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Equity, Efficiency, and Accessibility in Urban and Regional Health-Care Systems

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  • L D Mayhew
  • G Leonardi

Abstract

This paper explores four different criteria of health-care resource allocation at the urban and regional level. The criteria are linked by a common spatial-interaction model. This model is based on the hypothesis that the number of hospital patients generated in a residential zone i is proportional to the relative morbidity of i , and to the availability of resources in treatment zone j , but is in inverse proportion to the accessibility costs of getting from i to j . The resource-allocation criteria are based on objectives on which there is broad agreement among planners and other actors in a health-care system. These objectives are concerned with allocations that conform to notions of equity, efficiency, and two definitions of accessibility. The allocation criteria give mainly aggregate-level information, and are designed with the long-term regional planning of health-care services in mind. The paper starts by defining the criteria, and describes how they are intended to be employed in a planning context. The allocation rules are then formally derived and linked together mathematically. They are then applied to a region, London, England, which is known to have very complex health-care planning problems. As a result of this application, two of the criteria—equity and efficiency—are selected for further analysis. A new model is built and applied that specifically enables the user to trade off one of these criteria against the other.

Suggested Citation

  • L D Mayhew & G Leonardi, 1982. "Equity, Efficiency, and Accessibility in Urban and Regional Health-Care Systems," Environment and Planning A, , vol. 14(11), pages 1479-1507, November.
    • Handle: RePEc:sae:envira:v:14:y:1982:i:11:p:1479-1507
    DOI: 10.1068/a141479
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    References listed on IDEAS

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    1. Jefferson, T. R. & Scott, C. H., 1979. "The analysis of entropy models with equality and inequality constraints," Transportation Research Part B: Methodological, Elsevier, vol. 13(2), pages 123-132, June.
    2. Constantine Toregas & Ralph Swain & Charles ReVelle & Lawrence Bergman, 1971. "The Location of Emergency Service Facilities," Operations Research, INFORMS, vol. 19(6), pages 1363-1373, October.
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    Cited by:

    1. Cho, Cheol-Joo, 1998. "An equity-efficiency trade-off model for the optimum location of medical care facilities," Socio-Economic Planning Sciences, Elsevier, vol. 32(2), pages 99-112, June.
    2. Malczewski, Jacek & Jackson, Marlene, 2000. "Multicriteria spatial allocation of educational resources: an overview," Socio-Economic Planning Sciences, Elsevier, vol. 34(3), pages 219-235, September.
    3. Włodzimierz Ogryczak, 2009. "Inequality measures and equitable locations," Annals of Operations Research, Springer, vol. 167(1), pages 61-86, March.

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