Variations in the Flow Approach to CFCLP-TC for Multiobjective Supply Chain Design

We review the problem for the design of supply chains called Capacitated Fixed Cost Facility Location Problem with Transportation Choices (CFCLP-TC). The problem is based on a production network of two echelons with multiple plants, a set of potential distribution centers, and customers. The problem is formulated as an optimization model with two objective functions based on time and cost. This paper proposes three changes to the original model to compare the sets of efficient solutions and the computational time required to obtain them. The main contribution of this paper is to extend the existing literature by incorporating approaches for the supply of product to customers through multiple sources, the direct flow between plants and customers, without this necessarily implying removing the distribution centers, and the product flow between distribution centers. From these approaches, we generate mathematical programming models and propose to solve through the epsilon-constraint approach for generating Pareto fronts and thus compare each of these approaches with the original model. The models are implemented in GAMS and solved with CPLEX

Network Flexibility for Recourse Considerations in Bi-Criteria Facility Location

What is the best set of facility location decisions for the establishment of a logistics network when it is uncertain how a company’s distribution strategy will evolve? What is the best configuration of a distribution network that will most likely have to be altered in the future? Today’s business environment is turbulent, and operating conditions for firms can take a turn for the worse at any moment. This fact can and often does influence companies to occasionally expand or contract their distribution networks. For most companies operating in this chaotic business environment, there is a continuous struggle between staying cost efficient and supplying adequate service. Establishing a distribution network which is flexible or easily adaptable is the key to survival under these conditions. This research begins to address the problem of locating facilities in a logistics network in the face of an evolving strategic focus through the implicit consideration of the uncertainty of parameters. The trade-off of cost and customer service is thoroughly examined in a series of multi-criteria location problems. Modeling techniques for incorporating service restrictions for facility location in strategic network design are investigated. A flexibility metric is derived for the purposes of quantifying the similarity of a set of non-dominated solutions in strategic network design. Finally, a multi-objective greedy random adaptive search (MOG) metaheuristic is applied to solve a series of bi-criteria, multi-level facility location problems

OR models in urban service facility location : a critical review of applications and future developments

[EN] Facility location models are well established in various application areas with more than a century of history in academia. Since the 1970s the trend has been shifting from manufacturing to service industries. Due to their nature, service industries are frequently located in or near urban areas that results in additional assumptions, objectives and constraints other than those in more traditional manufacturing location models. This survey focuses on the location of service facilities in urban areas. We studied 110 research papers across different journals and disciplines. We have analyzed these papers on two levels. On the first, we take an Operations Research perspective to investigate the papers in terms of types of decisions, location space, main assumptions, input parameters, objective functions and constraints. On the second level, we compare and contrast the papers in each of these applications categories: (a) Waste management systems (WMS), (b) Large-scale disaster (LSD), (c) Small-scale emergency (SSE), (d) General service and infrastructure (GSI), (e) Non-emergency healthcare systems (NEH) and (f) Transportation systems and their infrastructure (TSI). Each of these categories is critically analyzed in terms of application, assumptions, decision variables, input parameters, constraints, objective functions and solution techniques. Gaps, research opportunities and trends are identified within each category. Finally, some general lessons learned based on the practicality of the models is synthesized to suggest avenues of future research.Ruben Ruiz is partially supported by the Spanish Ministry of Economy and Competitiveness, under the project "SCHEYARD - Optimization of Scheduling Problems in Container Yards (No. DPI2015-65895-R) financed by FEDER funds.Farahani, RZ.; Fallah, S.; Ruiz García, R.; Hosseini, S.; Asgari, N. (2019). OR Models in Urban Service Facility Location: A Critical Review of Applications and Future Developments. European Journal of Operational Research. 276(1):1-27. https://doi.org/10.1016/j.ejor.2018.07.036S127276

Hospital procedures concentration: how to combine quality and patient choice.

