Improving spatial accessibility to regional health systems through facility capacity management

In austerity times, the general interest to reduce costs and improve efficiency levels often resulted into local cuts to public expenditure and profound reorganizations of existing service networks, especially in sectors like healthcare. In Italy, a recent reform prescribed the reconfiguration of time-dependent (i.e. emergency) hospital networks with the aim of improving patients’ accessibility conditions. In order to evaluate the impacts determined by this reorganization, we perform a spatial analysis in which we consider the distance from the closest facility as an accessibility measure. Results obtained from the spatial analysis confirm that users effectively benefit from the reorganization process but also that further improvements are possible, especially for the worst served ones. To this end, we also propose solving a mathematical programming model aiming at redistributing the capacities, i.e. the supply of beds, among the hospitals of the network seeking to maximize users’ accessibility. The realized computational experiments show that averagely better and even more equitable accessibility conditions could be obtained by containing the deriving reorganization costs.     

GIS-based fuzzy multi-criteria approach for optimal site selection of fire stations in Istanbul,Turkey

Fire stations play a central role in protection and response activities as part of emergency management services in cases of fire incidences. With the rising urban populations and city expansions, the demand for more fire services resultantly increases. It then becomes critical to effectively plan the location of emergency facilities to adequately service the population and ensure the protection of lives and infrastructure. This study, therefore proposes the use of the fuzzy extension of the Multi-Criteria Decision-Making (MCDM) method of Analytical Hierarchical Process (AHP), hence called fuzzy AHP, integrated with Geographic Information Systems (GIS) approach to optimally site new fire stations for the case of Istanbul region. This proposed fuzzy approach simulates the subjective expert judgements for the preferences of the six criteria assessed for fire station suitability mapping and thereby accounted for the uncertainty of crisp comparison values via triangular fuzzy numbers (TFNs). The criteria weights evaluated from this procedure were used in a weighted overlay analysis of the reclassified criteria map layers in ArcGIS to generate a fire station suitability map. These resultant fuzzy AHP criteria weights were validated using another MCDM technique, called Best-Worst Method (BWM) and found to be comparable and consistent. The criteria that had the strongest influence on the selection of sites for fire stations were identified to be: the density of hazardous material facilities (DHM), a high population density (HPD) and proximity to main roads (PMR) with associated weights of 33.3%, 24.4% and 15.2%, respectively. Based on a thorough assessment within the areas represented by class values ranging from 3 to 5 on the suitability map, a total of 34 new fire station sites were selected complementing the existing 121 fire stations. Further, a prioritization analysis from low, medium to high, was performed to plan the phases for the construction of new fire stations in view of competing budgetary needs and resource constraints. The methodology to achieve this was proposed and modelled for enhancing the decision-making process in urban fire station site selection studies.     

Intermediate input sharing in the hospital service industry

This paper addresses two related questions that help to explain geographic variation in access to medical services. The first question examines the existence of agglomeration economies in the hospital service industry. The second considers whether the sharing of intermediate inputs contributes to spillovers from spatial concentration of hospital services. These questions are addressed by estimating a bivariate probit model that explicitly controls for potential correlations between whether a service is provided and how the service is provided. Three key findings are obtained. First, hospitals in more concentrated areas are more likely to outsource intermediate services to specialized intermediate service suppliers. This suggests that agglomeration economies exist in the hospital service industry and are generated in part through the sharing of intermediate inputs. Second, the presence of nearby small hospitals increases the tendency to outsource, which is consistent with a “Chinitz” effect identified elsewhere in the literature. Third, the agglomeration effect attenuates geographically.     

Locating emergency medical services in small town and rural settings

Locating emergency medical services in small town and rural settings presents subtle, but significant differences to those in metropolitan areas. The lack of service mix and unit choice, the measurement of response time in minutes rather than seconds, and the limits of the planning environment are discussed. Using time-distance comparisons and location-allocation techniques within a microcomputing environment, some aspects of planning emergency medical services are illustrated within the context of the Kingston (Ontario) Regional Ambulance Service.     

城乡统筹中的基本公共服务均等化规划技术探讨

在当前我国政府财力仍不雄厚、公共服务资源依然短缺的背景下,探讨以资源配置高效率为导向的基本公共服务均等化规划技术,有着十分积极的现实意义.本文将基本公共服务均等化问题转化为具有基本公共服务能力的服务节点相对于居民点的空间可达性问题,以四川省安岳县为案例,借助居民问卷调查资料和地理信息系统空间分析功能,重点分析了基本公共...     

