Skip to main content
SpringerLink
Log in

Determining Location and Size of Medical Departments in a Hospital Network: A Multiobjective Decision Support Approach

  • Published:
Health Care Management Science Aims and scope Submit manuscript

Abstract

Decisions on the location and size of medical departments in a given hospital network are prime examples of priority setting in health care, which is an issue of growing political importance. As such decisions are regularly characterized by multiple and often conflicting objectives in real-life, this paper integrates the fields of hospital planning and multiobjective decision support. The proposed two-phase solution procedure for our corresponding mathematical programming model does not require a priori preference information. Instead, it seeks efficient solutions by means of multiobjective tabu search in the first phase, while applying clustering in the second phase to allow the decision makers to interactively explore the solution space until the “best” configuration is determined. The real-world applicability of our approach is illustrated through a numerical example based on hospital data from Germany.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. O.S. Lian, Convergence or divergence? Reforming primary care in Norway and Britain, The Milbank Quarterly 81 (2003) 305–330.

    Google Scholar 

  2. Federal Statistical Office Germany, http://www.destatis.de, accessed May 2002.

  3. K. Levit, C. Smith, C. Cowan, H. Lazenby and A. Martin, Inflation spurs health spending in 2000, Health Affairs 21 (2002) 172–181.

    Google Scholar 

  4. K.R. Levit, H.C. Lazenby, B.R. Braden, C.A. Cowan, P.A. McDonnell, L. Sivarajan, J.M. Stiller, D.K. Won, C.S. Donham, A.M. Long and M.W. Stewart, National health expenditures 1995, Health Care Financing Review 18 (1996) 175–214.

    Google Scholar 

  5. S.B. Schweikhart and V.L. Smith-Daniels, Location and service mix decisions for a managed health care network, Socio-Economic Planning Sciences27 (1993) 289–302.

    Google Scholar 

  6. B. Japsen, Another record year for dealmaking, Modern Healthcare 1996 (26) 37.

    Google Scholar 

  7. W. Lynk, The creation of economic efficiencies in hospital mergers, Journal of Health Economics 14 (1995) 507–530.

    Google Scholar 

  8. L. Berghmans, P. Schoovaerts and J. Teghem, Implementation of health facilities in a new city, Journal of the Operational Research Society 35 (1984) 1947–1054.

    Google Scholar 

  9. C.C. Branas, E.J. MacKenzie and C.S. ReVelle, A trauma resource allocation model for ambulances and hospitals, Health Services Research 35 (2000) 489–507.

    Google Scholar 

  10. S. Chu and L. Chu, A modeling framework for hospital location and service allocation, International Transactions in Operational Research 7 (2000) 539–568.

    Google Scholar 

  11. J. Doherty, L. Rispel and N. Webb, Developing a plan for primary health care facilities in Soweto, South Africa: Applying locational criteria, Health Policy and Planning 11 (1996) 394–405.

    Google Scholar 

  12. R.D. Galvao, L.G.A. Espejo and B. Boffey, A hierarchical model for the location of perinatal facilities in the municipality of Rio de Janeiro, European Journal of Operational Research 138 (2002) 495–517.

    Google Scholar 

  13. A. Green, B. Ali, A. Naeem and D. Ross, Resource allocation and budgetary mechanisms for decentralized health systems: Experiences from Balochistan, Pakistan, Bulletin of the World Health Organization 78 (2000) 1024–1035.

    Google Scholar 

  14. T. Hindle and C. Ngwube, The relative accessibility for health districts to regionally supplied specialist services, Health Services Research 3 (1990) 16–21.

    Google Scholar 

  15. V. Marianov and P. Taborga, Optimal location of public health centres which provide free and paid services, Journal of the Operational Research Society 52 (2001) 391–400.

    Google Scholar 

  16. L. Mayhew, Urban Hospital Location (George Allen & Unwin, London, 1986).

    Google Scholar 

  17. A. Mehrez, Z. Sinuany-Stern, T. Arad-Geva and S. Binyamin, On the implementation of quantitative facility location models: The case of a hospital in a rural region, Journal of the Operational Research Society 47 (1996) 612–625.

    Google Scholar 

  18. R.S. Segall, Deterministic mathematical modelling for the spatial allocation of multi-categorical resources: With an application to real health data, Journal of the Operational Research Society 43 (1992) 579–589.

    Google Scholar 

  19. V.L. Smith-Daniels, S.B. Schweikhart and D.E. Smith-Daniels, Capacity management in health care services: Review and future directions, Decision Sciences 19 (1988) 889–919.

