title: A new approach to the tradeoff between quality and accessibility of health care.
abstract: BACKGROUND
  Quality of care is associated with patient volume. Regionalization of care is therefore one of the approaches that is suited to improve quality of care. A disadvantage of regionalization is that the accessibility of the facilities can decrease. By investigating the tradeoff between quality and accessibility it is possible to determine the optimal amount of treatment locations in a health care system. In this article we present a new model to quantitatively 'solve' this tradeoff. We use the condition breast cancer in the Netherlands as an example.
  
  
  METHODS
  We calculated the expected quality gains in Quality Adjusted Lifetime Years (QALY's) due to stepwise regionalization using 'volume-outcome' literature for breast cancer. Decreased accessibility was operationalized as increased (travel) costs due to regionalization by using demographic data, drive-time information, and the national median income. The total sum of the quality and accessibility function determines the optimum range of treatment locations for this particular condition, given the 'volume-quality' relationship and Dutch demographics and geography.
  
  
  RESULTS
  Currently, 94 locations offer breast cancer treatment in the Netherlands. Our model estimates that the optimum range of treatment locations for this particular condition in the Netherlands varies from 15 locations to 44 locations.
  
  
  CONCLUSIONS
  Our study shows that the Dutch society would benefit from regionalization of breast cancer care as possible quality gains outweigh heightened travel costs. In addition, this model can be used for other medical conditions and in other countries.
authors.affiliation: KPMG Plexus, Straatweg 68, 3621 BR Breukelen, The Netherlands. tanke.marit@kpmgplexus.nl
authors.forename: Marit A C
authors.initials: MA
authors.lastname: Tanke
authors.forename: David E
authors.initials: DE
authors.lastname: Ikkersheim
mesh_terms: D001943:Breast Neoplasms / Q000191:economics / Q000401:mortality / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D006801:Humans; D017146:Models, Organizational; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D058996:Quality Improvement; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D019057:Quality-Adjusted Life Years; D014195:Travel / Q000191:economics