The geographical assignment of cancer units: patient accessibility as an optimal allocation problem.
The seminal report A Policy Framework for Commissioning Cancer Services provides the foundation for a major reorganisation of cancer service provision in England and Wales. One central recommendation of the report, the establishment of a tier of specialised cancer units in each Health Authority Region has raised the fundamental question of where those units are to be located. In particular, a declared objective of the report is for services to be planned to maximise their accessibility to patients. This paper demonstrates a classical method (location-allocation modelling) by which the accessibility criterion can be used to determine the optimal number, location and capacity of units for a given cancer site. The method is illustrated with reference to cervical cancer in Trent Health Authority Region. The implications of the method for the guidance of access-related decisions on the placement of cancer services are considered, and the wider relevance of the method to the organisation of service provision in other branches of medicine is suggested.
Smallman-Raynor
M R
MR
Department of Geography, University of Nottingham, University Park, Nottingham, UK.
Muir
K R
KR
Smith
S J
SJ
D000465:Algorithms; D002173:Cancer Care Facilities / Q000458:organization & administration*; D004739:England; D005260:Female; D015276:Health Care Rationing / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006752:Hospital Planning / Q000458:organization & administration*; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D015233:Models, Statistical; D014186:Transportation; D002583:Uterine Cervical Neoplasms / Q000628:therapy*