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Optimizing Territorial Healthcare Networks with a Capacity-Constrained Hub-And-Spoke Allocation Algorithm: The

Edoardo Trebbi1, Tommaso Barlattani2, Antony Bologna2

  • 1Department of Public Health and Infectious Diseases, "La Sapienza" University of Rome, 00100 Rome, Italy.

Healthcare (Basel, Switzerland)
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PubMed
Summary

This study presents a data-driven framework for designing healthcare networks in mountainous regions, balancing travel times and population limits. The model helps optimize community-based healthcare access, addressing geographic disparities.

Keywords:
ItalyMinisterial Decree 77/2022capacity constraintscommunity health serviceshub-and-spoke modellocation allocationspatial equityterritorial health planningtravel-time accessibility

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Area of Science:

  • Healthcare Management
  • Geographic Information Systems (GIS)
  • Public Health Policy

Background:

  • Geographic and demographic factors significantly impact healthcare access, particularly in rural and mountainous areas.
  • Ministerial Decree 77/2022 in Italy aims to reorganize healthcare territorially using networked models.
  • Limited practical tools exist for translating policy into operational healthcare catchment areas.

Purpose of the Study:

  • To develop a data-driven framework for territorial healthcare planning in complex geographic settings.
  • To create operational catchment areas based on travel-time accessibility and population capacity.
  • To analyze trade-offs between accessibility and capacity compliance in hub-and-spoke network design.

Main Methods:

  • A transparent allocation framework was developed using travel-time accessibility and population capacity constraints.
  • A case study was conducted in Italy's Province of L'Aquila, a mountainous area with 65 municipalities.
  • Official ISTAT data and a national travel-time matrix were used, applying population caps and scenario analyses with varying travel-time thresholds (20, 30, 40 min).

Main Results:

  • Under a 30-minute travel-time threshold, one hub exceeded its population capacity, requiring adjustments that increased travel times.
  • A 20-minute threshold left 11 mountainous municipalities unallocated.
  • A 40-minute threshold allocated all municipalities without capacity violations.

Conclusions:

  • The proposed framework offers a reproducible method for territorial healthcare planning.
  • It highlights the inherent trade-offs between accessibility and capacity in designing healthcare networks.
  • The approach is particularly relevant for geographically challenging mountain settings.