BOOKS OF RtfiDIfGS - PAHO/WHO

More documents

Recommendations

Info

- 268 - A Spatial-Allocation Model bfor Regional Health-Services Planning ,Villiam J. AL-:rnathy and John C. llertshey Stanford Unwersi*y, Staniord, California (letccivc~l A\utgust 12, 1'971) In planning for health services, the need arises to determine the location, capacity. and number of health centers for a geographically defined region. The present paper formulates this problem in a form convenient for solution and presents results from the model to clarify some important aspects of this allocation decision. The planning region is assumed to consist of geographically defined subareas or census blocks, of known location. The population is stratified in such a way that each stratum exhibits relatively homogeneous patteras of health-care utilization. The model characterizes the effects of center locations upon aggregate utilization and utilization of individual centers, sad gives optimal locations of centers with respect to several alternative criteru. An example illustrating computational feasibility and the implications of various criteria for the location decision is presented. HE PROBLENl, <strong>OF</strong>' determining ipatial locatioxns of primary health-care :enters for a dispersed population is an important issue in primary health-care planning. This paper forniulates the problem iii terms oi four different criteria. 'The importance of accepting census statistics as .source data is recognized in the formulation ·and in the choice of optimization procedure. The distance from individuals in a community to sources of care is a recognized ' ' t barrier to utilization." "1 Several types of decay functions have been proposed to describe the inverse relation between distance to medical facilities and utilization ·M these facilities.l " '"- Recent research by the authors analyzes choice behavior among facilities when several facilities at varying distances are available. z'l It ¡e demonstrated that the influencc of distance upon choice behavior iN much stronger tairn ik the influence of distaince ulpn overall utilization. In addition, it is well known that demographic, socioeconomic, and health- *-tatus factors all influence individuals' medical-facility utilization. Strata that are ?differentiated by these factors show different utilization patterns as a funetion of distane .12.'," That ,''I , is, distancc is a larger barrier to utilization for ~some strata than for others. Substantial progress has been mnade in understanding the e oomplex interactions of distance and socioeconomic variables. However, a method for using these interactions to suggest alternativc locations of medical facilities has not heretofore been developed. A frequently stated goal of regional primary-ihealth-care planners i¡ to allocate facilitie to locations in sueih a manner os to provide as much of the primary care Idemanded by the population as possible. Y'et this may conflict with other goals. For example, if the health planner maximizet total utilization, centers may be ' placed closer to areas that contain large numbers of people for whom distance is a
