Optimize Healthcare Performance Assignment

Despite spending more per capita on medical care than any other nation, the United States ranks behind other industrialized nations in key health performance measures (World Health Organization 2000). One major factor is the deep disparities in access to care and health outcomes. Maldistribution of the health care workforce leads to the “shortages amid surplus paradox” (Hart et al. 2002, 212). Disparities between races and between the haves and have-nots in health insurance lead to more than 100,000 excessive deaths each year (Physicians for Social Responsibility 2009). Enactment of the Patient Protection and Affordable Care Act will have enormous implications for the supply and distribution of health care providers and provide great opportunities for researchers, including geographers, on related issues.

The U.S. Department of Health and Human Services (DHHS) has implemented various programs including the designations of Medically Underserved Areas/Populations (MUA/P) and Health Professional Shortage Areas (HPSAs) for improving access to health care services for the underserved. The effectiveness of such programs relies on appropriate and accurate measures of accessibility so that resources can be allocated to the neediest areas. Recent advancements in this area have benefited from spatial analysis supported by geographic information systems (GIS) technologies. Many new methods have been developed to improve health care accessibility measures. These methods need to be integrated into one framework to reveal the connection among them and compare their advantages and weaknesses.

Most work uses optimization methods to site health care facilities to maximize service coverage, minimize travel needs of patients, limit the number of facilities, maximize health, or combine some of these goals. Equity in health and health care is widely accepted as an important goal of public policy. Among a diverse set of principles of equity, equal access to health care (for those in equal need) is considered the most appropriate principle for health care policymakers to pursue. Minimizing inequality in health care accessibility helps to identify the adjustments needed to close the gaps.

Inequality in health care access comes at a personal and societal price, evidenced in disparities in various health outcomes. Outcomes include differential rates in infant mortality and birth weight, vaccination, complications from preventive and common diseases, late-stage cancer diagnosis, and quality patient care and survival, among others. Cancer stage (based on tumor size and invasion) at the time of diagnosis plays a critical role in determining the prognosis of patients. This article uses the risk factors of late-stage cancer diagnosis as an example to examine the relationship between health access and outcomes.

This review surveys recent literature on these three closely linked issues with emphasis on methodological advancements. Due to limited space, only representative or the most recent literature is cited on an issue of discussion. The article attempts to synthesize related methods in existing work and identify room for improvements for future studies……..