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

Mayhew, L.D. & Leonardi, G. (1982). Equity, Efficiency, and Accessibility in Urban and Regional Health-Care Systems. IIASA Research Report (Reprint). IIASA, Laxenburg, Austria: RR-82-047. Reprinted from Environment and Planning A, 14 [1982].

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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.

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