Regionalization of primary health care units with multi-institutional collaboration

Abstract

In this paper, the problem of locating and upgrading primary health care units within a multi-institutional public system is addressed. The problem is motivated by a real-world application in the Mexican Health Care System. Decisions also involve allocating customer demand to those facilities with the goal of minimizing the total travel distance in a capacitated facility location problem. The capacity is measured in units named basic kernels composed by a group of medical staff for outpatient services. A mixed-integer linear programming model is proposed. A computational study based on a real-world case in the State of Mexico is carried out. Test instances are successfully solved by branch and bound. The distribution of patient-to-health care unit distances and the variation of the capacity utilization rate of health care units are analyzed. Among the results, we found that the total travel distance had an average improvement of up to 32% when the capacity is shared between institutions. Some parameters such as the kernel capacity and the minimum allocated demand at each facility could help to balance the workload between health care units, but this outcome has a negative impact on the total travel distance. On average, 91% of demand travels less than 10 km to its health care units and 99% less than 20 km in the computed solutions. The results presented in this paper open the opportunity of using OR tools in the planning of health care resources in developing countries to face the challenges of the next decade in health care matters.