Abstract
This paper introduces an integer programming model for planning primary care facility networks, which accounts for the interests of different stakeholders while maximizing access to health care. Physician allocation to health-care facilities is explicitly modelled, which allows consideration of physician incentives in the planning phase. An illustrative case study in the Turkish primary care system is presented to show the implications of focusing on patient or physician preferences in the planning phase. A discussion of trade-offs between the different stakeholder preferences and some recommendations for modelling choices to match these preferences are provided. In the context of this case, we found that using an access measure that decays with distance, and incorporating nearest allocation constraints improves performance for all stakeholders. We also show that increasing the number of physicians may have adverse affects on access measures when physician preferences are addressed.
This is a preview of subscription content, log in via an institution to check access.
Notes
A more general approach could define access in terms of a preference function, which incorporates factors such as attractiveness of the location, or availability of public transportation, in addition to proximity.
This initiative has been one part of a comprehensive health reform in Turkey.
Note that there may be exceptional cases in which opening a facility may deteriorate coverage, depending on the location of candidate facilities. But this was not the case for our implementation.
References
Andersen R and Newman J (1973). Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quarterly 51 (1): 95–123.
Baker R and Streatfield J (1995). What type of general practice do patients prefer? Exploration of practice characteristics influencing patient satisfaction. British Journal of General Practice 45 (401): 654–659.
Berman O and Krass D (2002). The generalized maximal covering location problem. Computers & Operations Research 29 (6): 563–581.
Bruni M, Conforti D, Sicilia N and Trotta S (2006). A new organ transplantation location-allocation policy: A case study of Italy. Health Care Management Science 9 (2): 125–142.
Buchbinder S, Wilson M, Melick C and Powe N (2001). Primary care physician job satisfaction and turnover. American Journal of Managed Care 7 (7): 701–716.
Cánovas L, García S, Labbé M and Marín A (2007). A strengthened formulation for the simple plant location problem with order. Operations Research Letters 35 (2): 141–150.
Church R and ReVelle C (1974). The maximal covering location problem. Papers in Regional Science 32 (1): 101–118.
Current J, Min H and Schilling D (1990). Multiobjective analysis of facility location decisions. European Journal of Operational Research 49 (3): 295–307.
Daskin M and Dean L (2005). Location of health care facilities. In: Brandeau ML, Sainfort F and Pierskalla WP (eds). Operations Research and Health Care. International Series in Operations Research & Management Science, Springer, Boston, USA, pp 43–76.
Farinha R, Duarte Oliveira M and de Sa A (2008). Networks of primary and secondary care services: How to organise services so as to promote efficiency and quality in access while reducing costs. Quality in Primary Care 16 (4): 249–258.
Gladu F (2007). Perceived shortage of family doctors in Quebec: Can we do something about it? Canadian Family Physician 53 (11): 1858.
Gu W, Wang X and McGregor S (2010). Optimization of preventive health care facility locations. International Journal of Health Geographies 9 (1): Article 17.
Güneş E and Yaman H (2010). Health network mergers and hospital re-planning. Journal of the Operational Research Society 61 (2): 275–283.
Jia H, Ordóñez F and Dessouky M (2007). A modeling framework for facility location of medical services for large-scale emergencies. IIE Transactions 39 (1): 41–55.
Kindig D and Movassaghi H (1989). The adequacy of physician supply in small rural counties. Health Affairs 8 (2): 63–76.
Lepnurm R, Dobson R, Backman A and Keegan D (2007). Factors associated with career satisfaction among general practitioners in Canada. Canadian Journal of Rural Medicine: The Official Journal of the Society of Rural Physicians of Canada 12 (4): 217–230.
Macinko J, Starfield B and Shi L (2003). The contribution of primary care systems to health outcomes within organization for economic cooperation and development (OECD) countries, 1970–1998. Health Services Research 38 (3): 831–865.
MacKean P and Gutkin C (2003). Fewer medical students selecting family medicine. Can family practice survive? Canadian Family Physician 49 (4): 408.
Marianov V and Taborga P (2001). Optimal location of public health centres which provide free and paid services. Journal of the Operational Research Society 52 (4): 391–400.
Massachusetts Medical Society (2007). 2007 Massachusetts medical society physician workforce study, http://www.massmed.org/Content/NavigationMenu/NewsandPublications/ResearchReportsStudies/PhysicianWorkforceStudy/workforce07.htm, accessed 28 June 2012.
O'Reilly K (2010). Health reform's next challenge: Who will care for the newly insured. American Medical News, 12 April.
Owen S and Daskin M (1998). Strategic facility location: A review. European Journal of Operational Research 111 (3): 423–447.
Pong R and Pitblado J (2005). Geographic Distribution of Physicians in Canada: Beyond How Many and Where. Canadian Institute for Health Information: Ottawa, Canada.
Rahman S and Smith D (1999). Deployment of rural health facilities in a developing country. Journal of the Operational Research Society 50 (9): 892–902.
Rais A and Viana A (2011). Operations research in healthcare: A survey. International Transactions in Operational Research 18 (1): 1–31.
Rourke J (2008). Increasing the number of rural physicians. Canadian Medical Association Journal 178 (3): 322.
Ruth R (1981). A mixed integer programming model for regional planning of a hospital inpatient service. Management Science 27 (5): 521–533.
Shuman L, Hardwick C and Huber G (1973). Location of ambulatory care centers in a metropolitan area. Health Services Research 8 (2): 121.
Smith H and Harper P (2010). Bicriteria efficiency/equity hierarchical location models. Technical report, University of Southampton.
Smith H, Laporte G and Harper P (2009). Locational analysis: Highlights of growth to maturity. Journal of the Operational Research Society 60 (1): S140–S148.
Starfield B (1998). Primary Care: Balancing Health Needs, Services, and Technology. Oxford University Press: New York.
Verter V and Lapierre S (2002). Location of preventive health care facilities. Annals of Operations Research 110 (1): 123–132.
WHO (1978). Declaration of Alma-Ata. International Conference on Primary Health Care, 6–12 September, Alma-Ata, http://www.who.int/publications/almaata_declaration_en.pdf.
Zhang Y, Berman O and Verter V (2009). Incorporating congestion in preventive healthcare facility network design. European Journal of Operational Research 198 (3): 922–935.
Acknowledgements
The fourth author was supported by a Discovery Grant from the Natural Sciences and Engineering Council (NSERC) of Canada and by the Global researcher Programme of the Scientific and Technological Research Council of Turkey (TUBITAK). The authors are grateful to Burcin Bozkaya for providing the GIS-based population and road data for the Sakarya province. The authors also gratefully acknowledge Sakarya Provincial Health Department for the data and information provided.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Güneş, E., Yaman, H., Çekyay, B. et al. Matching patient and physician preferences in designing a primary care facility network. J Oper Res Soc 65, 483–496 (2014). https://doi.org/10.1057/jors.2012.71
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1057/jors.2012.71