The main focus of this PhD thesis is the use of managerial tools in the healthcare sector. In particular, the principal topic we focus on is the volume-outcome association, a relationship that has been empirically identifed in medical specialties. According to this relationship, there exists a positive association between the number of interventions (the so called volume of activity) performed by a facility and the quality of clinical outcomes, measured in terms of patients’ health conditions. The volume-outcome association has been identifed back in 1979, and it has been particularly documented in the last two decades for a variety of interventions and different outcome measures. All the studies mainly reveal that there is a positive effect of volume on outcomes for each medical procedure, although its extent varies depending on the clinical area itself. The observed trend can be explained by two main factors: (i) on a hospital level, the structure by which care is organised is likely to be poorer in low volume hospitals, which might lack consistent processes for postoperative care or for dealing with ostoperative complications; (ii) on a personnel level, outcomes may also be related to the familiarity of the staff with the treatment. Despite the number of studies focusing on it, the volume–outcome association still raises interest, due to the persistence of low volumes performed in healthcare facilities, in particular in Italian hospitals. Our starting point is the National Outcome Evaluation Program (PNE), a project sponsored by the Italian government that each year, from 2012, reports hospitals clinical performances with the objective to assess healthcare service quality levels. While many researchers have focused on the existence of the volume-outcome association from a clinical perspective, this PhD project deepens the volume-outcome association from a managerial perspective, by including it in a planning problem. The planning problem analysed consists in the decision of how to distribute volumes of activity among wards of hospitals perating in a same geographical area. In particular, among the different specialties, we consider surgery wards, since better results for higher volumes are especially plausible for this case. Our ultimate bjective is to exploit the information contained within the volume–outcome association and, as a consequence of the existing link among volume and outcomes, to reach an optimal planning for hospital wards. In this way, the reorganization of hospitals operating in a territory (planning decision) translates into the improvement of healthcare organization outcomes (clinical result). We take as reference healthcare system the Italian National Healthcare System (Servizio Sanitario Nazionale, SSN), a public health system that provides universal coverage for comprehensive and essential health services. The formulation of our problem varies depending on which actor is considered. In the SSN, there is a central decision maker, the commissioner, in charge of guaranteeing the compliance with the principles of universality, equality and equity. It is represented by an institutional figure at the national level, i.e., the Ministry of Health. However, all the administrative levels (e.g., Regions, municipalities, etc.) have to ollaborate in order to guarantee health quality to all the citizens. Hence, we can think of a commissioner at each layer of the system, which is responsible for the population health. Beyond the commissioner, other actors compose the Italian healthcare system. In particular, three other categories are involved in planning problems: providers, physicians and patients. Commissioners emand to providers to supply healthcare services. Providers (i.e., hospital administrators) answer through the supply of the requested services. Medical staff (surgeons, anesthetists, nurses, etc.) are the experts who deal with patients, who in turn receive the service. It should be noticed that there is no constraint enforcing patients to choose a specifc hospital where to be treated, and no patient is forced to receive healthcare services. Each actor has its own interests and perspectives, and therefore it is relevant to keep into consideration their different behaviors and interactions. Since the allocation of operation volumes to healthcare structures is a strategic decision that deals with territorial healthcare confguration and people health needs, we initially take the perspective of the commissioner, who is the first actor involved in this decision process. All the other actors will face the consequences of such strategic choice: providers will have to adapt the capacity of their structures to the new planned demand; medical staff will have to arrange new shifts and work organisation; patients will face new openings/closures of hospitals and will have to choose where to be treated. Among them, we reckoned as particularly worthy of attention the patients’ perspective, since their behaviour can alter the whole commissioner plan. The thesis is structured as follows. Chapter 2 summarizes the relevant literature. The chapter is organized in two sections dedicated to the two main felds of studies we refer to, namely location and allocation problems (from the health management literature) and choice models (from the health economics literature). Moreover, a section of the chapter reports the state of the art of the researches that have been conducted on the volume–outcome association. Chapter 3 is dedicated to the policy maker’s perspective. We take the point of view of the commissioners, i.e., that of planning the volume to be allocated to each hospital, and we propose an approach (based on mathematical programming) to determine the number of interventions to be strategically allocated to surgery wards, given several constraints related to hospital capacity, demand satisfaction and pidemiological concerns. Concentration vs. scattering of interventions among healthcare structures are explored in terms of quality and equity offered to the whole population. The proposed approach is tested on four case studies taking into account real life factors (such as reallocation of interventions, geographical distribution of hospitals, volume threshold constraints, and dissimilarities among hospital performances), and results are compared with real data from the PNE. Chapter 4 focuses on patients’ perspective. Specifcally, we analysed patients’ choice, in terms of hospital where they have decided to be treated, together with the list of hospitals that were available to them. By using the econometric methodology of the conditional logit, we modeled the trade-off faced by patients between hospitals’ characteristics, i.e., distance and quality. Eventually, we applied the choice model to Hospital Discharge Data for colon cancer patients in Piedmont from 2004 to 2014, showing patients’ revealed preferences. Results shed some light on how patients can react to facility specialization or closure, depending on demographic, social and clinical factors. Chapter 5 gathers the two perspectives and merge them. The objective is to support planning decisions that (i) are effective in terms of better health outcomes and (ii) guarantee patients’ choices to respect the volumes that have been strategically planned. To this aim, we explored two distinct approaches. The frst approach enriches the one proposed in Chapter 3 with the commissioner point of view, by adding constraints involving patients, e.g., the maximum distance they are willing to travel. The second approach, instead, aims to fully integrate patients’ and policy maker’s perspectives, by inserting predictions on patients’ behaviour within the decisional process of the policy maker. Eventually, results from all the approaches are compared, in terms of organizational quality and population health

