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. 2019 Apr 24;19(1):245.
doi: 10.1186/s12913-019-4016-2.

Economic efficiency versus accessibility: Planning of the hospital landscape in rural regions using a linear model on the example of paediatric and obstetric wards in the northeast of Germany

Neeltje van den Berg  1 , Franziska Radicke  2 , Ulrike Stentzel  2 , Wolfgang Hoffmann  2 , Steffen Flessa  3
Affiliations

Economic efficiency versus accessibility: Planning of the hospital landscape in rural regions using a linear model on the example of paediatric and obstetric wards in the northeast of Germany

Neeltje van den Berg et al. BMC Health Serv Res. .

Abstract

Background: Costs for the provision of regional hospital care depend, among other things, on the population density and the maximum reasonable distance to the nearest hospital. In regions with a low population density, it is a challenge to plan the number and location of hospitals with respect both to economic efficiency and to the availability of hospital care close to residential areas. We examined whether the hospital landscape in rural regions can be planned on the basis of a regional economic model using the example which number of paediatric and obstetric wards in a region in the Northeast of Germany is economically efficient and what would be the consequences for the accessibility when one or more of the three current locations would be closed.

Methods: A model of linear programming was developed to estimate the costs and revenues under different scenarios with up to three hospitals with both a paediatric and an obstetric ward in the investigation region. To calculate accessibility of the wards, geographic analyses were conducted.

Results: With three hospitals in the study region, there is a financial gap of €3.6 million. To get a positive contribution margin for all three hospitals, more cases have to be treated than the region can deliver. Closing hospitals in the parts of the region with the smallest population density would lead to reduced accessibility for about 8% of the population under risk.

Conclusions: Quantitative modelling of the costs of regional hospital care provides a basis for planning. A qualitative discussion to the locations of the remaining departments and the implementation of alternative healthcare concepts should follow.

Keywords: Care close to residence; Economic efficiency; Linear model, paediatric wards, obstetric wards; Regional hospital planning.

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Figures

Fig. 1
Fig. 1
Hospital costs per inhabitant depending on maximum distance to the nearest hospital [4]
Fig. 2
Fig. 2
Catchment areas of the hospitals with paediatric and obstetric ward based on car driving time and associated number of inhabitants
Fig. 3
Fig. 3
Accessibility by car to the hospitals with pediatric and obstetric wards in different settings: a Preserving the wards in Greifswald and Anklam; b Preserving the wards in Greifswald and Wolgast; c Concentration in one remaining hospital in Greifswald
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