Two‐tier healthcare service systems and cost of waiting for patients

Waiting has been a significant concern for healthcare services. We address this issue in the context of a two‐tier service system in this study. A two‐tier healthcare service system consists of two different service providers, typically one public service provider and one private service provider. In a baseline model, the two service providers are modeled by two queue servers, which charge each patient a common fixed fee for the service. Then, we study a queue model in which one service provider offers a subsidy or charges a premium while the other maintains the fixed service fee. This system provides a mechanism to segment patients along their waiting time cost through price discrimination. We analyze the problem from both the perspective of minimizing total waiting cost for all patients and the perspective of maximizing social gain for the public service provider or profit for the private service provider. We show that this model can significantly alleviate the burden of waiting for patients. The study addresses the design, the efficiency, and the implementation of two‐tier healthcare service systems. Copyright © 2017 John Wiley & Sons, Ltd.     

Incorporating congestion in preventive healthcare facility network design

Preventive healthcare aims at reducing the likelihood and severity of potentially life-threatening illnesses by protection and early detection. The level of participation to preventive healthcare programs is a crucial factor in terms of their effectiveness and efficiency. This paper provides a methodology for designing a network of preventive healthcare facilities so as to maximize participation. The number of facilities to be established and the location of each facility are the main determinants of the configuration of a healthcare facility network. We use the total (travel, waiting and service) time required for receiving the preventive service as a proxy for accessibility of a healthcare facility, and assume that each client would seek the services of the facility with minimum expected total time. At each facility, which we model as an M/M/1 queue so as to capture the level of congestion, the expected number of participants from each population zone decreases with the expected total time. In order to ensure service quality, the facilities cannot be operated unless their level of activity exceeds a minimum workload requirement. The arising mathematical formulation is highly nonlinear, and hence we provide a heuristic solution framework for this problem. Four heuristics are compared in terms of accuracy and computational requirements. The most efficient heuristic is utilized in solving a real life problem that involves the breast cancer screening center network in Montreal. In the context of this case, we found out that centralizing the total system capacity at the locations preferred by clients is a more effective strategy than decentralization by the use of a larger number of smaller facilities. We also show that the proposed methodology can be used in making the investment trade-off between expanding the total system capacity and changing the behavior of potential clients toward preventive healthcare programs by advertisement and education.     

Introducing competition in healthcare services: The role of private care and increased patient mobility

We study the operational implications from competition in the provision of healthcare services, in the context of national public healthcare systems in Europe. Specifically, we study the potential impact of two alternative ways through which policy makers have introduced such competition: (i) via the introduction of private hospitals to operate alongside public hospitals and (ii) via the introduction of increased patient choice to grant European patients the freedom to choose the country they receive treatment at. We use a game-theoretic framework with a queueing component to capture the interactions among the patients, the hospitals and the healthcare funders. Specifically, we analyze two different sequential games and obtain closed form expressions for the patients’ waiting time and the funders’ reimbursement cost in equilibrium. We show that the presence of a private provider can be beneficial to the public system: the patients’ waiting time will decrease and the funders’ cost can decrease under certain conditions. Also, we show that the cross-border healthcare policy, which increases patient mobility, can also be beneficial to the public systems: when welfare requirements across countries are sufficiently close, all funders can reduce their costs without increasing the patients’ waiting time. Our analysis implies that in border regions, where the cost of crossing the border is low, “outsourcing” the high-cost country’s elective care services to the low-cost country is a viable strategy from which both countries’ systems can benefit.     

Repeated congestion games with bounded rationality

We consider a repeated congestion game with imperfect monitoring. At each stage, each player chooses to use some facilities and pays a cost that increases with the congestion. Two versions of the model are examined: a public monitoring setting where agents observe the cost of each available facility, and a private monitoring one where players observe only the cost of the facilities they use. A partial folk theorem holds: a Pareto-optimal outcome may result from selfish behavior and be sustained by a belief-free equilibrium of the repeated game. We prove this result assuming that players use strategies of bounded complexity and we estimate the strategic complexity needed to achieve efficiency. It is shown that, under some conditions on the number of players and the structure of the game, this complexity is very small even under private monitoring. The case of network routing games is examined in detail.     