Healthcare Facility Location and Capacity Configuration under Stochastic Demand

This dissertation addresses two topics. The first topic is strategic dynamic supply chain reconfiguration (DSCR) problem, in which the proposed capacity configuration network is employed in the second topic: healthcare facility location and capacity configuration under stochastic demand. The second topic investigates two problems: the stochastic, single healthcare facility location and capacity configuration problem (SSHFCP) in a competitive environment and the stochastic, multiple healthcare facility location and capacity configuration problem (SMHFCP) based on a location-allocation model. The DSCR problem is to prescribe the location and capacity of each facility, select links used for transportation, and plan material flows through the supply chain, including production, inventory, backorder, and outsourcing levels. The objective is to minimize total cost. The network must be dynamically reconfigured (i.e., by opening facilities, expanding and/or contracting their capacities, and closing facilities) over time to accommodate changing trends in demand and/or costs. This research proposes a network-based model of DSCR and compares it with a traditional mixed integer programming (MIP) formulation via extensive, large-scale computational tests and sensitivity analyses, showing that the network-based model offers superior solvability. The SSHFCP is to prescribe the location and multi-service, multi-period capacity configuration of facility facing competition from existing facilities under uncertain patient demand, so that the expected excess revenue (i.e., the amount by which revenue exceeds cost) of the new facility is maximized. This dissertation describes a solution methodology that relates practical features relative to healthcare, including a multiplicative competitive interaction (MCI) model to reflect competition among providers and a method to model the stochastic problem as a deterministic resource constrained shortest path problem (RCSPP) on a specially constructed network, which can be solved in pseudo-polynomial time. This dissertation proposes two solution methods to SMHFCP. The dissertation shows that first method, a column-generation heuristic, solves test instances to near optimality; and the second one, an approximation method, provides a fast runtime with a bounding procedure to assess the quality of a solution. The application of SSHFCP and SMHFCP in locating and configuring new primary care centers in mid-Texas rural area validates the real business decision of industrial collaborators

Modelo de p-medianas hierárquico e acessibilidade: análise dos hospitais públicos de Santa Catarina

