Health Care Management Science

, Volume 9, Issue 1, pp 19–30 | Cite as

Modelling the redistribution of hospital supply to achieve equity taking account of patient's behaviour

  • Mónica Duarte Oliveira
  • Gwyn Bevan


Policies that seek to achieve geographic equity in countries with a National Health Services (NHS) require information on how to change the distribution of supply to achieve greater equity in access and utilisation. Previous methods for analysing the impact of hospital changes have relied on crude assumptions on patients' behaviour in using hospitals. The approach developed in this study is a multi-modelling one based on two mathematical programming location-allocation models to redistribute hospital supply using different objective functions and assumptions about the utilisation behaviour of patients. These models show how different policy objectives seeking equity of geographic access or utilisation produce different results and imply trade-offs in terms of reduction in total utilisation.


Equity of access Equity of utilisation Hospital planning Location-allocation models Redistribution Portugal 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Oliveira MDCD (2003) Achieving Geographic Equity in the Portuguese Hospital Financing System, PhD thesis (Operational Research Department, London School of Economics, University of London, London).Google Scholar
  2. 2.
    Rice N, Smith P (1999) Approaches to Capitation and Risk Adjustment in Health Care: An International Survey (Centre for Health Economics, York).Google Scholar
  3. 3.
    Rushton G (1987) Selecting the objective function in location-allocation analysis. Spatial Analysis and Location-Allocation Models, in: Ghosh A. Rushton G. (eds) (Van Nostrand Reinhold Company, New York).Google Scholar
  4. 4.
    Hodgson MJ, Rosing KE, Storrier ALG (1996) Applying the flow-capturing location-allocation model to an authentic network: Edmonton, Canada. European Journal of Operational Research 90: 427–443.Google Scholar
  5. 5.
    Mandell MB (1991) Modelling effectiveness-equity trade-offs in public service delivery systems, Management Science 27, 467–482.Google Scholar
  6. 6.
    O'Kelly ME (1987) Spatial-interaction-based location-allocation models, in: Spatial Analysis and Location-Allocation Models, ed. Ghosh A., Rushton G. (Van Nostrand Reinhold Company, New York).Google Scholar
  7. 7.
    Mayhew LD, Gibberd RW, Hall H (1986) Predicting patient flows and hospital case-mix. Environment and Planning A 18: 619–638.Google Scholar
  8. 8.
    Taket AR (1989) Equity and access: exploring the effects of hospital location on the population served -A case study in strategic planning. Journal of the Operational Research Society 40: 1001–1010.Google Scholar
  9. 9.
    Cho C-J (1998) An equity-efficiency trade-off model for the optimum location of medical care facilities. Socio-Economic Planning Sciences 32: 99–112.CrossRefGoogle Scholar
  10. 10.
    McLafferty S (1988) Predicting the effect of hospital closure on hospital utilization patterns. Social Science and Medicine 27: 255–262.Google Scholar
  11. 11.
    Porell FW, Adams EK (1995) Hospital choice models: A review and assessment of their utility for policy impact analysis. Medical Care Research Review 52: 158–195.Google Scholar
  12. 12.
    Congdon P (2001) The development of gravity models for hospital patient flows under systems change: A Bayesian modelling approach. Health Care Management Science 4: 289–304.CrossRefGoogle Scholar
  13. 13.
    Wu N (1997) The Maximum Entropy Method: With 53 Figures (Springer, New York, Huang et al. TS, (eds) Springer Series in Information Sciences).Google Scholar
  14. 14.
    Fang S-C, Kajasekera JR, and Tsao HSJ (1997) Entropy Optimization and Mathematical Programming (Kluwer Academic Publishers, Massachusetts. In: Hillier FS, (eds) International Series in Operations Research and Management Science).Google Scholar
  15. 15.
    Arndt CC (2001) Information Measures: Information and its Description in Science and Engineering–With 64 Figures (Springer-Verlag, Berlin).Google Scholar
  16. 16.
    Webber M (1978) Spatial interaction and the form of the city, in: Spatial Interaction Theory and Planning Models, In: Karlqvist et al. A (eds) (North Holland, Netherlands).Google Scholar
  17. 17.
    Anas A (1983) Discrete choice theory, information theory and the multinomial logit and gravity models, Transportation Research–B 17: 13–23.Google Scholar
