Accessibility and congestion optimization in healthcare networks

Abstract

The design of healthcare networks involves decision-making processes related to facility location, capacity allocation, and user assignment to healthcare centers. These decisions must consider that healthcare networks are often both centralized and fragmented, yet they must support the clinical pathways required by users.

This problem has been widely addressed in the literature within the context of Facility Location Problems and Network Design Problems with Congestion. However, there are few instances where clinical pathways are explicitly incorporated into the modeling. This study proposes an analytical framework for decision-making in healthcare network design that incorporates the structure of clinical pathways with the aim of improving two key aspects: user accessibility and resource congestion.

The proposed framework, referred to as Multi-Objective Healthcare Network Design, is based on the use of Open Queueing Networks to model user flow. Accessibility is evaluated using the Two-Step Floating Catchment Area metric, while congestion is assessed through resource utilization calculation.

The optimization problem is solved using the Adaptive Bisection AUGMECON algorithm, incorporating hypervolume and spread indicators to evaluate the quality of the Pareto front. Implementations in artificial networks and in a real healthcare network in a region of Colombia reveal opportunities for redesigning these systems, with a focus on improving patient flow in accordance with the clinical pathways defined in the network.