ISBN 9783843948951

978-3-8439-4895-1, Reihe Mathematik

Martin Comis
Robust Primary Care Systems

247 Seiten, Dissertation Rheinisch-Westfälische Technische Hochschule Aachen (2021), Hardcover, A5

Zusammenfassung / Abstract

Primary care systems are the backbone of universal health care. As the population ages and the number of primary care physicians declines, this foundation is starting to crumble. There result increasing access distances, waiting times, and workloads up to the point where the system's functioning can no longer be guaranteed. To counteract these developments, representatives from the government, insurances, and associations discuss an array of novel supply concepts and policy changes. This thesis aims to advance this discussion by providing suitable decision support tools, algorithms, and theoretic results. Special attention is thereby put on rural primary care systems, as these are particularly vulnerable due to their geographic-demographic facts. The resulting contributions can be categorized into three main groups and we summarize them hereinafter.

The first part of this thesis introduces the hybrid agent-based simulation model SiM-Care to quantify the quality of primary care systems. Sim-Care tracks the micro-interactions of patients and primary care physicians on an individual level and thereby enables decision makers to access several performance indicators such as patient waiting times and physician utilization.

The second part of this thesis examines mobile medical units (MMUs) for the supply of primary care services in rural environments. MMUs necessitate a complex prelaunch strategy to ensure their effectiveness and sustainability. To devise such strategies, this thesis contributes an integrated multi-phased optimization framework that considers two types of uncertain patient demands.

The third part of this thesis studies two matching problems that derive from the application of MMUs in primary care. It is shown that very restricted variants of these matching problems are already strongly NP-hard. Consequently, this thesis focuses on restricted graph classes and contributes a range of polynomial and pseudo-polynomial algorithms.