Location and service mix decisions for a managed health care network

For managers of managed health care organizations, the problem of designing a competitive multiple facility network cannot be solved by existing mathematical models. This paper thus presents a nonlinear integer model for determining a facilities design strategy that embodies the economic tradeoffs encompassed in a competitive strategy: minimizing cost and maximizing market share. The integrated location and service mix model determines the number, location and service offerings of facilities that maximize profitability in a two-level hierarchical referral delivery network where an organization's market share is represented by a multiplicative competitive interaction model. To demonstrate the usefulness of the proposed integrated model, a series of problems is solved by an interchange heuristic and compared to the solutions derived by a simpler approach that ignores market competition.     

Provisioning health care infrastructure in communities: Empirical evidences from West Bengal,India

We developed a framework to reinvigorate communities in terms of public health care infrastructure provisioning for outpatient needs within the neighborhoods. The health care seeking episode is often influenced by the physical and health care infrastructure availability within the neighborhood, need of the health care seeker as well as personal, household, occupational, and latent perception of the users. This empirical study has been developed for two different groups in West Bengal India, firstly based on location and secondly based on the choice of the health care seeker. In case of resident based approach, we focused on the revisit decision of the rural inhabitants who sometime tend to travel to the regional facilities in urban areas. Facility based approach analyzed the people who were at the regional facilities for health care services. We devised scenarios ascertaining improvisation in service delivery, emergency facility and mobility ease at local public facilities might reduce regional tours and instigate higher utilization of the neighborhood health care facility. We develop integrated choice and latent variable models to incorporate latent perception in choice of scenario for instigating revisit decision. Results showed choice of development scenarios have association with the household structure, social network, locational and infrastructural impedance. This framework lead to two distinct outcomes: (1) method to identify programs, those are essential to by initiate_revisit_to the health care facility (2) perception based assessment of the current mobility and health care infrastructure of the region, which could be instrumental in developing the overall health care infrastructural planning policy as a whole.     

Siting a facility in continuous space to maximize coverage of a region

Siting facilities in continuous space such that continuously distributed demand within a region is optimally served is a challenging location problem. This problem is further complicated by the non-convexity of regions typically encountered in practice. In this paper a model for maximizing the service coverage of continuously distributed demand through the location of a single service facility in continuous space is proposed. To address this problem, theoretical conditions are established and associated methods are proposed for optimally siting a service facility in a region (convex or non-convex) with uniformly distributed demand. Through the use of geographic information systems (GIS), the developed approach is applied to identify facility sites that maximize regional coverage provided limitations on facility service ability.     

Improving access to health facilities in Nouna district,Burkina Faso

The Nouna health district in Burkina Faso, has a population of approximately 275,000 people living in 281 villages, and is served by 25 health facilities, as of 2006. For many people, the time and effort required in traveling to a health facility, which may demand a journey of many kilometers over poor roads on foot, is a deterrent to seeking proper medical care. In this study we examine how access to health facilities in Nouna may be improved by considering the configuration of the road network in addition to the locations of the facilities. We model the situation as a facility location–network design problem and draw conclusions about how best to improve the physical access of the health facilities. Our model shows the extent to which access can be improved when the road network is considered along with facility locations, in contrast to facility locations considered alone.     

Improving accessibility to rural health services: The maximal covering network improvement problem

Accessibility to health facilities is a critical factor in effective health treatment for people in rural areas of lesser-developed countries. In many areas accessibility is diminished by the lack of all-weather roads, making access subject to weather conditions. Location-allocation models have been used to prescribe optimal configurations of health facilities in order to maximize accessibility, but these models are based on the assumption that the underlying transport network is static and always available. Essentially, past work has ignored the potential impacts of improvements to the transport system in modeling access. In this paper we propose a model that treats the opposite side of the location/transport equation; that is, a model that treats existing facility locations as fixed and improves health service accessibility by upgrading links of the transport network to all-weather roads. This new model, called the Maximal Covering Network Improvement Problem (MC-NIP) is formulated as an integer-linear programming problem. An application of the MC-NIP model to the Suhum District of Ghana is presented, which shows that even a modest level of road improvement can lead to substantial increases in all-season access to health service.     

