Primary care network development: the regulator’s perspective

Abstract

Our research is motivated by the proliferation of primary care models in Ontario, Canada. Currently, primary care is mainly provided by facilities belonging to six models of care. These models are remunerated by various schemes—a mixture of fee-for-service, capitation and salary. In addition, they provide different levels of care and several are better adjusted than others to treat complex health needs. The proposed mixed integer programming model allows the regulator to test the outcomes of locating different types of primary care facilities on the overall cost, accessibility and appropriateness of provided care. The network design is fitted to the heterogeneity of the population residing in a defined geographical area, directly using an index (deprivation index) that was found to correlate with increased health needs and barriers to care. The model capabilities are illustrated on the geographical area of Kingston, Ontario.

Keywords:

• health service
• location
• decision support systems
• optimization

Acknowledgements

The authors would like to thank Dr Kieran Moore and Dr Paul Belanger from KFL&A Public Health for the help with defining the scope of the problem and data collection, provided while preparing this article. In addition, the authors would like to thank the computing facility at HPCVL for providing the CPLEX capabilities for the full-size instance. Two anonymous reviewers greatly improved this article by providing valuable inputs.