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This paper presents the redesign of a network of health providing facilities, as far as geographical location and allocation of service levels are concerned. A novel methodology which integrates system dynamics (SD) and mathematical programming is used. Simulations of SD models of different patients-facilities system configurations provide forecasting scenarios for demand, which are then supplied as input to a stochastic facility location model formulated as a two-stage process. The first stage determines the strategic decisions concerning the range and type of services that every health centre should provide, while the second stage, which is scenario dependent, assigns patients to health centres. The proposed methodology allows experimentation with different system structures to gain a robust understanding of patient flows and facility service dynamics over the entire planning horizon. The methodology was applied in the (re)location of health services in a network of 32 primary care health centres and 13 hospitals in Southern Greece.

Redesigning a network of primary healthcare centres using system dynamics simulation and optimisation