An analysis of a number of contemporary bed planning methodologies, either in use or under development, reveals a number of limitations. In particular, the linkage between the optimal size of health facilities and the optimal size of their service areas has often been ignored; in addition, the determinants of utilization of services have often been ignored. An alternative approach to the size–location problem is proposed. Working from health economics–medical sociology concepts, a behavioral model of health services utilization is proposed on the demand side. The interface to the supply side is through a model of the consumer's perception of the total costs facing him in hospital care.
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References
1.
RosenthalG.The Demand for General Hospital Facilities, Chap. 2, pp. 10–15. Hospital Monograph Series No. 14, American Hospital Association, Chicago, 1964.
2.
JohnstoneD.The Concept and Definition of an Individual Hospital Geographic Service Area, Chaps. 2 and 3. Master's dissertation, George Washington University, 1971.
3.
GrossP. F.Health Planning in Colombia—Towards a Rational Framework for the Selection, Acquisition, Processing and Retrieval of Data for Planning. Working Document prepared for the Division for Research in Epidemiology and Communications Science (Project IR0660). World Health Organization, Geneva, September 18, 1970.
4.
NavarroV.Methodology on regional planning of personal health services. A case study: Sweden. Med. Care8(5): 386–394, 1970.
5.
Hill–Burton State Plan Data: A National Summary as of January1, 1968, pp. 8–9. Program Planning and Analysis Branch, Health Facilities Planning and Construction Service, PHS Publication 930-F-2. Health Services and Mental Health Administration, Department of Health, Education, and Welfare, Rockville, Maryland, 1969.
6.
Illinois State Survey and Plan for the Construction of Hospitals and Medical Facilities Fiscal Year 1970, 21st Annual Revision, p. 41. Illinois Department of Public Health, 1970.
7.
New Jersey 1969 State Plan for the Construction and Modernization of Hospitals and Related Medical Facilities, p. 41. Department of Institutions and Agencies, State of New Jersey, Trenton, 1969.
8.
Obstetrical Services in Connecticut, Parts I and II, pp. 73–74. Connecticut Hospital Planning, Inc., 1970.
9.
Hospital and Health Facilities in Eastern Massachusetts, p. 38. Report by Metropolitan Area Planning Council in cooperation with Massachusetts Department of Commerce and Development. Massachusetts Department of Public Works, Massachusetts Bay Transportation Authority, August 1967.
10.
de ViséP.Methods and concepts of an interdisciplinary regional hospital study. Health Serv. Res.3(3): 166–173, 1968.
11.
de ViséP.Hospital Study Districts for Metropolitan Chicago—A Geographic Analysis and Methodology, Chap. 5. Technical Report No. 2. Hospital Planning Council for Metropolitan Chicago, Chicago, April 1966.
12.
CherniackH.SchneiderJ.A New Approach to the Delineation of Hospital Service Areas, p. 3. Discussion Paper Series No. 16. Regional Science Research Institute, Philadelphia, August 1967.
13.
Public Health Service Regulations–Part 53: Pertaining to Hospital and Medical Facilities Survey and Construction Legislation, PHS Publication No.930-A-1, Department of Health, Education, and Welfare. Government Printing Office, Washington, D. C., 1962.
14.
SchneiderJ. B.A new approach to areawide planning of metropolitan hospital systems. Hospitals42(8): 79–83, 1968.
15.
Utilization of Short–Term General and Special Hospitals in the Chicago Metropolitan Area, Calendar Year 1968, Tables 1 and 2. Hospital Planning Council for Metropolitan Chicago, Report No. 9, Chicago, April 1969.
16.
BashshurR. L.ShannonG. W.MetznerC. A.The application of three–dimensional analogue models to the distribution of medical care facilities. Med Care8(5): 395–407, 1970.
17.
BashshurR. L.ShannonG. W.MetznerC. A.Some ecological differentials in the use of medical services. Health Serv. Res.6(1): 61–75, 1971.
18.
Hospital Discharge Data Report of the Conference on Hospital Discharge Abstracts Systems. Med. Care (suppl.) 8(4), 1970.
19.
KorperS.DeshaiesJ.SikerI.New Haven Health Information System—A Case Study in Linkage of Data Files, pp. 4–5. Paper presented at American Statistical Association Meeting, Detroit, December 29, 1970.
20.
DrosnessD. L.ReedI. M.LubinJ. W.The application of computer graphics to patient origin study techniques. Public Health Rep. 80(1): 33–40, 1965.
21.
Michigan Health Survey Fourth Baseline Report Detroit City, April 23, 1969–March 31, 1970. Center for Health Statistics, Michigan Department of Public Health, Lansing, 1970.
22.
ShannonG. W.BashshurR. L.MetznerC. A.The concept of distance as a factor in accessibility and utilization of health care. Med. Care Rev. 26(2): 143–161, 1969.
23.
EaricksenR.The Spatial Behavior of Hospital Patients. Research Paper No. 124, Department of Geography, University of Chicago, Chicago, 1970.
24.
GEOMET Report No. 7106, April 17, 1970, Office of Scientific and Technical Information, National Center for Health Services Research and Development, Department of Health, Education, and Welfare, Rockville, Maryland, 1970.
25.