Competitive location strategies for two facilities

In this paper we present the problem of locating a facility when competition from another facility is taken into consideration. Two problems are addressed here. One is the location of a new facility that will attract the most buying power from an existing facility. The other is the location of a facility that will secure the most buying power againts the best location of competing facility to be set up in the future.     

Household location in a linear multi-center metropolitan area

The application of monocentric models of residential location to the analysis of metropolitan areas with more than one center of economic activity, produces a distorted view of the spatial distribution of urban variables such as land values, housing prices, etc. This distortion results from the fact that monocentric models tend to underestimate the values of these variables in areas lying between the centers, and yield wider residential areas toward the outskirts of the city. In this paper, a model of household location is developed, which attempts to correct this distortion by simultaneously considering the urban centers during the residential location process.     

Optimization models in emergency logistics: A literature review

Optimization modeling has become a powerful tool to tackle emergency logistics problems since its first adoption in maritime disaster situations in the 1970s. Using techniques of content analysis, this paper reviews optimization models utilized in emergency logistics. Disaster operations can be performed before or after disaster occurrence. Short-notice evacuation, facility location, and stock pre-positioning are drafted as the main pre-disaster operations, while relief distribution and casualty transportation are categorized as post-disaster operations. According to these operations, works in the literature are broken down into three parts: facility location, relief distribution and casualty transportation, and other operations. For the first two parts, the literature is structured and analyzed based on the model types, decisions, objectives, and constraints. Finally, through the content analysis framework, several research gaps are identified and future research directions are proposed.     

Mathematical analysis of emergency ambulance location

Proper ambulance location is crucial in saving lives and reducing injury. To determine efficient and effective locations, it is necessary to evaluate both the spatial and temporal distributions of demand. Because of the complex nature of the ambulance response and transport activities, the problem is subdivided into a facility location problem and a vehicle allocation problem. A set covering model is modified to solve the location problem while a simulation is used to solve the allocation problem. Combining these two models provides a powerful methodology for systematically finding a satisfactory solution to the ambulance location problem.     

Simple methods for uncapacitated facility location/allocation problems

Facility location/allocation problems are encountered in many different areas of management science. The methods presented in the literature are complex and are not easily understood by practitioners who are not trained in the techniques of optimization. Simple heuristic methods are presented in this article. The methods are developed for three different types of uncapacitated problems: (1) unlimited facility capacity with no fixed cost; (2) unlimited facility capacity with a fixed cost for assignment; (3) multiperiod problems. Examples are included to illustrate the basic methods.     

Development of an integrated medical supply information system

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.     

Forecasting the New York State economy: The coincident and leading indicators approach

Currently there are no reliable summary indicators of the economic and fiscal condition of states and localities. This deficiency has hampered the efforts of policy makers at the sub-national level to monitor changes in the economic environment and predict how those changes will impact the fiscal health of governments. This paper attempts to fill this analytical vacuum by providing summary indicators of economic and fiscal health for New York State. The models developed are based on the single-index methodology developed by Stock and Watson [(1991). A probability model of the coincident economic indicators. In K. Lahiri and G. H. Moore (eds.), Leading economic indicators: new approaches and forecasting records (pp. 63–85). New York: Cambridge University Press]. This approach allows us to date New York business cycles and compare local cyclical behavior with the nation as a whole. We develop a leading index of economic indicators which predicts future movements in the coincident indicator. The Stock and Watson approach is used to create a fiscal indicator which acts as a summary indicator of revenue performance for New York. In addition, we explore the ability of our economic indicator series to predict future changes in state revenues. We find that changes in the leading indicator series have significant predictive power in forecasting changes in our revenue index.     

Multi-period location of flow intercepting portable facilities of an intelligent transportation system

Intelligent transportation systems are of great importance in urban traffic management. In this context variable message signs (VMS) play a major role in providing drivers with useful information during their trips.In this paper we consider the problem of finding the optimal location of a set of portable VMS on an urban network where flow patterns change during a time horizon.We propose two original solving approaches based on flow intercepting facility location ILP models.The paper presents an application of the proposed approaches to real-like test networks and discusses the results obtained providing some indications on their practical applications.     

