Building a tool to support the planning of long-term care networks under complexity: dealing with multiple objectives, uncertainty and policy strategies
Teresa Cardoso-Grilo | Centre for Management Studies of Instituto Superior Técnico
Multiple economic, demographic, epidemiologic and social changes are currently affecting European countries, posing extra challenges to the health care sector in general, and to the delivery of formal and informal Long-Term Care (LTC) in particular. Accordingly, policy-makers need to ensure that networks of LTC are responsive to population ageing and to an increasing prevalence of chronic diseases, as well as to make sure that scarce resources are adequately spent in LTC and that many policy objectives in the sector are pursued. This requires proper planning of LTC resources, which is specifically relevant for countries based on a National Health Service (NHS) that have been facing annual reductions in public health care spending. Planning of networks of LTC services is however a complex task, since the delivery of care is multi-service (comprising a combination of institutional, home-based and ambulatory services) and it is affected by health policies outside the LTC sector. Additionally, it is subject to uncertainty associated with the demand and the supply of care, and multiple objectives are to be attained by the delivery of care. Within this context, this study aims at building a comprehensive tool to aid policy-makers and health care planners making informed decisions on how to plan a network of LTC services under such a complex environment.
A planning tool based on optimization models is then developed so as to inform the planning of multi-service networks of LTC in the medium term, in terms of where to locate LTC services, how to plan capacities and to which patients deliver services. The tool is comprehensive by modelling the extent to which a LTC network accomplishes multiple, and often conflicting, policy objectives that are typically relevant for planners in the LTC sector, such as the maximization of health and wellbeing, the maximization of equity objectives (including equity of access, socioeconomic equity, geographical equity and equity of utilization), and the minimization of costs. The developed tool also considers how uncertainty in the demand and the delivery of care (forinstance, in the number of individuals needing care and in the length of stay of institutional services) and policy strategies outside the LTC sector (for instance, opting for institutionalized or community-based models of care) may influence the network of LTC services. Depending on the user of the tool: different objectives may be selected, the relative importance of these objectives may be defined; and alternative policy strategies may be set.
The applicability of the proposed tool is illustrated with a case study in the Great Lisbon region in Portugal, where a National Health Service (NHS) is in place. The obtained results allow for multiple analysis with the help of visual aids, including i) how and when to dimension existing and new services when different objectives are set, ii) which equity, health and wellbeing improvements can be obtained, and at which costs, and iii) how cost-effective may be different configurations of networks of care.