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

L D Mayhew and G Leonardi

Environment and Planning A, 1982, vol. 14, issue 11, 1479-1507

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.

Date: 1982
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Persistent link: https://EconPapers.repec.org/RePEc:sae:envira:v:14:y:1982:i:11:p:1479-1507

DOI: 10.1068/a141479

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