城市消防站点布局的改进启发式算法

面对数量较多需要及时处理的突发事故,为了满足最短应急时间限制,最低应急资源数和最少的出救点等目标,在城市规划决策中,考虑在一个确定应急限制期下的安全消防站选址问题,给出一个反映决策者对时间和费用偏好的折衷选址方案十分必要.从实际应用出发,运用改进启发式算法方法研究时间与资源限制条件下的多出救点组合模型求解问题.给出了应急限制期和安全消防设施点建立的费用模型,从理论上证明了模型求解方法的正确性.在给定限制期条件下,通过分析得出应急服务设施点选择方法.通过算例说明该计算方法的具体应用,为交通安全消防站点选择提供参考,该方法还适用于诸如医院急救站等类似公共设施的规划建设.     

A multicriteria approach to the location of public facilities

We argue that practical problems involving the location of public facilities are really multicriteria problems, and ought to be modeled as much. The general criteria are those of cost and service, but there exist several distinct criteria in each of those two categories. For the first category, fixed investment cost, fixed operating cost, variable operating cost, total operating cost, and total discounted cost are all reasonable criteria to consider. In terms of service, both demand served and response time (or distance traveled) are appropriate criteria, either agglomerated or considered on the basis of the individual clients. In this paper we treat such multicriteria questions in the framework of a model for selecting a subset of M sites at which to establish public facilities in order to serve client groups located at N distinct points. We show that for some combinations of specific criteria, parametric solutions of a generalized assignment problem (GAP) will yield all efficient solution. In most other cases the efficient solutions can be found through parametric solution of a GAP with additional constraints of a type which can be incorporated into an existing algorithm for the GAP. Rather than attempting to find all efficient solutions, however, we advocate an interactive approach to the resolution of multicriteria location problems and elaborate on a specific interactive algorithm for multicriteria optimization which for the present model solves a finite sequence of GAP's or GAP-type problems. Finally, some similar aspects of private sector location problems are discussed.     

Bicriteria efficiency/equity hierarchical location models for public service application

As is often the case in healthcare provision, public services may offer facilities at a hierarchy of levels in different locations, ranging from basic to specialised levels of care. In addition to efficiency objectives, with public services there is the concern of equity of provision when locating new facilities. We present, as a tool-kit for decision makers, a range of discrete hierarchical location models with bicriteria efficiency/equity objectives. These models are for use in location of facilities within hierarchical systems where a fair but efficient hierarchical service is sought. The hierarchical models have as efficiency criteria both p-median and maximal-covering types. These components are combined in a novel manner with appropriate equity objectives to give decision makers a range of choices of scenarios. We illustrate use of the models in a healthcare setting.     

A branch and bound algorithm for determining locations of long-term care facilities

This paper focuses on the problem of determining locations for long-term care facilities with the objective of balancing the numbers of patients assigned to the facilities. We present a branch and bound algorithm by developing dominance properties, a lower bounding scheme and a heuristic algorithm for obtaining an upper bound for the problem. For evaluation of the suggested branch and bound algorithm, computational experiments are performed on a number of test problems. Results of the experiments show that the suggested algorithm gives optimal solutions of problems of practical sizes in a reasonable amount of computation time.     

Scheduling healthcare services in a home healthcare system

We consider a scheduling problem in a home healthcare system in which nurses visit patients regularly for relatively minor healthcare services. Intervals between the visits may differ for different patients. On each day in the planning horizon, a nurse must visit the patients assigned to her/him on that day, and then return to the hospital. For the problem of determining the visiting schedule with the objective of minimizing total travel time of the nurse over the planning horizon, we develop a two-phase heuristic algorithm. To evaluate performance of the proposed algorithm, a series of computational tests is performed on a number of randomly generated problem instances and a real instance. Results of the tests show that the heuristic algorithm gives near optimal solutions for problems of practical sizes in a reasonable time.     