    Google Scholar 

  20. G. Higgs and M.I. Gould, Is there a role for GIS in the 'new NHS'? Health and Place 7 (2001) 247–259.

    Google Scholar 

  21. S. Kohli, K. Sahlen, A. Sivertun, O. Löfman, E. Trell and O. Wigertz, Distance from the primary health center: A GIS method to study geographical access to health care, Journal of Medical Systems 19 (1995) 425–436.

    Google Scholar 

  22. D. Love and P. Lindquist, The geographical accessibility of hospitals to the aged: A geographic information system analysis with Illinois, Health Services Research 29 (1995) 629–650.

    Google Scholar 

  23. W.J.Walsh, P.H. Page and W.M. Gesler, Normative models and healthcare planning: Network-based simulations within a geographic information system environment, Health Services Research 32 (1997) 243–258.

    Google Scholar 

  24. M.A. McGuirk and F.W. Porell, Spatial patterns of hospital utilization: The impact of distance and time, Inquiry 21 (1984) 84–95.

    Google Scholar 

  25. G.W. Shannon, R.L. Bashshur and C.A. Metzner, The concept of distance as a factor in accessibility and utilization of health care, Medical Care Review 26 (1969) 143–161.

    Google Scholar 

  26. S. Rahman and D.K. Smith, Use of location-allocation models in health service development planning in developing nations, European Journal of Operational Research 123 (2000) 437–452.

    Google Scholar 

  27. R. Jantzen and P.R. Loubeau, Hospital selection by managed care insurers, Health Care Management Review 25 (2000) 93–102.

    Google Scholar 

  28. E. Erkut and S. Neuman, Analytical models for locating undesirable facilities, European Journal of Operational Research 40 (1989) 275–291.

    Google Scholar 

  29. A.J. Keown and J.D. Martin, An integer goal programming model for capital budgeting in hospitals, Financial Management 5 (1976) 28–35.

    Google Scholar 

  30. A.K. Rifai and J.O. Pecenka, An application of goal programming in healthcare planning, International Journal of Production Management 10 (1989) 28–37.

    Google Scholar 

  31. M. Ehrgott and X. Gandibleux, A survey and annotated bibliography of multiobjective combinatorial optimization, OR Spektrum 22 (2000) 425–460.

    Google Scholar 

  32. H.S. Brown, Income, location, and the demand for health care from public, nonprofit, and for-profit hospitals, Journal of Health Care Finance 27 (2001) 24–38.

    Google Scholar 

  33. S.M. Goldstein, P.T. Ward, G.K. Leong and T.W. Butler, The effect of location, strategy, and operations technology on hospital performance, Journal of Operations Management 20 (2002) 63–75.

    Google Scholar 

  34. R.S. Segall, Some quantitative methods for determining capacities and locations of military emergency medical facilities, Applied Mathematical Modelling 24 (2000) 265–398.

    Google Scholar 

  35. M.A. Cohen and H.L. Lee, The determinants of spatial distribution of hospital utilization in a region, Medical Care 23 (1985) 27–38.

    Google Scholar 

  36. E.R. de Winter, Are we ignoring population density in health planning? The issues of availability and accessibility, Health Policy and Planning 7 (1992) 191–196.

    Google Scholar 

  37. G.W. Shannon and J.L.Skinner, Time and distance:The journey for medical care, International Journal of Health Services 3 (1973) 237–244.

    Google Scholar 

  38. E.K. Adams, R. Houchens, G.E. Wright and J. Robbins, Predicting hospital choice for rural Medicare beneficiaries: The role of severity of illness, Health Services Research 7 (1991) 583–612.

    Google Scholar 

  39. D. Parkin and J. Henderson, How important is equality of access to hospital? A case study of patients' and visitors' travel costs, Hospital and Health Services Review 83 (1987) 23–27.

    Google Scholar 

  40. N.R. Patel, Locating rural social service centers in India, Management Science 25 (1979) 22–30.

    Google Scholar 

  41. C. Toregas, R. Swain, C. ReVelle and L. Bergman, The location of emergency service facilities, Operations Reserach 19 (1971) 1363–1373.

    Google Scholar 

  42. J.B. Parr, Health care facility planning: Some developmental considerations, Socio-Economic Planning Sciences 13 (1979) 121–127.

    Google Scholar 

  43. D. Martin and H.C. Williams, Market area analysis and accessibility to primary health care centres, Environment and Planning 24 (1992) 1009–1019.

    Google Scholar 

  44. L.A. Aday and R.M. Andersen, A framework for the study of access to medical care, Health Services Research 9 (1974) 208–220.

    Google Scholar 

  45. R.M. Anderson, A. McCutcheon, L.A. Aday, G.Y. Chiu and R. Bell, Exploring dimensions of access to medical care, Health Services Research 18 (1983) 49–74.

