International Journal of Health Policy and Management

International Journal of Health Policy and Management

The Spatial Allocation of Hospitals With Negative Pressure Isolation Rooms in Korea: Are We Prepared for New Outbreaks?

Document Type : Original Article

Authors
Hyoungah Kim 1
Dohyeong Kim 2
Christopher Paul 3
Chang Kil Lee 4
1 Institute of Public Policy and Administration, Chung-Ang University, Seoul, South Korea
2 School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson TX, USA
3 Department of Public Administration, North Carolina Central University, Durham, NC, USA
4 Department of Urban Policy and Administration, Incheon National University, Incheon, South Korea
10.34172/ijhpm.2020.118
Abstract
Background
Allocation of adequate healthcare facilities is one of the most important factors that public health policy-makers consider when preparing for infectious disease outbreaks. Negative pressure isolation rooms (NPIRs) are one of the critical resources for control of infectious respiratory diseases, such as the novel coronavirus disease 2019 (COVID-19) outbreak. However, there is insufficient attention to efficient allocation of NPIR-equipped hospitals.
 
Methods
We aim to explore any insufficiency and spatial disparity of NPIRs in South Korea in response to infectious disease outbreaks based on a simple analytic approach. We examined the history of installing NPIRs in South Korea between the severe acute respiratory syndrome (SARS) outbreak in 2003 and the Middle East respiratory syndrome coronavirus (MERS-Cov) in 2015 to evaluate the allocation process and spatial distribution of NPIRs across the country. Then, for two types of infectious diseases (a highly contagious disease like COVID-19 vs. a hospital-based transmission like MERS-Cov), we estimated the level of disparity between NPIR capacity and demand at the sub-regional level in South Korea by applying the two-step floating catchment area (2SFCA) method.
 
Results
Geospatial information system (GIS) mapping reveals a substantial shortage and misallocation of NPIRs, indicating that the Korean government should consider a simple but evidence-based spatial method to identify the areas that need NPIRs most and allocate funds wisely. The 2SFCA method suggests that, despite the recent addition of NPIRs across the country, there should still be more NPIRs regardless of the spread pattern of the disease. It also illustrates high levels of regional disparity in allocation of those facilities in preparation for an infectious disease, due to the lack of evidence-based approach.
 
