Hierarchical health facility location model based on user demand: the case of Bursa

Abstract

Location theory has been studied in many disciplines such as economics, geography, statistics, industrial engineering and urban planning. The development of location theories has mostly been through the minimum cost-maximum profit targets of industrial areas. The public services are usually located considering the user demand, social benefit and construction cost. Therefore, increasing the efficiency of the public service is possible only by providing to as many people as possible and localizing the service. Accessibility, which does not have a single definition, can be defined as the capability to reach a service. Accessibility is a significant factor in both public and private sector's location decisions, and has different parameters within itself. Factors such as population growth and fast growth of cities make access to public health services difficult for users. Economic, political, cultural, spatial or physical barriers are factors that individualize accessibility. Accordingly, this study presents a hierarchical health facility model with users' hospital demand perspective. The aim is to develop a model based on spatial, economic and demographic data. In this context, four types of demand were calculated; based on age-gender, private and supplementary insurance, public transportation and distance. The study area is divided into nine zones based on district and neighborhood boundaries in order to determine the sub-regions where calculation of the hospital demand is made. A facility hierarchy was designed within the framework of current health legislation for facilities that are the general hospitals providing inpatient treatment. First of all, the age and gender-related inpatient treatment activities of each sub-region were calculated, and the number of inpatients was estimated for each sub-region as the demand value. Secondly, since the hierarchical system designed only includes public health facilities, economic measurement determines whether the demand is for private or public hospitals. For this reason, private and supplementary health insurance ownership ratios in the sub-regions were determined as parameters in the hospital demand based on economic measurement. In the hospital demand based on public transportation, the LRT network was determined as the reference transportation system. Firstly, sub-regions were scored considering the population ratio within walking distance of these LRT stops. Secondly, sub-regions were scored considering the LRT stops that are in the sphere of influence of the district centers. Finally, the total scores are multiplied by the estimated patient numbers in the sub-region. In the last demand type based on distance, Hansen's accessibility index based on hospital demand is calculated for each sub-region by using estimated patient numbers. The four different types of hospital demand must be weighted in order to be used in the location decision of the second and third stage facilities. In this part, the analytical hierarchy process (AHP) was used as a multiple criteria decision making method. The priorities of these criteria / demand types were determined through pairwise comparison. These demand values are the weight of each region in calculating the coordinates of the facilities in the model. The hierarchical health facility model designed within the scope of this thesis is compared with the current location and status of the facilities. In this study, the spatial equivalent of the health policies, the differences between current and model despite the same legal framework, the locality, and the sectoral distribution of the demand were also evaluated.