Improved spatial equity in healthcare access from novel logistics strategies

Abstract

A common problem in healthcare logistics is maximizing coverage of a scarce resource through optimal facility location. There are important equity considerations when some areas cannot access potentially life-saving medical services. For emergency healthcare which is time-sensitive, it is necessary to consider both the quality and extent of the coverage. Most past research in this area focused on maximizing coverage or survival by identifying better locations or offering better treatments. In this work, we compare how traditional and novel service delivery strategies affect both spatial and population coverage. This comparison highlights improvements in the quality and extent of that coverage.

The rendezvous strategy improves service coverage by allowing a patient to meet up with a healthcare resource or team in an intermediate location. Because the success of the treatment is time sensitive, we use an impedance function to measure the quality of accessibility. Choosing initial resource locations influences patient survival rates, which vary by location. The approach is applied to an emerging treatment for cardiac arrest where scarce resources/personnel should be optimally allocated to maximise the benefit to patients. The results are quantified and mapped in order to support discussion of the spatial equity of the coverage.

The coverage area significantly increases under the rendezvous strategy compared to a traditional delivery model. By maximizing survival rather than simply coverage, we identify facility location combinations that improve patient outcomes. In addition to or instead of changing where or which healthcare resources are offered, the accessibility of life-saving medical treatment is quantitatively improved in extent and quality by changing how the treatment is delivered. This finding can be generalized to equitable access to any time-sensitive social services.