  18. 18.
    Nijkamp P (1978) Compromise choices in spatial interaction and regional planning models. Spatial Interaction Theory and Planning Models. In: Karlqvist et al. A (North Holland, Netherlands).Google Scholar
  19. 19.
    Martin JJ et al, (2000) A goal programming scheme to determine the budget assignment among the hospitals of a sanitary system, in: Decision-Making: Recent Developments and Worldwide Applications. ed. Zanakis, SH Doukakis, G Zopounidis C (eds) (Kluwer Academic Publishers, Dordrecht).Google Scholar
  20. 20.
    Gonzalez MPLA (2001) Modelos multicriterio para la financiación de los Hospitales Comarcales del Servicio Andaluz de Salud, PhD thesis (Departamento de Economía Aplicada, Universidad de Málaga, Málaga).Google Scholar
  21. 21.
    Mohan J (1983) Location-allocation models, social science and health service planning: An example from North East England, Social Science and Medicine 17: 493–499.Google Scholar
  22. 22.
    Mayhew LD, Leonardi G (1982) Equity, efficiency, and accessibility in urban and regional health care systems, Environment and Planning A 14: 1479–1507.Google Scholar
  23. 23.
    Bennet WD (1981) A location-allocation approach to health care facility location: A study of the undoctored population in Lansing, Michigan, Social Science and Medicine 15: 305–312.Google Scholar
  24. 24.
    Marianov V, Serra D (2001) Hierarchical location-allocation models for congested systems. European Journal of Operational Research 135: 195–208.CrossRefGoogle Scholar
  25. 25.
    Church RL, Eaton DJ (1987) Hierarchical location analysis using covering objectives. Spatial Analysis and Location-Allocation Models. In: Ghosh A, Rushton G (Van Nostrand Reinhold Company, New York).Google Scholar
  26. 26.
    Rahman S, Smith DK (2000) Use of location-allocation models in health service development planning in developing nations. European Journal of Operational Research 123: 437–452.CrossRefGoogle Scholar
  27. 27.
    Current J, Min H, Schilling D (1990) Multi-objective analysis of facility location decisions, European Journal of Operational Research 49: 295–307.CrossRefGoogle Scholar
  28. 28.
    Oliveira MD (2004) Modelling demand and supply influences on utilisation: A flow demand model to predict hospital utilisation at the small area level. Applied Economics 36: 2237–2251.CrossRefGoogle Scholar
  29. 29.
    Goodwin P, Wright G (1998) Decision Analysis for Management Judgment (Wiley, Chichester, 2nd ed).Google Scholar
  30. 30.
    Oliveira MD, Bevan G (2003) Measuring geographic inequities in the Portuguese health care system: An estimation of hospital care needs. Health Policy 66: 277–292.CrossRefGoogle Scholar
  31. 31.
    Wilson RM, Gibberd RW (1990) Allocating resources between health care regions: Catchment populations and allocating policy. European Journal of Operational Research 49: 333–347.CrossRefGoogle Scholar
  32. 32.
    Hallefjord A, Jornsten K (1984) Gravity models with multiple objectives -Theory and applications, Transportation Research–B 20: (19–39).Google Scholar
  33. 33.
    Williams HP (1993) Model Building in Mathematical Programming (John Wiley & Sons, Chichester, 3rd ed).Google Scholar
  34. 34.
    Marsh MT, (1994) Schilling DA Equity measurement in facility location analysis: a review and framework. European Journal of Operational Research 71: 1–17.Google Scholar
  35. 35.
    Theil H (1967) Economics and Information Theory (North Holland, Amsterdam. In: Theil, H., (ed) Studies in Mathematical and Managerial Economics).Google Scholar
  36. 36.
    Williams HP (1993) Model Solving in Mathematical Programming (John Wiley & Sons, Chichester).Google Scholar
  37. 37.
    Paragon Decision Technology, AIMMS Academic (Network)—Unrestricted (Paragon Decision Technology, Netherlands, 2000).Google Scholar
  38. 38.
    Mooney GH (1983) Equity in health care: confronting the confusion. Effective health care 1: 179–84.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Engineering and Management Department, Instituto Superior TécnicoTechnical University of LisbonPortugal
  2. 2.LSE Health and Social CareLondon School of Economics and Political ScienceU.K.
  3. 3.Operational Research Department and LSE Health and Social CareLondon School of Economics and Political ScienceU.K.

Personalised recommendations