Evaluation of new first response initiatives in emergency services

By training and equipping human resources from other public service sectors than emergency response, to act as first responders, it is possible to reduce the first response times at a low cost. Before launching such an initiative, it is however important to evaluate the potential benefits. In this work, a method for doing this kind of evaluation is developed and applied to a potential initiative, utilizing fire service day personnel as new first responders. By developing a smartphone application and performing an experiment, sending alerts to potential first responders, and combining this with expert reviews of the possible value of their contribution, it is possible to estimate the response time reductions, as well as the monetary benefits of the initiative. The results show that there is a monetary benefit, even with a low number of new first responders, but that it is highly dependent on how quickly they can start travelling towards the emergency site.     

应急物流服务网点选址模型研究

应急物流是应对突发事件的重要保障。应急物流可以降低灾害影响程度,缩短受害持续时间,使突发性事件造成损失最小化。而在进行应急物流决策时,首先会面临应急物流服务网点的选址问题。应急物流服务网点置于合理的位置,不仅可以降低成本,而且还能够保证提供应急物资的时效性,从而避免可能导致的更大损失。在给定限制条件下应急服务网点选址模型基础上,综合考虑应急需求的随机性和由灾害导致应急配送时间模糊的不确定情况,研究新的模糊和随机混合机会约束规划选址模型。     

Exclusionary policies in urban development: Under-servicing migrant households in Brazilian cities

Localities in developed countries often enact regulations to deter low-income households from moving in. In developing countries, such restrictions lead to the emergence of informal housing sectors. To deter low-income migrants, localities in developing countries withhold public services to the informal housing sector. Using a large sample of Brazilian localities, we examine migration and exclusion, focusing on the public provision of water to small houses where low-income migrants are likely to live. Withholding water connections reduces the locality growth rate, particularly of low-education households. In terms of service provision, during dictatorship in Brazil, we find evidence of strategic exclusion, where localities appear to withhold services to deter in-migration. We also find evidence of strategic interactions among localities within metro areas in their setting of service levels: if one locality provides more services to migrant households, other localities respond by withholding service.     

城市应急避难场所空间布局合理性研究

应急避难场所是保障城市安全的一项重要公共服务设施,其空间布局的合理与否直接影响为市民提供服务的效果。以徐州市为例,基于GIS的网络分析法,构建了五个指标分析城市应急避难场所空间布局的合理性。结果表明,徐州市应急避难场所总体布局相对合理,存在的主要问题是服务重叠率偏高;各组团应急避难场所的空间服务范围大致相当,服务人口的数量有较大差异;分区尺度上,居民接近应急避难场所的机会相对均等,需要调整应急避难场所布局的分区较少。相关结论可为徐州市应急避难场所的调整与优化及新建设施提供可靠的布局参考。     

A hierarchical location model for determining capacities of neonatal intensive care units in Korea

Reforming the healthcare delivery system to provide optimum care to sick newborn infants is a critical task in Korea. Motivated by the efforts of the Korean government, we study a capacity allocation model to design an optimal capacity allocation plan for neonatal intensive care units (NICUs). Our model considers the following properties: 1) the hierarchical feature of neonatal care services and 2) the congestion effect in NICU operations. We develop a mathematical model that combines a hierarchical location model with queuing theory. We subsequently apply the proposed model to the problem of allocating capacities to NICUs in Korea. We provide information that can help policymakers draw an initial plan by evaluating various capacity allocation scenarios. We further examine two policy alternatives for improving accessibility to neonatal care. One involves increasing service capacity by adaptively adding resources to NICUs, and the other includes expanding physical service coverage by introducing helicopter transport. The results show that each alternative can contribute toward improving accessibility, and we believe that these findings will have practical implications for developing a better neonatal care system.     

A Fraternity Of Danger

A bstract . Interviews and participation with members of rural volunteer fire departments (VFDs) in New York State, indicate that local communities in rural regions are structured around VFDs. Such "communities" involves both the fraternity of the fire house, resting on the teamwork essential to firefighting, and a wider locality, which the VFDs spatially define and symbolically integrate through a ritual of parades, fund raising efforts, and their example of community service. The working class, attached to the locality by stable residence and recruited intergenerationally into the fire service, supplies the majority of volunteers.
Neoliberal modernization threatens this recruitment pattern. Problems have developed because the "new middle class" rejects VFD participation, except as ambulance volunteers. As localities compete for outside investment through the reduced cost of their services, they have exploited volunteers to provide fire protection at less cost than that of paid departments. This commodification of the VFDs risks destroying their character as a system of moral obligation unifying a locality and is an inequitable, and unsustainable, "tax" on working class volunteers. But innovative systems of emergency and other services can be used to attract the new male and female middle class into volunteer local activities.     

