A commuter-based two-step floating catchment area method for measuring spatial accessibility of daycare centers

Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis

Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike's information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01-2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization.

Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility

In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.

Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas

BACKGROUND

Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.

METHODS

This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations.

RESULTS

The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.

CONCLUSIONS

The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.

Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China

BACKGROUND

There is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future.

METHODS

Sichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment.

RESULTS

In Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region.

CONCLUSIONS

The combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

Measuring Spatial Accessibility of Health Care Providers - Introduction of a Variable Distance Decay Function within the Floating Catchment Area (FCA) Method

We integrated recent improvements within the floating catchment area (FCA) method family into an integrated 'iFCA`method. Within this method we focused on the distance decay function and its parameter. So far only distance decay functions with constant parameters have been applied. Therefore, we developed a variable distance decay function to be used within the FCA method. We were able to replace the impedance coefficient β by readily available distribution parameter (i.e. median and standard deviation (SD)) within a logistic based distance decay function. Hence, the function is shaped individually for every single population location by the median and SD of all population-to-provider distances within a global catchment size. Theoretical application of the variable distance decay function showed conceptually sound results. Furthermore, the existence of effective variable catchment sizes defined by the asymptotic approach to zero of the distance decay function was revealed, satisfying the need for variable catchment sizes. The application of the iFCA method within an urban case study in Berlin (Germany) confirmed the theoretical fit of the suggested method. In summary, we introduced for the first time, a variable distance decay function within an integrated FCA method. This function accounts for individual travel behaviors determined by the distribution of providers. Additionally, the function inherits effective variable catchment sizes and therefore obviates the need for determining variable catchment sizes separately.

Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach

Accessibility and satisfaction related to healthcare services are conceived as multidimensional concepts. These concepts can be studied using objective and subjective measures. In this study, we created two indices: a composite healthcare accessibility index (CHCA) and a composite healthcare satisfaction index (CHCS). To calculate the CHCA index we used three indicators based on three components of multidimensional healthcare accessibility: availability, acceptability and accessibility. In the indicator based on the component of accessibility, we included an innovative perceived time-decay parameter. The three indicators of the CHCA index were weighted through the application of a principal components analysis. To calculate the CHCS index, we used three indicators: the waiting time after the patient arrives at the healthcare service, the quality of the healthcare, and the healthcare service supply. These three indicators making up the CHCA index were weighted by applying an analytical hierarchy process. Three kinds of regressions were subsequently applied in order to explain the CHCA and CHCS indices: namely the Linear Least Squares, Ordinal Logistic, and Random Forests regressions. In these regressions, we used different independent social and health-related variables. These variables represented the predisposing, enabling, and need factors of people´s behaviors related to healthcare. All the calculations were applied to a study area: the city of Quito, Ecuador. Results showed that there are health-related inequalities in regard to healthcare accessibility and healthcare satisfaction in our study area. We also identified specific social factors that explained the indices developed. The present work is a mixed-methods approach to evaluate multidimensional healthcare accessibility and healthcare satisfaction, incorporating a pluralistic perspective, as well as a multidisciplinary framework. The results obtained can also be considered as tools for healthcare and urban planners, for more integrative social analyses that can improve the quality of life in urban residents.

Multi-modal two-step floating catchment area analysis of primary health care accessibility

Two-step floating catchment area (2SFCA) techniques are popular for measuring potential geographical accessibility to health care services. This paper proposes methodological enhancements to increase the sophistication of the 2SFCA methodology by incorporating both public and private transport modes using dedicated network datasets. The proposed model yields separate accessibility scores for each modal group at each demand point to better reflect the differential accessibility levels experienced by each cohort. An empirical study of primary health care facilities in South Wales, UK, is used to illustrate the approach. Outcomes suggest the bus-riding cohort of each census tract experience much lower accessibility levels than those estimated by an undifferentiated (car-only) model. Car drivers' accessibility may also be misrepresented in an undifferentiated model because they potentially profit from the lower demand placed upon service provision points by bus riders. The ability to specify independent catchment sizes for each cohort in the multi-modal model allows aspects of preparedness to travel to be investigated.