BOOKS OF RtfiDIfGS - PAHO/WHO

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Regional Health.Services Planning 641
scale. When niore fhau fotr i.e¡ter.s :te :all¿xated, thlere is little reltive inmproveimelit i
any of the imtea.urcs,
:uid liflerene.es among tilhe regíion-widc imeasires are negligible.
The thrce graphs incliuded iii Fig. 4 deincm.trate the use of Ihe model in the inlportant
aranlytic nrle of deternlining the incremental Ienefits from inrea:sin lthe nítiber of eenlers ii
a region. The siecifics ouf :ai'dy.is ean Iwx varied to aicomiodaitc t he planning ie problemi at
ligd. One or more centers cln be fixed in location or capacity to represFent existinig farilities,
different criteria can be studlied, and miniimum or maxiiiiiini ecnter sizes can be included iii
the formuílamtion. The moidel also gives vohlines bhy !.troat:s for eachl renter so thnt i¡.m'os related
to liiirmln size iiol :ei a ofie ,.rf rai e:il. e:I,1w dealt wii .hit Wlilh sp'ilie refinlements
can xie infrlimiruued to accolllxoditte a pIatticular plaiíning probleni, Fig. 4 illastrates the etylx
of analysis that can be performed to leterniine increniental beuefits from a.dding nmore eenters.
A health pl:iaitter can comniare tlie rost impllications of sugg.lted inimbers, sizer, and
ocaLatioi, of center.s wvithl thl( mriiír.iiic:l Ibeefits ofof l ervie, wlhere IM-nefit, :Mr,
inme.sllreu4 ii t1'm111ís (l . .l cMh 1 ritrio L :s ttilizaitiol tr',l¡'el di.,.lnse,, or per alfilat p ereent:íge
decrease i¡n utilization oun a region wide hAt.-is.
In the tinal aínalysis, the decision maker must decide how to weigh different
objeetivw,$. No olnl( curiterion is best. Thc ultimate decision as to tlw number.
capacity, aind location of health vueter moinst be hoised upoIn a broad range uf coínsiderations.
However, formal analysis can be extremely useful in reducin¡g ihe
number of variables that must be considered subjectively. Furthermilore, by
forcing the mniodel to evailate decisions that are proposed on other hbaes, the model
can serve' to qu 1itify th e'Oll(seluent s of alterliative choices for comparison with
the optimum solutioins derived from explicit criteria.
C(ONCLUS .ON
Tg REOIOXA4L allocation problem is a central issue in research on health-eare
delivery systems. This paper has undertaken to develop a method that can be
applied praectically by a liealth plasittcr in bridging tlihe gap betwveen re.eareh resulta
anid implementation. Emphazis is, on providing a formulatiotL tihat usefully
eharaeterizes the problem within a region rather thaun on the elegance of optimization
procedure!s. (As a benchnmark for eomputatioínal feasibility. cach optimization
for the above example reqccuired about 20 seconds of CPU time onu an IB.M
360-67.) The formulation distinguishes the separate impact of distance on various
.ocioeconomie strata with respect to their choice of a particular center as well as
overall utilization. Thc model can be extended to acecommodate considerations of
inlxOrtaunc! ina partituil:r aPpplieatioris by eh:alngiuíg tlíi cirteria: uisl for oIplinliza:tioi
autd the onllstraintls imposed ;11 the formnulationi.
ACKN.OWLED(;GM'ENT
RESEARCH REPOITED i11 this palper was
supported in part by thé National Center
for Health Services Rewtarch anid Dcvelopment, Departmeiit of Health, Education,
and Welfare.