- 269 - William J. Abernothy and John C. Hershey stronger barrier to utilization thau to areas with populations that are more mobile. Such an allocation of centers may be far from optimal in terms of thc goal of mini. mizing the average distance patienxts must travel for cach vis4it. The point is that alternative objectives i¡n thc spatial-allocatiosi problem will often eofliict. Any proposued louationie of health centera mnust be atudied i¡s Il ,. light of cach objective. This paper pres*enta a model that can a.rist a hcalth-.yístemn planncr in dlett.'r. mining the location and capacities of a specified number of health-ciLre (.'iuirs within a region in a'cord:uiec witi ritated criteria. Thc formulation reli(e4 ui,t, 0c,',wuS df nmakilg tnruleTffs among multiple objective.s is almo explol*rld. Ans e xamphl olTerinig ,mnutirical experienice with the model ia givwn that
Page 1 and 2:
L 00111111 MASTER COPY - NO TOCAR B
Page 3 and 4:
- ii - liancock, W., D. Magerlein y
Page 5 and 6:
FOREWORD These last years, PAHO wit
Page 7 and 8:
Workshop .- Education in Operationa
Page 9 and 10:
-3. The format of the workshop was
Page 11 and 12:
-5- 2. Programs for bringing togeth
Page 13 and 14:
II. R.commendations -7- A series of
Page 15 and 16:
-9- there are technically trained i
Page 17 and 18:
-11- and selected individuals who h
Page 19 and 20:
-13- 6. In order to improve the qua
Page 21 and 22:
-15- cnve!opment will typically be
Page 23 and 24:
-17- 16. All participants sbould pr
Page 25 and 26:
A. Short Courses -19- Short courses
Page 27 and 28:
-21- 4. Presentation of a case to b
Page 29 and 30:
Topic Introduction to Systems Analy
Page 31 and 32:
-25- 12. Elementary Statistics ior
Page 33 and 34:
-27- 8. Applications of data proces
Page 35 and 36:
-29- problems. The graduate should
Page 37 and 38:
-31- Lblo-w. Also given is that typ
Page 39 and 40:
- 33 -' -Case Mix Definition by Dia
Page 41 and 42:
- 35 - Acknowledgment The authors w
Page 43 and 44:
ML ICAL CAE1 Februurl 1980, Vol. XV
Page 45 and 46:
X;' VIII, No. 2. Suippllce,t - 39 -
Page 47 and 48:
- 41 - dMLDICAL C.ARE '.Fcbrtanj 19
Page 49 and 50:
\'nKV 111,I No. 2, IIIJ·,ri - 43 -
Page 51 and 52:
Vol. XVIII, No. 2, Supplenent - 45
Page 53 and 54:
'Vol. XVIII. No. 2, Supplemient - 4
Page 55 and 56:
?Vol. XVIII. No. 2. Sttilluleareilt
Page 57 and 58:
.'yo. XVIII. No. 2, Supplentcsit Si
Page 59 and 60:
.V'oL XVIII. No. 2. Stpphlidary dia
Page 61 and 62:
Vol..'XVlII, No. 2, Supplement - 55
Page 63 and 64:
- 57 - MEDICAL CARE Febiuary 1980,
Page 65 and 66:
- 59 - .SlDiCL ( :AL.. FcbnartlrJ p
Page 67 and 68:
Vol. XVIII, No. 2, Suppletiment - 6
Page 69 and 70:
Vol. XVIII, No. 2, Supplenwt - 63 -
Page 71 and 72:
- 65 - £.¡EDCAL CARE ebrNuarV 1;9
Page 73 and 74:
Vol. XVIII, No. 2, Sn",,phl- steal
Page 75 and 76:
VoL XVIII. No. 2, Supplemnlent - 69
Page 77 and 78:
'XVII. No. 2. Supplement - 71 - P)i
Page 79 and 80:
;.'. 'Vol. XVIII. No. 2. Siupplemen
Page 81 and 82:
:`". XVIII, No. 2. Stupplenent - 75
Page 83 and 84:
,VoL XVIII, No. 2, Supplement Major
Page 85 and 86:
.. Vol. XVIII, No. 2. Supl|lemcent
Page 87 and 88:
i,..X VIII. No. 2. Supplemeiint - 8
Page 89 and 90:
T XVIII. No. 2. S.pphlts"t .i¿jor
Page 91 and 92:
·. ¥XVIII. No. 2 Supplement )i, "
Page 93 and 94:
- 87 - 'i1. XVIII. No. -. Supplemne
Page 95 and 96:
Vl. \'ll. No. 2. Sntiít'ult.uit M.