An applied stochastic model of the quality–quantity trade-off in the public health care sector

It is a striking feature of the many of the developing country public service sectors that the sectors in question often overproduce the quantity of services but underproduce the quality. This feature, which is exemplified in this paper, is rooted in a wide spectrum of economic and sociological factors ranging from the economic and sociological profile of the service receiving people to the asymmetric density of service-receiving population across their regions. This feature, we conjecture, is a source of a considerable degree of suboptimality in some of the developing countries. If our conjecture is correct, correcting such suboptimalities is likely to yield significant welfare improvements that could help speed up the process of development in the underdeveloped regions of the world. To analyze the supoopimalites in question, we will first develop a concept (and a model) of optimal quality in the public service sector, which indicates the level of quality that maximizes expected public satisfaction subject to available resources. Resources are used in an efficient manner to produce the service in question. The concept and the model in the paper make a needed contribution to the quality discourse by presenting a way of determining the quality improvements (or adjustments) necessary to achieve optimum in the public service sector. The paper presents an application (a case study) of this new concept in the public healthcare sector in Turkey, and explores the differences between the actual and optimal quality in the sector in question. It turns out that there is a considerable difference between the actual and optimal levels of quality (as well as those of quantity) in the Turkish public healthcare sector in an overpopulated city (Istanbul), indicating a significant overproduction of quantity and underproduction of quality. Thus, to achieve the optimal levels, the sector should increase quality and reduce quantity by a considerable margin. The quantified differences (gaps) between actual and optimal levels point out a considerable room for welfare improvement. Optimum-seeking adjustments closing these gaps could be shown to lead to considerable satisfaction and welfare gains, the measurement of which is worthy of future research.     

A goal programming model for the siting of multilevel EMS systems.

Facility siting models known as location covering techniques have proven to be useful particularly for emergency medical services (EMS) planning, given the importance of ambulances responding to demand within some maximum time constraint. These models represent a set of methods which focus the health planner's attention on the access of people to health care, since they attempt to “cover” people in need of service within some specified time standard.This research develops a technique for the locational planning of sophisticated EMS systems, characterized by multiple levels of emergency health services. Specifically, a two-tiered system with “basic life support” and “advanced life support” capabilities is modeled as a goal program.By applying location covering techniques within a goal programming framework, this study develops a method for the siting of multilevel EMS systems so that (1) each service level maximizes coverage of its own demand population, and (2) “back-up” coordination between levels is assured. The usefulness of this goal program as a health planning tool is evidenced in the model's explicit articulation of EMS policy objectives and its ability to link system levels in terms of “goal-directed behavior”. The working of this multilevel covering model is demonstrated by reference to EMS planning scenarios and related numerical examples.     

ACCESSIBILITY AND THIRD WORLD RURAL DEVELOPMENT: A Case Study of Sumatra*

Road and transport service improvements are widely recognized as important catalysts to economic development in most third world countries. When integrated with other programs which create new employment opportunities, roads and bus services enable subsistence farmers to seek off-farm salary-earning jobs. This paper examines the relationship between accessibility and economic well-being using data from rural Sumatra in Indonesia. The research relies on multiple indicators of both measures. Households in more remote rural villages are found to average appreciably lower levels of consumption expenditures. When isolated from subregional market and trade centers, consumption levels fall dramatically. The research also shows that the average value of farm produce increases with road quality, frequency of bus service, and close proximity of commerical centers. Thus, agriculture productivity is linked to both transport supply and spatial proximity factors. Additionally, the analysis shows that off-farm earnings increase when migrant households have access to both motorcycles and bicycles. Loans and subsidies for purchasing such “low tech” vehicles as bicycles, scooters, and micro-buses could prove more beneficial to many rural villagers than capital-intensive road projects. Lastly, the research suggests that the siting of transmigration settlements within reasonable proximity to regional and subregional market centers is important if the planned villages are to develop trade linkages and experience sustained economic growth.     