Estimating debt capacity of New York State health facilities

A measure of the capacity to take on new debt is developed for health facilities. This measure is a function of the current financial position of the facility, future financial market conditions (interest rates and bond/loan maturities), and a policy variable (the debt service coverage ratio) to be set by state health policy makers. The quality of this measure was shown to depend on the quality of current health facility financial accounting data, on the quality of forecasts of interest rates and future cashflow, and on the appropriateness of the criterion debt service coverage ratio. Some of the limitations of the estimate are discussed. Consideration of the debt capacity estimate serves to highlight some crucial issues in imposing capital expenditure limits, namely the interrelationships between financial viability, interest rates and access to capital markets.     

A multiobjective modeling approach to locating incinerators

The location of hazardous material incineration facilities is an important problem due to the environmental, social, and economic impacts that they impose. The costs associated with the facilities and the risks placed on nearby populations are important concerns as are the distributions of these costs and risks. This paper introduces a mixed-integer, multiobjective programming approach to identify the locations and capacities of such facilities. The approach incorporates a Gaussian dispersion model and a multiobjective optimization model in a GIS-based interactive decision support system that planners can access via the Internet. The proposed approach is demonstrated via a case study in central Portugal where the national government has decided to locate a large facility for the incineration of hazardous industrial waste. Due to intense local and national opposition, construction of the facility has been delayed. The system has been designed so that it can be used by decision makers with no special training in dispersion modeling, multiobjective programming, or GIS.     

Capacity planning in service operations: The case of hospital outpatient facilities

This paper presents models that may be used to balance service capacity and demand in situations in which demand is external and, therefore, is not fixed but may fluctuate in response to factors that include the waiting time imposed upon customers. Such situations are common in retailing, financial services, health services, and other service sector industries. An application is shown to a hospital outpatient facility.     

Locating a Biorefinery in Northern Spain: Decision Making and Economic Consequences

Biofuels are emerging as a prominent renewable and sustainable energy sources in developed countries. In this sense, this paper presents a case study in which a biorefinery has to be sited in Northern Spain. Thus, the strategic decision of locating such a facility is deeply investigated through strategic policy evaluation. Then, tactical decisions ranging from purchasing and transportation policies to storage protocols are carried out. Only local and limited biomass can be harvested for supplying the biorefinery through a heterogeneous vehicle fleet. Moreover two different and mutually exclusive storage strategies are evaluated: direct supply from crops to biorefinery and using intermediate-collectors. Additionally, crop exploitation factors and biorefinery sizes are used to generate several scenarios in which the strategic decision of location as well as all the tactic decisions are made. Some mixed integer linear programming models are proposed to figure out all relevant decision problems.The results suggest that the Northwest study area as the best option to locate the biorefinery and recommend the intermediate-collector storage strategy. Moreover, the key information about critical biomass, crops and times are also provided.     

Critical infrastructure location under supporting station dependencies considerations

This paper develops a framework to locate critical infrastructure (CI) facilities to most fully capitalize on the supporting stations (SSs) they depend on for normal operation. CI facilities include health services, transportation and electricity; agencies that impact the national economy, security and the public's health and wellbeing. SSs are facilities that provide essential services for the regular operation of a CI. For instance, the power service, communication services and water supply services are SSs for Hospitals. In this paper SSs are independent from the CIs that they service and have a heterogeneous probability of failure that will cripple the dependent CI. The proposed framework ranks the SS according to its cost of providing service such that the rank-1 SS is the primary service provider and incorporates the probability of failure for the SS. The CI will be served from secondary SS if the primary fails due to a disaster. This formulation insures the continuous service to the CI from SS and determines both the optimal location of the CI and the optimal number of demands served. A mixed integer linear programming approach is applied to develop a Reliable Facility Location Problem considering Supporting Stations (RFLP-SS) to identify the optimal location to build a critical facility. In addition to that, The RFLP-SS determines the capacity of the optimally located facility and its allocated demands. This research highlights the importance of considering dependencies among the SSs that service CI. The paper presents a case study in Puerto Rico to demonstrate the applicability of the proposed framework. The case study investigates the status of health services in Puerto Rico, and identifies the optimal locations to establish new hospitals. The paper recommends 11 locations for new hospitals so that the people of Puerto Rico will be better served than they are currently.