Hospital volume allocation: a decision made by commissioner and patients. Integrating multiple actors with multiple methodologies
Our work focuses on the allocation of surgical interventions among healthcare facilities in a territory. Even though the strategical decision falls within the purview of the policy maker, we reckon that patients’ preferences should be included in the decisional process. The aim of our model is to reach a solution that is optimal in terms of both i) better health outcomes, ii) patients’ adherence.
Two models were developed to represent the single behaviour of the two actors considered, i.e., policy maker and patient. From the policy maker perspective, we are interested in maximizing health outcomes. Since several constraints (structural, clinical and social) prevent from concentrating all the surgeries within a unique hospital, we look for the allocation that, by respecting constraints, guarantees the lowest mortality. From the patient perspective, our objective is to maximize the utility gained by a high-quality treatment. Two distinct territorial configurations are obtained as solutions, and we compare them in terms of organizational and clinical characteristics.
Starting from the two single-actor models, two solution approaches were developed to integrate the actors' perspectives. The first one resumes the model for the policy maker alone, but it adds a constraint related to patients’ willingness to travel.
The second one, instead, consists in a more complex algorithm composed by three step. First of all, we restrict the set of the territorial configurations that can be considered, up to the ones that are acceptable based on the policy maker constraints. Secondly, a prediction of patients’ behaviour for each configuration is done, in order to compute the volumes resulting from patients’ choices. Eventually, a comparison of clinical outcomes among the different configurations is performed, in order to establish the optimal solution in terms of clinical outcomes.
Elisabetta Listorti is a PhD candidate at the Department of Management and Production Engineering at the Politecnico di Torino. She has a master degree in Management Engineering, and she has a master certificate in Health Economics and Policy.
Her research area includes planning problems in healthcare systems, where she combines knowledge of health management, health economics and epidemiological studies.
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