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro Tecnológico, Programa de Pós-Graduação em Engenharia de Produção, Florianópolis, 2016.A escassez de meios, na história da humanidade, sempre motivou a criação e o desenvolvimento de técnicas que melhorassem a efetividade de aplicação dos recursos. Em diversas áreas de atuação governamental é essencial saber onde posicionar as unidades de atendimento de forma a facilitar ao máximo o acesso de toda a população ao serviço. Considerando serviços de saúde, não somente valores econômicos estão envolvidos, mas principalmente a vida das pessoas. Os principais problemas envolvendo a localização de instalações de saúde incluem questões sobre planejamento de serviços, agendamento de recursos, logística, diagnóstico, tratamento e cuidados preventivos.O trabalho versa sobre um problema de localização que tem por objetivo reduzir a distância ponderada percorrida pelos usuários para acessar uma rede hierárquica pública de serviços, mantendo o nível de acessibilidade dos usuários a patamares aceitáveis. Para tal fim, utiliza-se um modelo matemático de análise locacional que traz em seu bojo um indicador de acessibilidade para avaliar a equidade para a população, sem perder de vista a eficiência do sistema.Propõe-se uma avaliação da rede pública do Sistema de Saúde do estado de Santa Catarina e a compara com a solução ótima do problema de p-medianas hierárquico não capacitado com demanda fixa. O indicador de acessibilidade proposto foi aplicado à distribuição de unidades de forma a permitir avaliar o grau de acessibilidade e de eficiência do sistema, e através de um algoritmo genético multiobjetivo novas e mais adequadas soluções foram produzidas e comparadas, buscando satisfazer simultaneamente equidade e eficiência.Em suma, o estudo permite gerar subsídios para melhor avaliar os impactos da política de distribuição dos sistemas de saúde. Sua aplicação visa resultar ganhos à sociedade em termos de qualidade no serviço prestado e eficiência na aplicação dos recursos, justificando estratégias a partir dos resultados obtidos que estabeleçam uma configuração no sistema de saúde mais próxima dos interesses dos usuários.Abstract : The stringency of resources, in mankind's history, always had driven the creation and development of techniques that aim to the maximal effectiveness use of resources. In many areas of governmental action, it is fundamental to know where to locate healthcare units in order to ease population accessing to medical services. The main awkwardnesses about locating health facilities include planning services, scheduling, logistics, diagnosis, treatment and preventive care. Concerning health services, not only economic values are involved, but, above all things, human lives.This work deals with a location problem which targets to curb the weighted distance traveled by users to access a public hierarchical network services, maintaining the level of accessibility within acceptable levels. For this purpose, a location mathematical model that assess equity through an accessibility indicator is applied, in order to improve efficiency meanwhile keeping accessibility to the system.An assessment of the public health system in the state of Santa Catarina network is proposed and portrait against to the optimal solution of the fixed demand unconstrained p-median hierarchical problem. The proposed accessibility indicator had been applied to the spreading healthcare units to make possible to gauge the degree of accessibility and efficiency of the system. Last but not least a multi-objective genetic algorithm was implemented aiming to provide and compare new and appropriate solutions, which searches simultaneously satisfying equity and efficiency.In short, this study paves ways to generate data and arguments to better assess the impacts of the distribution policy of health systems. Its application could lead gains to society in terms of quality in service and efficiency in application of resources, and justifies strategies to settle, resettle and augment the healthcare network system, directing investments to the interest of the users

Measuring and optimizing accessibility to emergency medical services

Emergency medical services (EMSs) undertake the responsibility of providing rapid medical care to patients suffering from unexpected illnesses or injuries and transferring them to definitive care facilities. This research concerns several research gaps that are associated with different EMS trips, real-time traffic conditions, improving EMS efficiency and equalities. This research aims to develop GIS-based spatial optimization methods to improve service efficiency and equality in EMS systems. Specifically, the research intends to achieve the following goals: (1) to measure spatiotemporal accessibility to EMS; (2) to improve EMS efficiency and provision through spatial optimization approaches; (3) to reduce urban-rural inequalities in EMS accessibility and coverage using spatial optimization approaches. The proposed approaches are applied in three empirical studies in Wuhan, China. To achieve the first objective, the proximity and the enhanced two-step floating catchment method (E-2SFCA) are adopted to evaluate spatiotemporal accessibility. First, the EMS travel time is estimated for the two related trips as an overall EMS journey: one is from the nearest EMS station to the scene (Trip 1), and the other is from the scene to the nearest emergency hospital (Trip 2). Then, the E-2SFCA method is employed to calculate the accessibility score that integrates both geographic accessibility and availability of EMS. Travel time is estimated by using both static road network with standard speed limits and online map service considering real-time traffic. To achieve the second objective, two facility location models are proposed to improve EMS service coverages for two-related trips (Trips 1 and 2). The first model maximizes the amount of demand covered by both ambulance coverage (EMS station – demand) and hospital coverage (demand – hospital). The second model maximizes the amount of demand that can be served by both ambulance coverage and overall coverage (EMS station – demand – hospital). To achieve the third objective, two bi-objective optimization models are developed. The two models have the same primary objective to maximize the total covered demand by ambulance. The second objective is to minimize one of the two inequality measures: one focuses on accessibility of uncovered rural people, and the other concerns the urban-rural inequality in service coverage. For the first empirical study with respect to spatiotemporal access to EMS, different spatial patterns are found for the three trips (two partial trips and the overall trip). Good accessibility to one trip cannot guarantee good accessibility to another trip. In addition, urban-rural inequalities in EMS accessibility and coverage are observed. Finally, it is observed that real-time traffic conditions greatly affect EMS accessibility, particularly in urban districts. Specifically, the accessibility of EMS becomes poor during the morning (7-9 am) and evening peak periods (5-7 pm). For the second empirical study in relation to EMS optimization involving two related trips, the results find that the first proposed model can guarantee that more demand to be covered by both ambulance and hospital coverages than the Maximum Coverage Location Problem (MCLP). The second proposed model can ensure that as many people as possible to be served by both ambulance and overall coverage than the work by ReVelle et al. (1976). For the third empirical study attempting to reduce urban-rural inequality in EMS, the results show that the first bi-objective model can improve EMS accessibility of uncovered rural demand, and the second model can reduce EMS service coverages between urban and rural areas. However, the improvement EMS inequalities between urban and rural areas leads to a cost of a decrease in the total covered population, especially in urban areas. Regarding policy implications, this research suggests that different EMS trips and traffic conditions should be considered when measuring spatial accessibility to EMS. Spatial optimization research can help improving service efficiency and reduce regional equalities in EMS systems. The work presented in this thesis can aid the planning practice of public services like EMS and provide decision support for policymakers