Estimated Need for Nursing Home and Health–Related Facilities and Services in the Six Counties of Western New York, pp. 1–2. Comprehensive Health Planning Council of Western New York, Inc., Buffalo, September 1970.
26.
LazarusS.Hospital Facilities Utilization as a Function of Patient Age, Sex and Admitting Service, Working Paper Series No. S7023, Systems Analysis Program, Graduate School of Management. University of Rochester, 1970.
27.
1969 Source Book of Health Insurance Data, p. 32. Health Insurance Institute, New York, 1970.
28.
Anderson, U., and others. High risk groups—Definition and identification. N. Engl. J. Med.273(6): 308–313, 1965.
29.
PyleG.Some Examples of Urban Medical Geography. Unpublished Master's dissertation, University of Chicago, 1968.
30.
ReesP.A Factorial Ecology of Metropolitan Chicago. Unpublished Master's dissertation, University of Chicago, 1968.
31.
WinkelsteinW.KantorS.DavisE. W.ManeriC. S.MosherW. E.The relationship of air pollution and economic status to total mortality and selected respiratory system mortality in men, Parts I and II. Arch. Environ. Health14(1): 162–171, 1967, and 16(3): 401–405, 1968.
32.
FarisR.DunhamH.Mental Disorders in Urban Areas. University of Chicago Press, 1939 (Phoenix Books edition, 1965).
33.
WhortonE.GrossP.HillD.Health Care Data for the Medical Sciences. Final Report, Contract No. HSM 110-70-38, National Center for Health Services Research and Development, Rockville, Maryland, June 1971.
34.
WeissJ. E.GreenlickM. R.Determinants of medical care utilization: The effects of social class and distance on contacts with the medical care system. Med. Care8(6): 456–462, 1970.
35.
WeissJ.GreenlickM.JonesJ.Determinants of Medical Care Utilization: The Impact of Ecological Factors. Paper presented at American Public Health Association 98th Annual Meeting, Houston, Texas, October 1970.
36.
GreenlickM. R.FreebornD. K.ColomboT. J.PrussinJ. A.SaywardE. W.Comparing the Use of Medical Care Services by a Medically Indigent and a General Membership Population in a Comprehensive Prepaid Group Practice Program. Paper presented at American Public Health Association 98th Annual Meeting, Houston, Texas, October 1970.
37.
LewisC.KeairnesH.Controlling costs of medical care by expanding insurance coverage. Study of a paradox. N. Engl. J. Med.282(25): 1405–1412, 1970.
38.
DouglassC. W.A social–psychological view of health behavior for health services research. Health Serv. Res.6(1): 6–14, 1971.
39.
GrossP. F.Poverty and health: Extrapolation from an empirical study of health services utilization in urban and rural poverty areas to the evaluation of public health strategies to raise the health levels of the poor. In preparation.
40.
BiceT. W.WhiteK. L.Factors related to the use of health services: An international comparative study. Med. Care7(2): 124–133, 1969.
41.
World Health Organization/International Collaborative Study of Medical Care Utilization, Manuals 1–9. The Coordinating Committee, Baltimore, 1970.
42.
Determination of Economic Attributes of Community Health Profiles and Health Indices. Technical Report No. 8, Community Profile Data Center, Community Health Services. Health Services and Mental Health Administration, Department of Health, Education, and Welfare, Rockville, Maryland, May 1970.
43.
BerryB.HortonF.Geographic Perspectives on Urban Systems with Integrated Readings, Chaps. 4 and 7. Prentice Hall, Englewood Cliffs, N. J., 1970.
44.
BeckmannM.Location Theory. Random House, New York, 1968.
45.
AlonsoW.Location theory. In Regional Development and Planning: A Reader, edited by FriedmannJ.AlonsoW., pp. 78–106. Massachusetts Institute of Technology Press, Cambridge, 1964.
CarrW. J.Economic efficiency in the allocation of hospital resources: Central planning versus evolutionary development. In Empirical Studies in Health Economics, edited by KlarmanH., pp. 195–221. Johns Hopkins Press, Baltimore, 1970.
48.
BeckmannM.Equilibrium Versus Optimum: Spacing of Firms and Patterns of Market Areas. Department of Economics. Brown University, Providence, April 1970.
49.
SmolenskyE.TidemanN.BurtonR.The Efficient Provision of Local Non–Private Goods. Discussion Paper No. 43, Program on Regional and Urban Economics, Harvard University, February 1969.
50.
NicholsD.SmolenskyE.TidemanT.Discrimination by waiting time in merit goods. Am. Economic Rev. 61(3): 312–323, June 1971.
51.
FeldsteinM.Hospital Cost Inflation: A Study of Nonprofit Price Dynamics. Discussion Paper No. 139, Harvard Institute of Economic Research, Harvard University, October 1970.
52.
FeldsteinP.KelmanS.An Econometric Model of the Medical Care Sector. Paper presented at the Second Conference on the Economics of Health, Baltimore, December 1968.
53.
ShepsC.MadisonD.Evaluation of Neighborhood Health Centers: A Plan For Implementation, Office of Economic Opportunity, Washington, D. C., July 1967.
54.
GrossP. F.Some determinants of development and implementation of health care technology and some lessons of the U.S. experience. Inquiry, in press.
