Planning maternity care

Abstract

This thesis demonstrates the potential of 'inverse-programming' - a technique adapted from linear-programming - as an aid to planning the provision of medical care services for the next three to five years. In order to minimise the definition and measurement problems inherent in all economic analyses of medical care, maternity services provided within Sunderland County Borough were used in the investigation as a simplified version of a health service. It is suggested that the next stage will be to apply the technique to ‘Area Health Board’ planning. Chapter 1 provides a background picture of the present pattern of providing maternity care in England and Wales, and Sunderland County Borough; and Chapter 2 goes on to examine certain factors associated with the quality of maternity care services in terms of mortality rates and the use made of the available services. Chapter 3 introduces the basic ideas of 'inverse-programming' and describes a model of a hypothetical maternity hospital providing only two services. It shows how the trade-offs implicit in the decisions taken by administrators can be made explicit by using the observed production technology and activity levels to predict the range of weights defined by the slopes of those resource constraints which are limiting further expansion. First approximations of these relative benefits were derived from short-run unit costs. These ideas are then employed in Chapter 4 for the planning of Sunderland County Borough's maternity services - first as a descriptive tool to make the administrators' estimates of relative benefit explicit, and then as a means of simulating changes, suggested by Chapter 2, in resource levels, the technology, and in planners' priorities.