings, for example local authorities. This is often cited as an objective for the design of HAs e for example the 2006 White Paper Our Health, our care, our say [10] notes that providing “for Primary Care Trusts (PCTs) [i.e. HA] boundaries to be the same as those of local authorities with social services responsibilities, which would make it easier to achieve better integration of health and social care” is a desirable feature of a geography. (This cannot be the only objective as far as the White Paper is concerned since the post-2006 PCT structure does differ from the local authority structure in some respects: the White Paper is not very explicit about why this should be so.) O3
The first question which we examine is the efficiency of the existing partitioning of the territory of the East of England into 14 HAs (“Primary Care Trusts”)
Summary
One of the more depressing features of health policy in publicly funded systems is the frequency with which reorganisations take place, redefining institutional roles, centralising what was previously decentralised (or vice versa), splitting or consolidating different delivery organisations, and so on [1]. For the empirical part of the paper, we turn our attention to revealing the tradeoffs imposed by an actual healthcare geography, in this case the geography of the East of England Because this problem is computationally intractable, we use a state-of-the-art multi-objective genetic algorithm customised for the needs of our study.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