Desenvolvimento de ferramentas de apoio multicritério à decisão em problemas de localização

Tese de doutoramento, Estatística e Investigação Operacional (Análise de Sistemas), Universidade de Lisboa, Faculdade de Ciências, 2014Nesta tese, apresenta-se um Sistema de Apoio à Decisão, desenvolvido e implementado com o objectivo de apoiar a tomada de decisão em problemas de localização bicritério que envolvam preocupações ambientais. O apoio é dado em duas fases interactivas distintas, acreditando que os métodos interactivos são a melhor forma de abordar os modelos multicritério. Na primeira fase, recorre-se a um procedimento de optimização combinatória para obter, de forma progressiva e participativa, qualquer solução não dominada dos modelos de localização bicritério implementados. Nesta primeira fase interactiva, destaca-se a importância de ser possível utilizar um Sistema de Informação Geográfica, integrado no Sistema de Apoio à Decisão, para a obtenção de dados relevantes para os modelos em causa, especialmente aqueles que requerem mais preocupações relativamente aos impactos ambientais. O uso do Sistema de Informação Geográfica, ao longo de todo o processo de decisão, também permite uma visualização apelativa e real das soluções interactivamente obtidas. Na segunda fase, caso seja necessário, usa-se a posteriori uma ferramenta de análise multiatributo para estudar em detalhe as soluções de compromisso provenientes da primeira fase. Esta ferramenta corresponde a uma implementação interactiva simples do método conjuntivo, fazendo uso de um gráfico radar como base do procedimento. A ferramenta proposta pretende contornar o problema da compensação, evitando uma agregação intercritério. O método de análise inerente à ferramenta não exige qualquer transformação ou normalização, de forma a assegurar a comparabilidade entre os critérios. De modo a descrever e a validar as potencialidades e as funcionalidades do SABILOC – o Sistema de Apoio à Decisão desenvolvido e implementado, explora-se um caso de estudo de um problema real relativo à localização de estações de transferência de resíduos.In this thesis, we present a two-phase interactive Decision Support System aimed at supporting decision-making concerning bicriteria location models in which the facilities to be located could have environmental impacts. The decision support is provided through two interactive phases, believing that interactive methods are the best way to deal with multicriteria models. First, a combinatorial optimization procedure to obtain, in a progressive and participatory way, any non-dominated solution of the bicriteria location models implemented, is used. In this first phase, we highlight that a Geographic Information System, embedded into the Decision Support System, can be used to obtain relevant data for the models concerned, especially those considering environmental issues. The Geographic Information System also allows, throughout the decision process, visualizing in an appealing and real way the solutions interactively obtained. Next, if necessary, a multiattribute a posteriori analysis tool could also be employed in order to analyze in detail a set of compromise solutions from the first phase. This one stands for a simple interactive implementation of the conjunctive method making use of a radar chart as basis for the procedure. The tool proposed is intended to circumvent the problem of compensation, avoiding aggregation inter-criteria. To use the method inherent to the tool proposed, it is not required any transformation or normalization to insure the comparability between criteria. In order to describe and validate the potentialities and functionalities of SABILOC – the Decision Support System developed and implemented, we present a case study of a real world problem applied to waste transfer station siting.Fundação para a Ciência e a Tecnologia (FCT, Programa de Apoio à Formação Avançada de Docentes do Ensino Superior Politécnico - PROTEC

