Forecasting acute-care hospital beds using intra-regional transfers

Governments in this country have a mandate from their electorate to obtain the best social return from public investment in health care. Because of escalating capital and operating costs, the acute-care-hospital component of health care has recently come under close scrutiny. Accordingly, governments must forecast public demands for hospital services in order to plan the most effective and efficient delivery of these expensive hospital services. This thesis examines the British Columbia Ministry of Health's current method of forecasting acute-care-bed requirements which has been applied to the Greater Vancouver Regional Hospital District (G.V.R.H.D.) and then proposes an improved method which accounts for the movement of hospital patients from their district of residence to a district providing hospital services. A computer forecasting program was designed using the Provincial forecasting method as a base with the addition of a Transfer Matrix that distributes the acute-care patient-days generated by each of the G.V.R.H.D districts to those districts that provide hospital services. With this addition, the computer forecasting program better reflects the G.V.R.H.D.'s current source and distribution of the demand for hospital service. The computer forecasting program was verified by comparing its Standard Forecast to a manually calculated forecast. The program was then used firstly to analyse the sensitivity of the forecast of Hospital-Bed Requirements to changes in the values of the Population and Incidence Rate variables, and secondly, to analyse the effects of alternate policies regarding the input values of the program's variables. Firstly, the sensitivity analysis showed that if certain equal changes are made to the values of input variables, the sensitivity of the output forecast can vary among the districts. This aspect of the forecast enhances the value of the program as a method of analysing unexpected relationships. Secondly, the policy analysis showed that the computerized forecasting program can quickly produce alternate forecasts that correspond to alternate policies regarding the values selected for the program's variables. The policy-maker can then analyse the effects of these policies and thus be in a better position to weigh the costs and the benefits involved. For these reasons, the computer forecasting program developed for this thesis is an improvement over the current method used in British Columbia. However, the thesis does describe other current techniques that can, and should, now be incorporated into the computer forecasting program to offer more flexibility when analysing the effects of possible future conditions.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat