Modelling the Health Mobility for Rational Resource Distribution Policies



Modelling the Health Mobility for Rational Resource Distribution Policies

Authors

Domenico Gattuso, Università Degli Studi Mediterranea Di Reggio Calabria (Department of Information Engineering Infrastructure and Sustainable Energy), Giuseppe Quattrone, Università Cattolica del Sacro Cuore (DISES)

Description

In this paper, a model of intra-regional patient mobility is proposed in order to asses the impact of hospital closures on equity of access to health service in regional areas.

Abstract

The National Health Service has always played a key role in the economic growth of a country. For this reason it is subject to continuous revisions in attempt to find the right balance between available resources and appropriateness of care. This is why, scientific research develops models that describe the production process in order to obtain an overall improvement in the quality of the service offered, given a limited number of resources (Habicht T. et al, 2015, Páez A, et al., 2012).
However, the effectiveness of a health service does not depend only on the efficiency of a single facility, but also on the capacity of patients to easily reach such a resource (Koike et al., 2016, Matsumoto M. et al., 2012). For this reason, the difficulty of managing the phenomenon of mobility tends to increase in relation to the territorial structure and road network where the demand flows move (Neutens T., 2015).
In this paper, a model of intra-regional patient mobility is proposed allowing to evaluate the impact of the close-down of facilities on equity of accessibility to healthcare services.
The transport model proposed is a “capacity-distance model” which describes the spatial interactions between supply and demand by simulating of closure of healthcare facilities.
A modified gravity based model was used to determine the strength of interaction between the facilities offering the service and the municipalities were the demand originates. Results obtained were used to develop a demand-based model which incorporated the coefficients of attraction within the objective function to assign the demand to facilities. As a result of this application, patients does not move only according to a principle of facility proximity, but following a path, where geographic distance and facility capacity are taken into account.
In order to test the model, a specific application has been implemented, considering the cardiac surgery services supplied in Cosenza province in Southern Italy.
The choice to apply the model on this area is due to the orography of such territory characterized by a wide mountainous area (exceeding 50%) which affect spatial accessibility to healthcare service by the resident population.
A sensitivity analysis, hypothesizing a variation in number of beds and variations in road connections was conducted to assess the access levels both on the basis of the road network and the total capacity of each facility.
The application of this transport model to a time critical unit such as cardiac surgery services allowed evaluating the interactions existing between healthcare mobility and utilization rates of the units. The model can be used to support health policy decision in order to rationalize healthcare resource distribution in regional areas.

Publisher

Association for European Transport