Equity, Efficiency, and Accessibility in Urban and Regional Health-Care Systems

Abstract

FOREWORDThe principal aim o f health care research at IIASA has been to develop a family of submodels of national health care systems to be used by health service planners. The modeling work has involved the construction of linked submodels dealing with population, disease prevalence, resource need, resource allocation, and resource supply.This article considers four resource allocation criteria for assessing the long-term health resource requirements of different areas in a region. The spatial interaction model used here provides a simple method for selecting between different configurations, when population size and structure and resource availability are changing over time and space. The allocation criteria, based on objectives about which there is broad agreement among planners and other actors in the system, are concerned with improving the equity or the efficiency of the system, or the accessibility of the population to the supply of health services. Environment and Planning A, 1982, volume 14, pages 1479-1507 Equity, efficiency, and accessibility in urban and regional health-care systems Abstract. This paper explores four different criteria of health-care resource allocation at the urban and regional level. The criteria are linked by a common spatial-interaction model. This model is based on the hypothesis that the number of hospital patients generated in a residential zone i is proportional to the relative morbidity of i, and to the availability of resources in treatment zone i , but is in inverse proportion to the accessibility costs of getting from i to j . The resource-allocation criteria are based on objectives on which there is broad agreement among planners and other actors in a health-care system. These objectives are concerned with allocations that conform to notions of equity, efficiency, and two definitions of accessibility. The allocation criteria give mainly aggregatelevel information, and are designed with the long-term regional planning of health-care services in mind. The paper starts by defining the criteria, and describes how they are intended to be employed in a planning context. The allocation rules are then formally derived and Jinked together mathematically. They are then applied to a region, London, England, which is known to have very complex health-care planning problems. As a result of this application, two of the criteria-equity. and efficiency -are selected for further analysis. A new model is built and applied that specifically enables the user to trade off one of these criteria against the other. ANDREI ROGERS Chairman Human Settlements and Services Area IntroductionThis paper describes the theory and application of a set of possible methods to assist in the regional planning of health-care services. These methods are concerned with finding a set of resource allocations in different parts of a region when the morbidity, demographic structure, and resource availability are changing over time and space. They were designed with applications in the strategic planning of health se...

Inequality measures and equitable locations

“…They can be measured (modeled) as travel time, travel costs as well as in a more subjective way as relative travel costs (e.g., travel costs by clients incomes) or ultimately as the levels of clients dissatisfaction (individual disutility) of location decisions. Several specialized measures of proximity or accessibility have been developed for public service delivery systems (Abernathy and Hershey 1972;Malczewski 2000;Mayhew and Leonardi 1982;Tsou et al 2005). In typical formulations of location problems related to desirable facilities a smaller value of the outcome (distance) means a better effect (higher service quality or client satisfaction).…”

“…Especially, various public facilities (or public service delivery systems) like schools, libraries, health-service centers etc. require some spatial equity while making locationallocation decisions (Coulter 1980;Mayhew and Leonardi 1982;O'Brien 1969). Equity is usually quantified with the so-called inequality measures to be minimized.…”

Regional Perspectives on Public Health

“…The types, quality, and costs of health services vary spatially, and as a result, impact individual access. Proximity is highly correlated with health services utilization (Mayhew and Leonardi 1982) and is also important for saving lives (Cudnik et al 2012). Measures and metrics associated with spatial access abound.…”

Location Problems in Healthcare

“…We note that the equity criterion is commonly considered in combination with the efficiency (access) criterion since the equity objectives alone can produce undesirable solutions (Smith et al 2013). The reader can refer to Mayhew and Leonardi (1982), Cho (1998), Mitropoulos et al (2006), and Smith et al (2009Smith et al ( , 2013 for examples on applications with bi-criteria equity-efficiency objectives. Stummer et al (2004) developed a multi-objective model to determine the size and location of departments in facilities within a given network of hospitals.…”