    Google Scholar 

  46. R. Keeney and H. Raiffa, Decisions with Multiple Objectives: Preferences and Value Trade-Offs (Wiley, New York, 1976).

    Google Scholar 

  47. D.F. Jones, S.K. Mirrazavi and M. Tamiz, Multi-objective metaheuristics: An overview of the current state-of-the-art, European Journal of Operational Research 137 (2002) 1–9.

    Google Scholar 

  48. C. Coello, An updated survey of GA-based multiobjective optimization techniques, ACM Computing Surveys 32 (2000) 109–143.

    Google Scholar 

  49. P. Czyzak and A. Jaszkiewicz, Pareto Simulated Annealing: A metaheuristic technique for multiple-objective combinatorial optimization, Journal of Multi-Criteria Decision Analysis 7 (1998) 34–47.

    Google Scholar 

  50. X. Gandibleux, N. Mezdaoui and A. Freville, A tabu search procedure to solve multiobjective combinatorial optimization problems, in: Advances in Multiple Objective and Goal Programming, Essays and Surveys on Multiple Criteria Decision Making, eds. F. Ruiz and R. Steuer (Springer, Berlin, 1997).

    Google Scholar 

  51. F. Glover, Tabu search: Part I, ORSA Journal on Computing 1 (1989) 190–206.

    Google Scholar 

  52. F. Glover, Tabu search: Part II, ORSA Journal on Computing 2 (1990) 4–32.

    Google Scholar 

  53. J. Skorin-Kapov, Tabu search applied to the quadratic assignment problem, ORSA Journal on Computing 2 (1990) 33–45.

    Google Scholar 

  54. A. Oddi and A. Cesta, Toward interactive scheduling systems for managing medical resources, Artificial Intelligence in Medicine 20 (2000) 113–138.

    Google Scholar 

  55. M.P. Hansen, Tabu search for multiobjective combinatorial optimization: TAMOCO, Control and Cybernetics 29 (2000) 799–818.

    Google Scholar 

  56. M. Sun and R. Steuer, InterQuad: An interactive quad tree based procedure for solving the discrete alternative multiple criteria problem, European Journal of Operational Research 89 (1996) 462–472.

    Google Scholar 

  57. R. Steuer and F. Harris, Intra-set point generation and filtering in decision and criterion space, Computers and Operations Research 7 (1980) 41–53.

    Google Scholar 

  58. J. Morse, Reducing the size of the nondominated set: Pruning by clustering, Computers and Operations Research 7 (1980) 55–56.

    Google Scholar 

  59. B.S. Everitt, Cluster Analysis, 3rd ed. (Arnold, London, 1993).

    Google Scholar 

  60. A. Hardy, On the number of clusters, Computational Statistics and Data Analysis 23 (1996) 83–96.

    Google Scholar 

  61. G.A. Miller, The magical number seven, plus or minus two: Some limits on our capacity for processing information, Psychological Review 63 (1956) 81–97.

    Google Scholar 

  62. J.D. Jobson, Applied Multivariate Data Analysis: Categorical and Multivariate Methods (Springer, New York, 1992).

    Google Scholar 

  63. H.C. Romesburg, Cluster Analysis for Researchers (Krieger, Malabar, 1984).

    Google Scholar 

  64. R.E. Steuer, Multiple Criteria Optimization: Theory, Computation, and Application (Wiley, New York, 1986).

    Google Scholar 

  65. R.M. Davies, An interactive simulation in the health service, Journal of the Operational Research Society 36 (1987) 597–606.

    Google Scholar 

  66. G.M. Erickson and S.A. Finkler, Determinants of market share for a hospital's services, Medical Care 23 (1985) 1003–1018.

    Google Scholar 

  67. J. Morrisey, Top 100 hospitals set new success standards, Modern Healthcare 24 (1994) 74–76.

    Google Scholar 

  68. R. Stock, Distance and utilization of health facilities in Nigeria, Social Science and Medicine 17 (1983) 563–570.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Business, Economics, and Computer Science, University of Vienna, Bruenner Str. 72, A-1210, Vienna, Austria

    Christian Stummer, Karl Doerner, Axel Focke & Kurt Heidenberger

Authors
  1. Christian Stummer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl Doerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Axel Focke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kurt Heidenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Stummer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stummer, C., Doerner, K., Focke, A. et al. Determining Location and Size of Medical Departments in a Hospital Network: A Multiobjective Decision Support Approach. Health Care Management Science 7, 63–71 (2004). https://doi.org/10.1023/B:HCMS.0000005399.23600.69

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/B:HCMS.0000005399.23600.69

Search

Navigation