Page 97 and 98:
- 91 - R. FRIRICHIS AND J. PRAWDA W
Page 99 and 100:
- 93 - 414 R. FRRKICkIS AND J. PRAW
Page 101 and 102:
- 95 - R. F'RERICItS'AND J. PRAWDA
Page 103 and 104:
- 97 - R. F'RRICHS AND J. PRAWDA wh
Page 105 and 106:
- 99 - 420 R. MFRIlC}IS AND J. PRAW
Page 107 and 108:
V - 101 - McUCi. (:Au AWuu IMI. VoL
Page 109 and 110:
GREENLAND ET AL - 103 - the case (p
Page 111 and 112:
CREENLAND iT AL - 105 - TABLE 2. Fi
Page 113 and 114:
GREENLAND ET AL. 3. Cornfleld J, Ha
Page 115 and 116:
160 I indicates the flow of patient
Page 117 and 118:
162 CONGESTION POINTS ANU CONTROL.A
Page 119 and 120:
164 c 8o Table 4. The cffect of cha
Page 121 and 122:
166 B. LEV etal. significant differ
Page 123 and 124:
MEREDITH - 117 - ciety. However. ch
Page 125 and 126:
I MEREDITH - 119 - varying oulcome
Page 127 and 128:
MEDICAL CARE ,arch 1981, Vol. XIX,
Page 129 and 130:
%,I. XIX, No. 3 iclnts. It should d
Page 131 and 132:
n'ol. XIX, No. 3 - 125 - tailed exa
Page 133 and 134:
1 Vol. XIX. No. 3 - 127 - tant for
Page 135 and 136:
Vi. .XIX, No. 3 - 129 - tom' s reco
Page 137 and 138:
- 131 - A \ ,,1. XIX, No. 3 PEHFOHR
Page 139 and 140:
V Xl. IX, No. 3 - 133 - PERFORMANCE
Page 141 and 142:
- 135 - The fourth requirement is l
Page 143 and 144:
- 137 - Systems and Procedures of P
Page 145 and 146:
- 139 - 2. ldentify problemn areas
Page 147 and 148:
c 1 '-a
Page 149 and 150:
u. o a.- 1 W. LZi - 143 - c c S C.
Page 151 and 152:
- 145 - Thc cu rrent appointmren t-
Page 153 and 154:
- 147 - A pure block appointment sy
Page 155 and 156:
- 149 - ihe future. It was discover
Page 157 and 158:
- 151 -
Page 159 and 160:
- 153 - Figui.'¢ VII. Patient Arri
Page 161 and 162:
- 155 - sonnel working in positions
Page 163 and 164:
- 157 - 17. Keep the time span of t
Page 165 and 166:
- 159 - TABLE I: Pnmary DesklConsul
Page 167 and 168:
.Recomme;tded systenz - 161 - .;any
Page 169 and 170:
- 163 - system, there is nr'. :vste
Page 171 and 172:
- 165 - - A major problem with such
Page 173 and 174:
- 167 - T1c Iteole of Olieraionls R
Page 175 and 176:
- 169 - Larry J. Shumc- Harvey Wolf
Page 177 and 178:
- 171 - '- ionoal Heolth Ploanning
Page 179 and 180:
- 173 - Regional Health Planning ar
Page 181 and 182:
- 175 - Regio.,oi Health Planning w
Page 183 and 184:
- 177 - Regionao rfeclth Planning l
Page 185 and 186:
A^CJonoal neonah ronning 21. 1'. F.
Page 187 and 188:
- .,1 - Programming, Budgeting, and
Page 189 and 190:
- 183 - the health care industí ,
Page 191 and 192:
- 185 - was apparently no scarcity.
