Reduction of a Hospital Network as a Multiple Criteria Optimisation Problem

The paper describes the design of a hospital network using mathematical programming approach. The problem is formulated as a multiple-criteria location problem. The criteria reflect patients’ demand for high-quality and accessible health care. It means that the network should include: (1) high-quality and (2) complex hospitals with a broad range of emergency departments, (3) ensuring good transportation accessibility for most people, and at the same time (4) equitable distributed across the region. The economic criterion emanating from a limited budget is implemented as a constraint on the number of open hospitals. Given a complete network of hospitals and the desired number of hospitals, the model decides (according to the multiple criteria) which hospitals should be closed down. At the same time, it determines the allocation of municipalities to the open hospitals, defining the attraction zone of each hospital. Changing the weights of the objectives, a set of the alternative solutions (hospital networks) may be generated and evaluated. Thus the model can be used as a managerial tool in the process of reducing the hospital network with the aim of increasing the efficiency of the provided medical care. In the case study we have implemented the model in the Slovak Republic conditions. We present two analyses aimed at (1) the impact of reducing the hospital network on the accessibility, and (2) comparison of the mathematical solutions with the current networks of hospitals which have contracts with two biggest health insurance companies.