Este trabalho tem por objetivo comparar a distribuição de unidades hospitalares, considerando os diferentes graus de especialização, em Santa Catarina, Brasil, com a distribuição de unidades resultantes da aplicação do modelo hierárquico de p-medianas, em três níveis. O modelo de p-medianas é usado para determinar a localização das unidades, e a seguir é comparado o deslocamento médio da população para alcançar as unidades médicas nos dois cenários, o atual e o simulado. Um indicador quantitativo de acessibilidade é proposto e é usado para avaliar a acessibilidade da distribuição atual com a simulada. O trabalho tem o intuito de revelar regiões subatendidas, e de servir de ferramenta de auxílio à decisão de gestores na área de saúde para possíveis intervenções no sistema, no sentido de torná-la mais homogênea e mais acessível à população

The study proposes a differentiated approach to the localization of public services (unlike methods focusing solely on locational efficiency in the distribution of such services), with a nonlinear model that incorporates an accessibility indicator and allows rejecting solutions in which accessibility fails to comply with acceptably established minimum parameters. The method aims to minimize the total time spent by a region's population to reach a public services network, while controlling the range between the highest and lowest accessibility to the services. The resulting solution is not as efficient as other models (e.g., p-median) in relation to total cost for the population as a whole to access the system, but it seeks to prevent the most distant areas from experiencing greater difficulty due to their disproportional traveling time. The model was tested in a region in the hospital network of the State of Santa Catarina, Brazil, and the results show that incorporation of the indicator suggests improvement when compared to the current distribution of hospitals in that area. The proposed methodology can be a useful tool for planning balanced resource allocation during installation of health services for the population.

OBJECTIVETo analyze the methodology used for assessing the spatial distribution of specialized cardiac care units.METHODSA modeling and simulation method was adopted for the practical application of cardiac care service in the state of Santa Catarina, Southern Brazil, using the p-median model. As the state is divided into 21 health care regions, a methodology which suggests an arrangement of eight intermediate cardiac care units was analyzed, comparing the results obtained using data from 1996 and 2012.RESULTSResults obtained using data from 2012 indicated significant changes in the state, particularly in relation to the increased population density in the coastal regions. The current study provided a satisfactory response, indicated by the homogeneity of the results regarding the location of the intermediate cardiac care units and their respective regional administrations, thereby decreasing the average distance traveled by users to health care units, located in higher population density areas. The validity of the model was corroborated through the analysis of the allocation of the median vertices proposed in 1996 and 2012.CONCLUSIONSThe current spatial distribution of specialized cardiac care units is more homogeneous and reflects the demographic changes that have occurred in the state over the last 17 years. The comparison between the two simulations and the current configuration showed the validity of the proposed model as an aid in decision making for system expansion.