Uniform pricing and subsidy coordination mechanism in a two-tier healthcare system under a co-payment policy

Recently, the lengthy waiting time in public hospitals (called the public system) under the free healthcare policy has become a serious problem. To address this issue, motivated by the Japanese healthcare system, this paper investigates a two-tier co-payment healthcare system under a uniform pricing and subsidy coordination mechanism. In such a setting, the public system and the private system (i.e., the private hospitals) compete for market share with different objectives, whereas the government uniformly sets the service price and the subsidy rate to maximize social welfare under a total budget constraint. Compared with two free healthcare policy cases implemented in the Canadian and Australian healthcare systems respectively in terms of social welfare, the results show that when the market demand (or the patient service quality sensitivity) is sufficiently high (sufficiently low), the uniform pricing and subsidy coordination mechanism is better and worse otherwise; and when the patient's waiting sensitivity (or the total government budget) is in an appropriate middle range (sufficiently low or high), the mechanism can outperform than the free policy cases.     

p-Hub approach for the optimal park-and-ride facility location problem

Park and Ride facilities (P&R) are car parks at which users can transfer to public transportation to reach their final destination. We propose a mixed linear programming formulation to determine the location of a fixed number of P&R facilities so that their usage is maximized. The facilities are modeled as hubs. Commuters can use one of the P&R facilities or choose to travel by car to their destinations, and their behavior follows a logit model. We apply a p-hub approach considering that users incur in a known generalized cost of using each P&R facility as input for the logit model. For small instances of the problem, we propose a novel linearization of the logit model, which allows transforming the binary nonlinear programming problem into a mixed linear programming formulation. A modification of the Heuristic Concentration Integer (HCI) procedure is applied to solve larger instances of the problem. Numerical experiments are performed, including a case in Queens, NY. Further research is proposed.     

A facility location model with safety stock costs: analysis of the cost of single-sourcing requirements

We consider a supply chain setting where multiple uncapacitated facilities serve a set of customers with a single product. The majority of literature on such problems requires assigning all of any given customer??s demand to a single facility. While this single-sourcing strategy is optimal under linear (or concave) cost structures, it will often be suboptimal under the nonlinear costs that arise in the presence of safety stock costs. Our primary goal is to characterize the incremental costs that result from a single-sourcing strategy. We propose a general model that uses a cardinality constraint on the number of supply facilities that may serve a customer. The result is a complex mixed-integer nonlinear programming problem. We provide a generalized Benders decomposition algorithm for the case in which a customer??s demand may be split among an arbitrary number of supply facilities. The Benders subproblem takes the form of an uncapacitated, nonlinear transportation problem, a relevant and interesting problem in its own right. We provide analysis and insight on this subproblem, which allows us to devise a hybrid algorithm based on an outer approximation of this subproblem to accelerate the generalized Benders decomposition algorithm. We also provide computational results for the general model that permit characterizing the costs that arise from a single-sourcing strategy.     

A capacitated competitive facility location problem

We consider a mathematical model similar in a sense to competitive location problems. There are two competing parties that sequentially open their facilities aiming to “capture” customers and maximize profit. In our model, we assume that facilities’ capacities are bounded. The model is formulated as a bilevel integer mathematical program, and we study the problem of obtaining its optimal (cooperative) solution. It is shown that the problem can be reformulated as that of maximization of a pseudo-Boolean function with the number of arguments equal to the number of places available for facility opening. We propose an algorithm for calculating an upper bound for values that the function takes on subsets which are specified by partial (0, 1)-vectors.     

Balancing U-lines in a multiple U-line facility

U-shaped production lines and facilities consisting of many such lines are important parts of modem manufacturing systems. The problem of balancing and rebalancing U-line facilities is studied in this paper. Like the traditional line balancing problem this problem is NP-hard. The objective is to assign tasks to a minimum number of regular, crossover, and multiline stations while satisfying cycle time, precedence, location, and station-type constraints. A secondary objective is to concentrate the idle time in one station so that improvement efforts can be focused there in accordance with modern just-in-time principles. A reaching dynamic programming algorithm is presented for determining optimal balances. It is effective for balancing and rebalancing facilities with any number of U-lines, provided that individual U-lines do not have more than 22 tasks and do not have wide, sparse precedence graphs.     

