Reconciling spatial demand/supply imbalances in acute care

Abstract

In assessing the performance of acute care hospital systems, most of the emphasis has been on supply factors, such as patient throughput, occupancy rates, etc., and the associated hospital operating costs. Less attention has been paid to assessing the need for care, and to reconciling the spatial discrepancies between this need and the actual satisfied demand as reflected in observed admissions within a given supply configuration. The determination of the need for care is especially important in the excess demand situations which exist in most large cities in countries with highly-subsidised public hospital systems. This is because (i) the spatial distribution of the unsatisfied demand has significant equity implications and (ii) the abstraction of need for care from the observed spatial pattern of admissions becomes more difficult as excess demand levels increase. In order to forecast the behaviour of such a system, two models are required. Firstly, it is necessary to forecast the need for care from within different parts of a region (e.g. the different municipalities within a metropolitan area). This need is clearly not unbounded, and must conform with constraints such as income levels and the corresponding incidence of private hospital insurance.