环渤海中心城市服务业的结构及特征

以环渤海区域地级及以上城市为主要考察对象,以从业人员为主要指标,分析了该区域中心城市服务业发展现状、内部结构差异及服务业发展的空间分异特征。研究认为,近年来环渤海区域服务业发展迅速,服务业布局呈现梯度化空间分布特征;服务产业,尤其是消费性服务集中于行政级别较高的中心城市。研究还发现,环渤海区域服务业存在城市之间服务产业发展不平衡、部分区位条件优越的城市服务业发展滞后以及山东半岛和辽东半岛部分中心城市服务职能有待强化等问题。在此基础上,提出了根据服务业内部各行业特点和城市的发展条件、遵循区别对待原则确定具体服务行业的发展重点和优先顺序等对策措施。     

Analyzing the volume and nature of emergency medical calls during severe weather events using regression methodologies

An effective emergency medical service (EMS) response to emergency medical calls during extreme weather events is a critical public service. Nearly all models for allocating EMS resources focus on normal operating conditions. However, public health risks become even more critical during extreme weather events, and hence, EMS systems must consider additional needs that arise during weather events to effectively respond to and treat patients. This paper seeks to characterize how the volume and nature of EMS calls are affected during extreme weather events with a particular focus on emergency preparedness. In contrast to other studies on disaster relief, where the focus is on delivery of temporary commodities, we focus on the delivery of routine emergency services during blizzards and hurricane evacuations. The dependence of emergency service quality on weather conditions is explored through a case study using real-world data from Hanover County, Virginia. The results suggest that whether it is snowing is significant in nearly all of the regression models. Variables associated with increased highway congestion, which become important during hurricane evacuations, are positively correlated with an increased call volume and the likelihood of high-risk calls. The analysis can aid public safety leaders in preparing for extreme weather events.     

长江中游城市群空间结构效益比较与优化研究

基于OpenStreetMap公路路网和社会经济数据,利用可达性分析及空间相互作用引力模型,从规模效益、距离效益、空间联系效益3个方面对2017年长江中游城市群的空间结构效益进行比较分析。研究发现:武汉城市圈城市紧凑度高,平均可达性最好,内部联系强度大,空间凝聚力强;长株潭城市群在人口及经济规模上具有明显优势,中等联系层面网络趋于完善,一体化程度高,但空间可达性差;环鄱阳湖城市群综合竞争能力弱,空间联系松散且较弱,但空间可达性较好。未来,长江中游城市群的发展可以从重构区域发展空间结构、加强不同等级规模城市梯度建设、构建综合交通运输网、建立区域发展协调机制和促进产业生态绿色发展等方面寻找着力点。     

宜昌市森林防火应急物流系统研究

为了提高宜昌市森林防火应急物流资源信息化管理水平及指挥调度效率,降低决策偏差,使森林火灾造成的损失最小化,文章在现代物流理论和应急管理理论的基础上结合宜昌市森林防火的物流需求构建了一套适合宜昌市情的森林防火应急物流系统,此研究对提高宜昌市抗御重大森林火灾的能力具有重大的实际意义。     

Solar powered light emitting diode distribution in developing countries: An assessment of potential distribution sites in rural Cambodia using network analyses

The objective of this research is to use geographic information systems and spatial analyses to create a template for distributing lighting, particularly light emitting diodes, in developing countries. Approximately 1.6 billion people do not have access to traditional electrical systems; therefore, a significant number of people do not have access to safe, efficient, and inexpensive lighting technologies. This research addresses the need for lighting in one developing country. As an introductory case study area for the distribution of lighting products, Cambodia has a population that is considerable, rural, and without electricity. In addition, a significant percentage of Cambodia’s population will not have access to grid-quality electricity by 2030. To help alleviate this lighting deficiency, eliminate inappropriate distribution areas, and create a list of potential locations, the authors use geographic information system techniques to address four site-specific characteristics (grid electricity access, water inundation potential, hazardous landmine locations, and extreme poverty levels). To select among potential locations, the authors combine spatial analyses, service area delineations, and origin-destination cost matrices into a heuristic method for determining one location. These analyses identify the commune of Kantreang as the most appropriate location for lighting distribution.     

基于模糊综合评判的城市消防应急能力评估研究

城市消防应急能力的综合评价是衡量消防工作是否充分有效的重要手段。文章分析影响城市消防应急能力的各种因素,建立消防救援能力评价指标体系,结合模糊综合评判方法,建立消防应急能力评价模型,最后以佛山市某区为实例,实现数据收集、评价,完成应用示范研究,基于评价结果分析,为提高城市消防应急能力、保障城市安全提出建议和对策。