Optimal location of public health centres which provide free and paid services

A model and a heuristic are presented for finding the most effective location of public health centres providing non-vital services in competition with existing private health centres. While private centres provide only services to customers who can pay for them, public centres provide both paid services to affluent customers, and subsidised services to customers belonging to low-income groups (a hierarchical structure). While low-income customers are assigned to fixed public centres, high-income customers can choose which centre to patronise. To find the solution of this problem, the equilibrium between maximum coverage of low-income population (within a pre-specified distance), and an adequate capture of high-income population must be found. Thus, in the public service, the revenues obtained from paid services are used to partly cover the costs of the subsidised services, and the number of centres that can be located depends on how many high-income clients can be captured. Capture of a high-income client happens when a public centre is located closer to the client than any of the existing private centres. Computational experience with optimal, as well as special heuristic, methods for solving this problem is described.     

An improved Benders decomposition algorithm for the logistics facility location problem with capacity expansions

We investigate a logistics facility location problem to determine whether the existing facilities remain open or not, what the expansion size of the open facilities should be and which potential facilities should be selected. The problem is formulated as a mixed integer linear programming model (MILP) with the objective to minimize the sum of the savings from closing the existing facilities, the expansion costs, the fixed setup costs, the facility operating costs and the transportation costs. The structure of the model motivates us to solve the problem using Benders decomposition algorithm. Three groups of valid inequalities are derived to improve the lower bounds obtained by the Benders master problem. By separating the primal Benders subproblem, different types of disaggregated cuts of the primal Benders cut are constructed in each iteration. A high density Pareto cut generation method is proposed to accelerate the convergence by lifting Pareto-optimal cuts. Computational experiments show that the combination of all the valid inequalities can improve the lower bounds significantly. By alternately applying the high density Pareto cut generation method based on the best disaggregated cuts, the improved Benders decomposition algorithm is advantageous in decreasing the total number of iterations and CPU time when compared to the standard Benders algorithm and optimization solver CPLEX, especially for large-scale instances.     

The multi-facility min-max Weber problem

An algorithm is presented to solve the problem of the locating a given number of facilities on the plane amongst given customers so that the maximum weighted distance from any facility to the customers it services is minimised. The algorithm successfully overcomes the allocation aspects of this problem by generating partitions of customers using a method originally designed for graph colouring embedded within a modified bisection search. Problems of 50 customers and three facilities can be solved in entirely acceptable computer times.     

A decomposition approach for facility location and relocation problem with uncertain number of future facilities

In this paper, we discuss two challenges of long term facility location problem that occur simultaneously; future demand change and uncertain number of future facilities. We introduce a mathematical model that minimizes the initial and expected future weighted travel distance of customers. Our model allows relocation for the future instances by closing some of the facilities that were located initially and opening new ones, without exceeding a given budget. We present an integer programming formulation of the problem and develop a decomposition algorithm that can produce near optimal solutions in a fast manner. We compare the performance of our mathematical model against another method adapted from the literature and perform sensitivity analysis. We present numerical results that compare the performance of the proposed decomposition algorithm against the exact algorithm for the problem.     

带惩罚的容错设施布局问题的近似算法

在带惩罚的容错设施布局问题中, 给定顾客集合、地址集合、以及每个顾客和各个地址之间的连接费用, 这里假设连接费用是可度量的. 每位顾客有各自的服务需求, 每个地址可以开设任意多个设施, 顾客可以被安排连接到某些地址的一些开设的设施上以满足其需求, 也可以被拒绝, 但这时要支付拒绝该顾客所带来的惩罚费用. 目标是确定哪些顾客的服务需求被拒绝并开设一些设施, 将未被拒绝的顾客连接到不同的开设设施上, 使得开设费用、连接费用和惩罚费用总和最小. 给出了带惩罚的容错设施布局问题的线性整数规划及其对偶规划, 进一步, 给出了基于其线性规划和对偶规划舍入的4-近似算法.     

基于演化博弈的公共交通、共享汽车与私家车的博弈分析

出行者的选择行为分析是交通系统中的一项重要内容,随着城市的发展,交通出行方式大体分为三大类:公共交通出行、辅助公共交通出行和私人交通出行。本文在以往的研究基础上,采用演化博弈的方法研究公共交通、共享汽车以及私家车三者之间的博弈关系,模拟出行者的选择行为,分析博弈均衡点稳定性及参数条件。通过模型仿真实验,演化结果中各项比例大小取决于各项收益、补贴、损失以及额外收益,要增加公共交通的配套设施,增收拥堵费以及增加对共享汽车的补贴及配套服务。