Equitable distribution of neonatal intensive care unit: a healthcare planning case study

Document Type : Research Paper


1 Department of Industrial Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran

2 Department of Healthcare Systems Engineering, Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran

3 Department of Industrial Engineering, Science and Research branch, Islamic Azad University, Tehran, Iran

4 Department of Pediatrics, Tabriz University of Medical Sciences, Tabriz, Iran


Background and objectives: The regionalization is a suitable approach to reduce the cost of health services and to increase the number of patients covered by special services. Since the establishment of the Neonatal Intensive Care Unit (NICU) needs expensive equipment and experts, it is critical to find the optimal number and location for NICU beds and referral networks.
Methods: The geographical access to NICU beds was investigated by collecting the annual demand and the distance between cities at first. The demand consisted of the number of neonates that were born under 32 weeks of gestational age or having less than 1500 gram birth weight in one province of Iran. Next, the location of the available hospital has defined on the map. A maximizing coverage model was developed to find the optimal location for NICUs by ArcMap software. Scenarios of reducing NICU centers were built to simulate real situations for policymakers. Coverage and average traveled distances were then calculated for each scenario. The results were compared with the natural journey of pregnant women and the available distribution of resources in the province.
Results: The results revealed that reducing the number of NICU centers has had no direct impact on average traveled distance. A comparison of the optimal result with the natural journey of pregnant women represented a long distance traveled. The data also showed that 64% of neonates were born outside of their residential cities, and 31% of them were born outside of their provinces, although the occupation rate of available NICU was less than 50% on average.
Conclusion: The effect of reducing NICU centers on total coverage and average transportation was studied in this paper. The proposed methodology with the objective of equity in access can be used as a referral model to other resource allocation cases in health care.