Conclusion
These findings highlight the importance of evidence-based decision-making processes in allocating public health facilities, as misallocation of facilities could impede the responsiveness of the public health system during an epidemic. This study provides some evidence to be used to allocate the resources for NPIRs, the urgency of which is heightened in the face of rapidly evolving threats from the novel COVID-19 outbreak.
Keywords
Infectious Disease Outbreak
Health Facility Allocation
Geographic Information System
Evidence-Based Health Policy
South Korea
Subjects
  1. Semenza JC, Lindgren E, Balkanyi L, et al. Determinants and drivers of infectious disease threat events in Europe. Emerg Infect Dis. 2016;22(4):581-589. doi:10.3201/eid2204
  2. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study. Lancet. 2020;395(10225):689-697. doi:10.1016/s0140-6736(20)30260-9
  3. Kim D, Min S, Kim H. Korean Health Policies. In: Moon C, Moon MJ, eds. Routledge Handbook of Korean Politics and Public Administration. 1st ed. Routledge; 2020:484-498.
  4. Su S, Wong G, Liu Y, Gao GF, Li S, Bi Y. MERS in South Korea and China: a potential outbreak threat? Lancet. 2015;385(9985):2349-2350. doi:10.1016/s0140-6736(15)60859-5
  5. Al-Tawfiq JA, Abdrabalnabi R, Taher A, Mathew S, Rahman KA. Infection control influence of Middle East respiratory syndrome coronavirus: a hospital-based analysis. Am J Infect Control. 2019;47(4):431-434. doi:10.1016/j.ajic.2018.09.015
  6. Assiri A, McGeer A, Perl TM, et al. Hospital outbreak of Middle East respiratory syndrome coronavirus. N Engl J Med. 2013;369(5):407-416. doi:10.1056/NEJMoa1306742
  7. Kang CK, Song KH, Choe PG, et al. Clinical and epidemiologic characteristics of spreaders of Middle East respiratory syndrome coronavirus during the 2015 outbreak in Korea. J Korean Med Sci. 2017;32(5):744-749. doi:10.3346/jkms.2017.32.5.744
  8. World Health Organization (WHO). Chapter 10: controlling the spread of infectious diseases. In: Magnusson R, ed. Advancing the Right to Health: The Vital Role of Law. WHO; 2013:151-164.
  9. Offermann FJ, Eagan A, Offermann AC, Subhash SS, Miller SL, Radonovich LJ. Potential airborne pathogen transmission in a hospital with and without surge control ventilation system modifications. Build Environ. 2016;106:175-180. doi:10.1016/j.buildenv.2016.06.029
  10. Kim SH, Chang SY, Sung M, et al. Extensive viable Middle East Respiratory Syndrome (MERS) coronavirus contamination in air and surrounding environment in MERS isolation wards. Clin Infect Dis. 2016;63(3):363-369. doi:10.1093/cid/ciw239
  11. Miller SL, Clements N, Elliott SA, Subhash SS, Eagan A, Radonovich LJ. Implementing a negative-pressure isolation ward for a surge in airborne infectious patients. Am J Infect Control. 2017;45(6):652-659. doi:10.1016/j.ajic.2017.01.029
  12. Fraser VJ, Johnson K, Primack J, Jones M, Medoff G, Dunagan WC. Evaluation of rooms with negative pressure ventilation used for respiratory isolation in seven midwestern hospitals. Infect Control Hosp Epidemiol. 1993;14(11):623-628. doi:10.1086/646654
  13. Woolhouse M. How to make predictions about future infectious disease risks. Philos Trans R Soc Lond B Biol Sci. 2011;366(1573):2045-2054. doi:10.1098/rstb.2010.0387
  14. Moran KR, Fairchild G, Generous N, et al. Epidemic forecasting is messier than weather forecasting: the role of human behavior and internet data streams in epidemic forecast. J Infect Dis. 2016;214(suppl_4):S404-S408. doi:10.1093/infdis/jiw375
  15. Heesterbeek H, Anderson RM, Andreasen V, et al. Modeling infectious disease dynamics in the complex landscape of global health. Science. 2015;347(6227):aaa4339. doi:10.1126/science.aaa4339
  16. Hui DS, Azhar EI, Kim YJ, Memish ZA, Oh MD, Zumla A. Middle East respiratory syndrome coronavirus: risk factors and determinants of primary, household, and nosocomial transmission. Lancet Infect Dis. 2018;18(8):e217-e227. doi:10.1016/s1473-3099(18)30127-0
  17. Shankar S. MERS Outbreak Hits South Korea Economy, GDP Growth At 6-Year Lowe. International Business Times; 2015.
  18. Petersen E, Hui DS, Perlman S, Zumla A. Middle East Respiratory Syndrome - advancing the public health and research agenda on MERS - lessons from the South Korea outbreak. Int J Infect Dis. 2015;36:54-55. doi:10.1016/j.ijid.2015.06.004
  19. Ki M. 2015 MERS outbreak in Korea: hospital-to-hospital transmission. Epidemiol Health. 2015;37:e2015033. doi:10.4178/epih/e2015033
  20. Chua M, Lee J, Sulaiman S, Tan HK. From the frontline of COVID-19 - how prepared are we as obstetricians? a commentary. BJOG. 2020;127(7):786-788. doi:10.1111/1471-0528.16192
