International Journal for Equity in Health (Nov 2023)

Optimal allocation of physicians improves accessibility and workload disparities in stroke care

  • Kazuki Ohashi,
  • Toshiya Osanai,
  • Kyohei Bando,
  • Kensuke Fujiwara,
  • Takumi Tanikawa,
  • Yuji Tani,
  • Soichiro Takamiya,
  • Hirotaka Sato,
  • Yasuhiro Morii,
  • Tomoki Ishikawa,
  • Katsuhiko Ogasawara

DOI
https://doi.org/10.1186/s12939-023-02036-9
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Background Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload. Methods This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists. Results The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities. Conclusions The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.

Keywords