Serviços de interesse geral e coesão territorial: o caso da saúde

Doutoramento em Ciências SociaisDe uma forma simples, esta é uma tese que associa a dimensão territorial à formulação de políticas públicas no âmbito dos Serviços de Interesse Geral, expressão atualmente utilizada no seio da Comissão Europeia em substituição do termo Serviços Públicos. O ponto de partida é o de que, particularmente nas últimas duas décadas, estes serviços tiveram de se adaptar a um mundo em mudança, quer ao nível das tendências políticas, quer do ponto de vista dos constrangimentos financeiros. A decisão sobre a afetação e distribuição de recursos tem, por isso, obtido uma atenção crescente no domínio das políticas públicas. Contudo, as decisões sobre a natureza, a abrangência e a distribuição dos recursos a prestar são complexas, envolvendo, não só critérios técnicos, mas também julgamentos de valor e a criação de consensos políticos. Esta questão é ainda mais premente numa conjuntura, por um lado, de contenção de gastos, no qual a procura de eficiência ganha maior preponderância, e, por outro, de incremento das próprias expectativas dos cidadãos, em que a ideia de equidade é valorada. Atendendo a este contexto, é natural que em diversos processos de tomada de decisão haja alguma tensão entre estes dois princípios, questionando-se sobre quanto é que se deve sacrificar da equidade a favor da eficiência e vice-versa. A presente investigação filia nestas inquietações. O argumento subjacente é o de que o princípio de Coesão Territorial, enquanto novo paradigma de desenvolvimento do território europeu e um dos mais recentes objetivos políticos da Comissão e dos estados-membros, contribui para ajudar a ponderar a relação equidade/eficiência em processos de decisão política sobre provisão de Serviços de Interesse Geral. A linha condutora de investigação centra-se na saúde (em geral) e nos cuidados de saúde (em particular) como exemplo de um serviço que, dada a sua importância na sociedade, justifica uma atenção especial das políticas públicas, mas que tem sido alvo de debate político e académico e de reorganização da sua estrutura na tentativa de diminuição dos custos associados, com repercussões do ponto de vista territorial. A esta questão acresce o facto de que pouco se conhece sobre quais os princípios e os critérios que estão na base de decisões políticas no campo da saúde e qual o papel que o território aqui ocupa. Para compreender se e como a dimensão territorial é considerada na formulação de políticas de saúde, bem como de que forma a adoção do princípio de coesão territorial na formulação de políticas públicas introduz um outro tipo de racionalidade aos processos de tomada de decisão, optou-se por uma metodologia de abordagem essencialmente qualitativa, baseada i) na realização de entrevistas semiestruturadas conduzidas presencialmente a atores-chave da esfera da decisão pública, ii) na análise dos principais instrumentos programáticos das políticas de saúde e iii) na análise de dois estudos de caso (sub-regiões do Baixo Vouga e da Beira Interior Sul). Os resultados alcançados permitem, por um lado, compreender, discutir e clarificar os processos de tomada de decisão em saúde, por outro, justificar o propósito da adoção do princípio de Coesão Territorial na formulação de políticas e, por fim, avançar com linhas de investigação futura sobre Serviços de Interesse Geral e Coesão Territorial.How to embrace the territorial dimension in policy-making regarding Services of General Interest is, simply put, the primary focus of this thesis. Replacing the notion of public services, at the hands of the European Commission, Services of General Interest have faced in the past two decades several political and financial challenges. Accordingly, discussions about resource allocation and distribution regarding the provision of these services have been subject of increasing interest in political and academic fields. However, decisions about the nature and focus of resources are complex and combine technical criteria with ethical/moral judgements and institutional cooperation. The present trend to diminish public expenditure (thus emphasising the idea of efficiency) and the increasing expectations of citizens (highlighting the importance of equity) provide an additional challenge to decision-making processes: how to deal with the equity/efficiency trade-off? This thesis asserts that Territorial Cohesion, one of the most recent overarching goals of EU, can be of added value to ponder the equity/efficiency trade-off in policy making regarding Services of General Interest. The research work aims to discuss this issue in the particular case of healthcare. Highly debated in present times, healthcare provides an interesting example of how recent policy trends towards service concentration are affecting people in different territorial environments. Moreover, little is known about the rationale behind health policy making: what are the main priorities in resource allocation? Which criteria are used? How is the territorial dimension being considered in these processes? Focusing on the Portuguese National Health System, the search for answers to these disquiets from an empirical viewpoint has followed primarily a qualitative approach based on i) semi-structured interviews to national and regional health policymakers; ii) document analysis (main health policy plans and guidelines) and iii) case study analysis to two NUTS III regions (Baixo Vouga and Beira Interior Sul). The empirical research results, not only provide a fruitful portray of how decision makers design and implement health policies, but also justify the added value of integrating territorial cohesion in public policy making. The results achieved in the thesis can also be seen as a framework for further research regarding Services of General Interest and Territorial Cohesion