Page 193 and 194:
ut, u a. íL ._c E 0 t42 a .. 0m u
Page 195 and 196:
plex stochastic distribution of arr
Page 197 and 198:
- 191 cumulated according to any or
Page 199 and 200:
- 193 - Step 2 represents the heart
Page 201 and 202:
ÍA en .aa
Page 203 and 204:
- 197 - analysis, forecasting, and
Page 205 and 206:
Budgeting Attitudes - 199 - The pla
Page 207 and 208:
- 201 Health Services Research most
Page 209 and 210:
a. - 203 - Health Services Research
Page 211 and 212:
- 205 - DESIGN OF ALTERNATIVE PROVI
Page 213 and 214:
- 207 - 1. A change in the immigrat
Page 215 and 216:
- 209 - accessibility of health car
Page 217 and 218:
- 211 - dimensional graph to illust
Page 219 and 220:
- 213 - Primary Care Health Service
Page 221 and 222:
- 215 - different health and educat
Page 223 and 224: - 217 - The tasks that were rated "
Page 225 and 226: IC1 o -a - i - w im W..i C -J M. -
Page 227 and 228: 0 z 0 u _ I- 0 Ut. I,, uj CD Q U- ,
Page 229 and 230: TABLE 3 TASK ANALYSIS OF MALNUTRITI
Page 231 and 232: 11 - 225 - TASK ANALYSIS OF MALNUTR
Page 233 and 234: - 227 - 12. Reisman, A., F.Staub, B
Page 235 and 236: - 229 - METHODS Parameters Affectin
Page 237 and 238: - 231 - ~HNCOCK Fig. 1. Daily censu
Page 239 and 240: - 233 - HANCOCK Table 1. Parameters
Page 241 and 242: - 235 - Fig. 3. Maximum average occ
Page 243 and 244: - 237 - HANCOCK ET AL Fig. 4. Maxim
Page 245 and 246: - 239 - AECOCL. Table 2. Eflect of
Page 247 and 248: - 241 - HANCOCK Discussion ET AL Th
Page 249 and 250: #12 Estinating the Need for Additio
Page 251 and 252: Pri c= arvicc a ia Indina. - 245 -
Page 253 and 254: . 1' - - IIINDLE Algorithmn for Det
Page 255 and 256: - 249 - HINDLE that all tlie primar
Page 257 and 258: - 251 - HINDLE 6. Computc Mhe Avail
Page 259 and 260: - 253 - HINDLA Tablek Meamm of Zfic
Page 261 and 262: HINDLE Tr AL HIALTH falvCU - 255 -
Page 263 and 264: - 257 - HIiDLZ 26. Ado, An . ad L.
Page 265 and 266: - 259 - REISMIAN, DEAN, ESOOBUE, AG
Page 267 and 268: - 261 - REISMAN, DEAN, ESOGBUE, AGG
Page 269 and 270: - 263 - 1350 REISMiAN, DEAN, ESOOBU
Page 271 and 272: - 265 - REISMAN, DEAN, ESOOBUE, AGO
Page 273: - 267 - 1354 REISMAN, IEAN, ESOGCUE
Page 277 and 278: - 271 - William J. Abernathy and Jo
Page 279 and 280: - 273 - William 1. Abernothy ond Jo
Page 281 and 282: - 275 - William J. Abrnarthy and Jo
Page 283 and 284: - 277 - William J. Abernathy and Jo
Page 285 and 286: - 279 - William J. Aberncthy and Jo
Page 287 and 288: - 281 - 642 William J. Abernathy an
Page 289 and 290: Decmand in Mintu és/Day Numnlber o
Page 291 and 292: Disposal System 326 IIstlic I,',i,
Page 293 and 294: i Trays 334 Colorful pattenis anid
Page 295 and 296: tiie, gency L:ghting 347 ,i',., .:.
Page 297 and 298: - 296 - REVEI.LE we believe to be t
Page 299 and 300: - 293 R£VELLE is apparent in light
Page 301 and 302: - 295 - REVEt.EI. ET AL. poSJcd pro
Page 303 and 304: - 297 - RM.VELLE EL AL. of faciliti
Page 305 and 306: REVELLE ET AL. HALTOI SERVICUS RESE
Page 307 and 308: REVELLE ET Al.. - 301 - Fig. 4. Ano
Page 309 and 310: - 303 - REVet. ¡T AL Act of 1973.
Page 311 and 312: - 305 - REVELLE possible within ilh
Page 313 and 314: - 307 - RLVELI.E 29- Khumawala. a.
