Senese Francesca, Tubertini Paolo, Mazzocchetti Angelina, Lodi Andrea, Ruozi Corrado, Grilli Roberto
Regional Agency for Health and Social Care of Emilia-Romagna, Via Aldo Moro 21, 40127, Bologna, Italy.
Department of Electrical, Electronic, and Information Engineering, University of Bologna, Bologna, Italy.
Hum Resour Health. 2015 Jan 30;13(1):7. doi: 10.1186/1478-4491-13-7.
Italian regional health authorities annually negotiate the number of residency grants to be financed by the National government and the number and mix of supplementary grants to be funded by the regional budget. This study provides regional decision-makers with a requirement model to forecast the future demand of specialists at the regional level.
We have developed a system dynamics (SD) model that projects the evolution of the supply of medical specialists and three demand scenarios across the planning horizon (2030). Demand scenarios account for different drivers: demography, service utilization rates (ambulatory care and hospital discharges) and hospital beds. Based on the SD outputs (occupational and training gaps), a mixed integer programming (MIP) model computes potentially effective assignments of medical specialization grants for each year of the projection.
To simulate the allocation of grants, we have compared how regional and national grants can be managed in order to reduce future gaps with respect to current training patterns. The allocation of 25 supplementary grants per year does not appear as effective in reducing expected occupational gaps as the re-modulation of all regional training vacancies.
意大利各地区卫生当局每年都会就由国家政府资助的住院医师培训名额数量以及由地区预算资助的补充名额数量和组合进行谈判。本研究为地区决策者提供了一个需求模型，以预测地区层面未来对专科医生的需求。
我们开发了一个系统动力学（SD）模型，该模型预测了规划期（至2030年）内医学专科医生供应的演变情况以及三种需求情景。需求情景考虑了不同的驱动因素：人口统计学、服务利用率（门诊护理和医院出院情况）以及医院病床数量。基于系统动力学的输出结果（职业和培训缺口），一个混合整数规划（MIP）模型计算出预测期内每年医学专科培训名额的潜在有效分配方案。
为了模拟培训名额的分配，我们比较了如何管理地区和国家培训名额，以便相对于当前的培训模式减少未来的缺口。每年分配25个补充培训名额在减少预期职业缺口方面似乎不如对所有地区培训空缺进行重新调整有效。
