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AN AGENT-BASED ANALYSIS APPROACH TO RESOURCE ALLOCATION IN THE DUTCH YOUTH HEALTH CARE SYSTEM

AN AGENT-BASED ANALYSIS APPROACH TO RESOURCE ALLOCATION IN THE DUTCH YOUTH HEALTH CARE SYSTEM. Erik Giesen 1 , Wolfgang Ketter 2 , Rob Zuidwijk 2 1 INITI8, 2 Erasmus University Rotterdam, 14-12-2009. NEWSLINES. Rouvoet admits; waiting lists stay (NRC Handelsblad, 30 October 2009)

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AN AGENT-BASED ANALYSIS APPROACH TO RESOURCE ALLOCATION IN THE DUTCH YOUTH HEALTH CARE SYSTEM

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  1. AN AGENT-BASED ANALYSIS APPROACH TO RESOURCE ALLOCATION IN THE DUTCH YOUTH HEALTH CARE SYSTEM Erik Giesen1, Wolfgang Ketter2, Rob Zuidwijk2 1INITI8, 2Erasmus University Rotterdam, 14-12-2009

  2. NEWSLINES • Rouvoet admits; waiting lists stay (NRC Handelsblad, 30 October 2009) • Youth health care is eight million short (Parool, 6 November 2009) • Gelderland spends 150 million on youth health care in 2010 (Locourant.nl, 25 November 2009) • New youth health care farm opens with waiting list (PZC, 12 November 2009) An agent-based analysis approach to resource allocation in the Dutch youth health care system

  3. CONTEXT Care provider A Care provider A Care provider A Care provider B Care provider B Care provider B Care provider C Care provider C Care provider C Care provider D Care provider D Care provider D Province Province Province Institution for youth health care Institution for youth health care Institution for youth health care € € € € € € Government € € € An agent-based analysis approach to resource allocation in the Dutch youth health care system

  4. CONTEXT MOTIVATION: • Lack of scientific research for resource allocation in health care taking into account the rich level of complexity in waiting line behavior by incorporating multi-agent theory based on an extensive amount of real-world data. Child allocation Care provider A Care provider B Care provider C Care provider D Institution for youth health care An agent-based analysis approach to resource allocation in the Dutch youth health care system

  5. RESEARCH OBJECTIVE OBJECTIVE Improve the child allocation process between: • the institution for youth health care • the associated care providers by: • designing an experimental platform based on: • multi agent simulation • real world data MAIN QUESTIONS • What are relevant characteristics of the child allocation process? • How can a queue management in the youth care sector be organised? • What should a simulation model of the youth care sector look like? • Which factors influence the choice for an optimal queue management philosophy? An agent-based analysis approach to resource allocation in the Dutch youth health care system

  6. METHODOLOGY BLOCK DIAGRAM SIMULATION Sources Input analyses Modeling Output analyses Reporting Key Performance Indicators Allocation behavior Expert Interviews Simulation model Experiments Results Case selection behavior Data analyses Real world data Validation An agent-based analysis approach to resource allocation in the Dutch youth health care system

  7. QUEUE MANAGEMENT STRATEGIES IN THE YOUTH CARE SECTOR Push to decentralized queues Push from a centralized queue 1 2 Free Free Push Push 4 3 Pull to decentralized queues Pull from centralized queue Pull Pull An agent-based analysis approach to resource allocation in the Dutch youth health care system

  8. RELEVANT CHARACTERISTICS OF THE RESOURCE ALLOCATION PROCESS • Many factors including: • a withdrawal and return mechanism • a non-stationary Poisson arrival process • single child and group based treatment • age based in/exclusion filters • geographical bounded allocation • but most importantly… • a preference algorithm to include a care provider’s case preference An agent-based analysis approach to resource allocation in the Dutch youth health care system

  9. RELEVANT CHARACTERISTICS OF THE RESOURCE ALLOCATION PROCESS • Real world case selection at the care providers based on: • Characteristics of care position • Actual waiting time • Difficulty of a case expressed as expected treatment time Age related dependencies Queue of waiting cases Potential cases Case selection for treatment Political influence An agent-based analysis approach to resource allocation in the Dutch youth health care system

  10. RELEVANT CHARACTERISTICS OF THE RESOURCE ALLOCATION PROCESS • Indifference curves for the strategic decision algorithm An agent-based analysis approach to resource allocation in the Dutch youth health care system

  11. RELEVANT CHARACTERISTICS OF THE RESOURCE ALLOCATION PROCESS • Indifference curves for the linear approach Beta = 0 BCEG Beta = 0,1 BCEG Beta = 0,2 CBEG Beta = 0,3 CBEG Beta = 0,4 CEBG Beta = 0,5 CEGB Beta = 0,6 CEGB Beta = 0,7 CEGB Beta = 0,8 CEGB Beta = 0,9 CEGB Beta = 1,0 CEGB An agent-based analysis approach to resource allocation in the Dutch youth health care system

  12. RELEVANT CHARACTERISTICS OF THE RESOURCE ALLOCATION PROCESS • Indifference curves for the random approach Any order of children is possible! An agent-based analysis approach to resource allocation in the Dutch youth health care system

  13. FACTORS OF INFLUENCE FOR CHOSING THE OPTIMAL ALLOCATION STRATEGY MEASUREMENT • Average waiting time performance over whole system (horizontal) • Average waiting time performance over top 5% waiting cases (vertical) An agent-based analysis approach to resource allocation in the Dutch youth health care system

  14. CONCLUSIONS & CONTRIBUTION CONCLUSIONS • The use of a simplified decision algorithm in a agent-based simulation can lead to very different and misleading outcomes and therefore conclusions of a research. • While a higher level of unfairness increases throughput, it significantly decreases the performance of the whole system regarding waiting time. CONTRIBUTION • Successful implementation of an agent-based simulation model in a real world setting with real world data • A simulation platform including a high level of complexity for studying waiting line scenarios in youth health care An agent-based analysis approach to resource allocation in the Dutch youth health care system

  15. FUTURE WORK FUTURE WORK: • Analysis on different regional configurations of the youth care system • Increase complexity of care profiles to meet real world behaviour • Development of a guide towards optimal system design in form of a flowchart Region Dense? Fairness? Providers? System Y System Z System X An agent-based analysis approach to resource allocation in the Dutch youth health care system

  16. TIME FOR QUESTIONS

  17. Erik Giesen Wolgang Ketter Rob ZuidwijkINITI8 Erasmus University Erasmus UniversityGiesen@initi8.nl WKetter@rsm.nl RZuidwijk@rsm.nl INITI8, Erasmus University Rotterdam, 14-12-2009

  18. SIMULATION SETUP An agent-based analysis approach to resource allocation in the Dutch youth health care system

  19. RELEVANT CHARACTERISTICS OF THE RESOURCE ALLOCATION PROCESS • Indifference curves for the linear approach – as used in the paper Beta = 0 GECB Beta = 0,1 GECB Beta = 0,2 GCEB Beta = 0,3 CGEB Beta = 0,4 CGEB Beta = 0,5 CGEB Beta = 0,6 CGEB Beta = 0,7 CEGB Beta = 0,8 CEGB Beta = 0,9 CEGB Beta = 1,0 CEGB An agent-based analysis approach to resource allocation in the Dutch youth health care system

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