Systemic planning vs. individual Choice: The optimal matching for urban Healthcare Facilities and patient population

Abstract

Urban healthcare facilities planning faces a challenge that patient population tend to bypass lower-level for higher-level healthcare facilities despite increased distance and cost along with overcrowding at high-level facilities and underutilization at low-level ones. This phenomenon and its challenges are presumably influenced by individual behaviors of patients and urban healthcare facilities planning by local governments. This paper examines this phenomenon through optimal matching of patient population to healthcare facilities in two approaches representing top-down planning and bottom-up individual choice. More specifically, planning matching spatially assigns the patients to the closest facilities and choice matching, including multinomial logit matching or game theoretic matching, optimally selects facilities based on patient choices. Using Hangzhou, China as a test bed with 194 healthcare facilities and 588 residential communities, this research has found that: (1) the inconsistency between planning and individual choice leads to population bypassing certain facilities; (2) the trade-offs between healthcare service level and community-facility distance are consistent across matchings; (3) systemic planning outperforms individual choice concerning distance and actual utility while the reverse holds true for service level and indirect utility; (4) certain thresholds exist beyond which neither approach excels, suggesting a mix of the two approaches.