A two-stage stochastic game model for elective surgical capacity planning and investment

Waiting for elective procedures has become a major health concern in both rich and poor countries. The inadequate balance between the demand for and the supply of health services negatively affects the quality of life, mortality, and government appraisal. This study presents the first mathematical framework shedding light on how much, when, and where to invest in health capacity to end waiting lists for elective surgeries. We model the healthcare system as a two-stage stochastic capacity expansion problem where government investment decisions are represented as a non-symmetric Nash bargaining solution. In particular, the model assesses the capacity requirements, optimal allocation, and corresponding financial investment per hospital, region, specialty, and year. We use the proposed approach to target Chile's elective surgical waiting lists (2021–2031), considering patients’ priorities, 10 regional health services, 24 hospitals, and 10 surgical specialties. We generate uncertain future demand scenarios using historical data (2012–2021) and 100 autoregressive integrated moving average prediction models. The results indicate that USD 3,331.677 million is necessary to end the waiting lists by 2031 and that the Nash approach provides a fair resource distribution with a 6% efficiency loss. Additionally, a smaller budget (USD 2,000 million) was identified as necessary to end the waiting lists in a longer planning horizon. Further analysis revealed the impact of investment in patient transfer and a decline in investment yield.