  21. Twu SJ, Chen TJ, Chen CJ, et al. Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerg Infect Dis. 2003;9(6):718-720. doi:10.3201/eid0906.030283
  22. Kanamori H, Aso N, Weber DJ, et al. Latent tuberculosis infection in nurses exposed to tuberculous patients cared for in rooms without negative pressure after the 2011 great east Japan earthquake. Infect Control Hosp Epidemiol. 2012;33(2):204-206. doi:10.1086/663716
  23. Ministry of Health and Welfare. The 2015 MERS Outbreak in the Republic of Korea: Learning from MERS. http://nih.go.kr/board/board.es?mid=a20504000000&bid=0014&tag=&act=view&list_no=128379. Published 2015.
  24. Chowell G, Abdirizak F, Lee S, et al. Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study. BMC Med. 2015;13:210. doi:10.1186/s12916-015-0450-0
  25. Smith N, Mitton C, Dowling L, Hiltz MA, Campbell M, Gujar SA. Introducing new priority setting and resource allocation processes in a Canadian healthcare organization: a case study analysis informed by multiple streams theory. Int J Health Policy Manag. 2015;5(1):23-31. doi:10.15171/ijhpm.2015.169
  26. Smith N, Mitton C, Davidson A, Williams I. A politics of priority setting: Ideas, interests and institutions in healthcare resource allocation. Public Policy Adm. 2014;29(4):331-347. doi:10.1177/0952076714529141
  27. Gibson JL, Martin DK, Singer PA. Priority setting in hospitals: fairness, inclusiveness, and the problem of institutional power differences. Soc Sci Med. 2005;61(11):2355-2362. doi:10.1016/j.socscimed.2005.04.037
  28. Harris C, Allen K, King R, Ramsey W, Kelly C, Thiagarajan M. Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting. BMC Health Serv Res. 2017;17(1):328. doi:10.1186/s12913-017-2211-6
  29. Cumming JM. Priority setting meets multiple streams: a match to be further examined? comment on "introducing new priority setting and resource allocation processes in a Canadian healthcare organization: a case study analysis informed by multiple streams theory.” Int J Health Policy Manag. 2016;5(8):497-499. doi:10.15171/ijhpm.2016.58
  30. World Health Organization (WHO). Guidance on Ethics and Equitable Access to HIV Treatment and Care. Geneva, Switzerland: WHO, Department of Ethics, Trade, Human Rights, and Health Law; 2004.
  31. Zhang W, Cao K, Liu S, Huang B. A multi-objective optimization approach for health-care facility location-allocation problems in highly developed cities such as Hong Kong. Comput Environ Urban Syst. 2016;59:220-230. doi:10.1016/j.compenvurbsys.2016.07.001
  32. Rahman S, Smith DK. Use of location-allocation models in health service development planning in developing nations. Eur J Oper Res. 2000;123(3):437-452. doi:10.1016/s0377-2217(99)00289-1
  33. Ministry of Health and Welfare. Detailed Criteria for Installation and Operation of Negative Pressure Isolation Rooms. Sejong, Korea: Ministry of Health and Welfare: 2015.
  34. Luo W, Qi Y. An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians. Health Place. 2009;15(4):1100-1107. doi:10.1016/j.healthplace.2009.06.002
  35. Langford M, Higgs G, Fry R. Multi-modal two-step floating catchment area analysis of primary health care accessibility. Health Place. 2016;38:70-81. doi:10.1016/j.healthplace.2015.11.007
  36. Tao Z, Yao Z, Kong H, Duan F, Li G. Spatial accessibility to healthcare services in Shenzhen, China: improving the multi-modal two-step floating catchment area method by estimating travel time via online map APIs. BMC Health Serv Res. 2018;18(1):345. doi:10.1186/s12913-018-3132-8
  37. Kim D, Zhang Y, Lee CK. Understanding needs and barriers to using geospatial tools for public health policymaking in China. Geospat Health. 2018;13(1):594. doi:10.4081/gh.2018.594
  38. Kim D, Sarker M, Vyas P. Role of spatial tools in public health policymaking of Bangladesh: opportunities and challenges. J Health Popul Nutr. 2016;35:8. doi:10.1186/s41043-016-0045-1
  39. Lee JS, Kim ES, Chung MH, et al. National questionnaire survey on managing patients with severe acute respiratory syndrome, 2003. Infect Chemother. 2004;36(3):132-138.
  40. Dowell SF. Seasonal variation in host susceptibility and cycles of certain infectious diseases. Emerg Infect Dis. 2001;7(3):369-374. doi:10.3201/eid0703.010301
International Journal of Health Policy and Management
Volume 9, Issue 11
November 2020
Pages 475-483

  • Received Date 14 March 2020
  • Revised Date 13 June 2020
  • Accepted Date 29 June 2020
  • First Published Date 01 November 2020
  • Published Date 01 November 2020