Page 315 and 316: - 309 - assuring thal the maxinmum
Page 317 and 318: -311 - the implemented strategy he
Page 319 and 320: - 313 - analytical approximalions w
Page 321 and 322: - 315 - rcquired Ior shipping and o
Page 323 and 324: - 317 - Controlling ¡he system The
Page 325 and 326:
- 319 - The light pen techniques ar
Page 327 and 328:
- 321 - shipnients have to be on ro
Page 329 and 330:
- 323 THE CREATER NEIW' YORK BLOOD
Page 331 and 332:
_,~ .- - 3. 2- - TABLE 1. PATIENT C
Page 333 and 334:
TABLE 3. MEDICAL INTENSIVE CARE UNI
Page 335 and 336:
Nursing Stalf Level (i of nurss/day
Page 337 and 338:
Table 1. Factors ¡i denad for medi
Page 339 and 340:
e forecast. This section descijbcs
Page 341 and 342:
ei, paid to these standards in cond
Page 343 and 344:
O Emphasis u.on the explicit enumer
Page 345 and 346:
*1 1 21 1 «i 1 1 1 1 - 331, -- For
Page 347 and 348:
Therc are ihreec basic prcessecs fi
Page 349 and 350:
- 343 - Forecasting Hcalth Care Ser
Page 351 and 352:
#20 Jaime 1B. Henrs Rtxlnc. I.. Ro:
Page 353 and 354:
- 347 - I v,'N ti.K 1tHm.pi.l !, t1
Page 355 and 356:
Ra.fo.renem.. aid %.hs '. - 31!9 -
Page 357 and 358:
; / larman u empirical research has
Page 359 and 360:
I Klarman - >3 - benefits that for
Page 361 and 362:
I Klaman Ctitena for Inchmion - 355
Page 363 and 364:
IClarman - 37 - The prevailing tend
Page 365 and 366:
1 Klarman Intargibl Benefits - .5 -
Page 367 and 368:
Kllarman - 361 - thi prospects of r
Page 369 and 370:
- 363 - Thua, it did not consider w
Page 371 and 372:
I Klannan - 365 - again if the new
Page 373 and 374:
Klarman - 367 - At the other pole,
Page 375 and 376:
- 369 - seem worth exploring. Howev
Page 377 and 378:
iKlarman - 371 - in the use of serv
Page 379 and 380:
Kmnnan - 373 - REFERENCES 1. Havema
Page 381 and 382:
- 375 - 59. Valr y, W. S. One eonoi
Page 383 and 384:
- 377 - i aSll a _ . b, CuaMu L. L,
Page 385 and 386:
WAHRNER ANI) I|UTTr)N The puroses I
Page 387 and 388:
WARNER AND HUTfON - 381 - observers
Page 389 and 390:
.AHNF:R AND IIl'TIoN - 383 - rare I
Page 391 and 392:
WARNER AND HUTTrU., TABLE 1. Trenda
Page 393 and 394:
W'AHNER AND IHUTTON - 387 - treatme
Page 395 and 396:
AAHNER AND HU'TON - 389 - Several d
Page 397 and 398:
WARNER AND HUTTON pal orientations
Page 399 and 400:
w'ARNER AND UL'TTOit'u ' . N Engl I
Page 401 and 402:
I,,qr *ir 'ilu.,i XV. Seplteri¡br
Page 403 and 404:
In.lumin- i',)i.eIu XV. Seph.irhb'r
Page 405 and 406:
In#unrvlVolutn XV. September 1978 h
Page 407 and 408:
Problemas identificados - 401 - Dur
Page 409 and 410:
Programas educativos 3 - 403 - 1. S
Page 411 and 412:
- 405 - maestrfa, donde se supone q
Page 413 and 414:
- 407 - presentación formal de inf
Page 415 and 416:
- 409 - * Curso para ingenieros ind
Page 417 and 418:
- 411 - ¢ 16. Hancock, W., D. Mage
Page 419 and 420:
- 413 - 2. Barrenechea, J. J. La se
Page 421 and 422:
- 415 - Curwso (8 a 16 horas) para
Page 423 and 424:
- 417 - 4. Necesidades de los admin
Page 425 and 426:
MOISES ARTEAGA DR. DAVID GOMEZ COVA
show all

BOOKS OF RtfiDIfGS - PAHO/WHO

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?