Measurement, Optimization, and Impact of Health Care Accessibility: A Methodological Review

Modeling Health Seeking Behavior Based on Location-Based Service Data: A Case Study of Shenzhen, China

Understanding residents’ health seeking behavior is crucial for the planning and utilization of healthcare resources. With the support of emerging location-based service (LBS) data, this study proposes a framework for inferring health seeking trips, measuring observed spatial accessibility to healthcare, and interpreting the determinants of health seeking behavior. Taking Shenzhen, China as a case study, a supply–demand ratio calculation method based on observed data is developed to explore basic patterns of health seeking, while health seeking behavior is described using a spatial analysis framework based on the Huff model. A total of 95,379 health seeking trips were identified, and their analysis revealed obvious differences between observed and potential spatial accessibility. In addition to the traditional distance decay effect and number of doctors, the results showed health seeking behavior to be determined by hospital characteristics such as hospital scale, service quality, and popularity. Furthermore, this study also identified differences in health seeking behavior between subgroups with different ages, incomes, and education levels. The findings highlight the need to incorporate actual health seeking behavior when measuring the spatial accessibility of healthcare and planning healthcare resources. The framework and methods proposed in this study can be applied to other contexts and other types of public facilities.

Auto-Icon+ : An Automated End-to-End Code Generation Tool for Icon Designs in UI Development

Approximately 50% of development resources are devoted to UI development tasks~[9]. Occupying a large proportion of development resources, developing icons can be a time-consuming task, because developers need to consider not only effective implementation methods but also easy-to-understand descriptions. In this paper, we present Auto-Icon+ , an approach for automatically generating readable and efficient code for icons from design artifacts. According to our interviews to understand the gap between designers (icons are assembled from multiple components) and developers (icons as single images), we apply a heuristic clustering algorithm to compose the components into an icon image. We then propose an approach based on a deep learning model and computer vision methods to convert the composed icon image to fonts with descriptive labels, thereby reducing the laborious manual effort for developers and facilitating UI development. We quantitatively evaluate the quality of our method in the real world UI development environment and demonstrate that our method offers developers accurate, efficient, readable, and usable code for icon designs, in terms of saving 65.2% implementing time.

Identifying the vulnerable regions of emergency medical services based on the three-stage of accessibility: a case study in Xi'an, China

Background

Emergency department crowding is an obstacle in the process of obtaining emergency care services, which will lead to the increase of time cost. Most studies focused on the direct access to emergency medical resources, and few studies took the crowding of hospital emergency department as an evaluation index to reflect the convenience of obtaining emergency medical resources. It is a significance for the identification of areas with insufficient access to emergency service resources with this method.

Methods

This paper utilizes the improved potential model and the inverted Two-Step Floating Catchment Area method, combined with network map API service data to evaluate response time, delivery time and waiting time (for emergency department crowding) spent in different residential areas of Xi’an City in the process of emergency. Meanwhile, the vulnerable regions of gaining emergency medical resources are identified through the comprehensive analysis of the three stages of emergency.

Results

The studies show that the residents in built-up area are more convenient to get ambulance service and arrive at care hospitals than those in suburban areas, but they may face greater hospital crowdedness. Although suburban residents are faced with low hospital crowdedness, they spend more time on getting ambulances and going to care hospitals. The accessibility of emergency medical resources varies greatly among residents in different regions, with 5.38% of the residents were identified in the high-risk area distributing in suburban residential areas in the south of the city center, 21.92% in the medium risk area in the southern mountainous areas and the periphery of the core suburban areas of the city, and 46.11% in the low-risk area which are mainly distributed in built-up areas in gaining emergency medical services.

Conclusions

Obviously, getting an ambulance and arriving at the nearest hospital quickly shows that it is conducive to access to emergency resources. However, the impact of hospital emergency crowding can not be ignored, especially in the area surrounded by high-grade hospitals in the central area of the city. In considering the spatial layout of emergency stations and emergency hospitals, the dislocation distribution of hospitals at different levels should be reasonably adjusted to balance the equity of residents in obtaining emergency medical resources.

An External Patient Healthcare Index (EPHI) for Simulating Spatial Tendencies in Healthcare Seeking Behavior

Background

Healthcare resources are always more limited compared with demand, but better matching supply with demand can improve overall resource efficiency. In countries like China where patients are free to choose healthcare facilities, over-utilization and under-utilization of healthcare resources co-exist because of unreasonable healthcare seeking behavior. However, scholarship regarding the spatial distribution of utilization for healthcare resources, resulting from unreasonable spatial tendencies in healthcare seeking, is rare.

Methods

In this article, we propose a new External Patient Healthcare Index (EPHI) to simulate the spatial distribution of utilization for healthcare resources, based on the Two-Step Floating Catchment Area (2SFCA) method, which is widely used to assess potential spatial accessibility. Instead of using individual-level healthcare utilization data which is difficult to obtain, the EPHI uses institution-level aggregated data, including numbers of inpatient/outpatient visits. By comparing the estimated utilization (based on local healthcare institution services provision) with the expected utilization (based on local population morbidity), guest patients (e.g., patients flowing in for treatment) and bypass patients (patients flowing out) can be identified. To test the applicability of this index, a case study was carried out on China's Hainan Island. The spatial tendencies of patients for inpatient and outpatient services were simulated, then incorporated with spatial access to healthcare resources to evaluate overall resource allocation efficiency, thus guiding future resource allocations and investment for policy makers and healthcare providers.

Results

The EPHI revealed that bypass activities widely exist on Hainan Island in both inpatient and outpatient care, with patients tending to travel from less developed regions with fewer healthcare resources to more highly developed regions with more healthcare resources to receive healthcare. Comparison with spatial accessibility demonstrated how bypass activities on Hainan produced an under-utilization of doctors in less developed regions and over-utilization of doctors in more developed coastal regions.

Conclusions

This case study on Hainan Island demonstrates that this new index can very clearly identify both the sources and sinks of patient spatial tendencies. Combining these results with spatial accessibility of healthcare resources, how efficiently the available supply matches the utilization can be revealed, indicating wide-ranging applicability for local governments and policymakers.

Pediatric Participant Retention Rates in a Longitudinal Malaria Immunology Study

The resurgence of drug-resistant Plasmodium falciparum parasites continues to motivate the development of a safe and efficacious malaria vaccine. Immuno-epidemiologic studies of naturally acquired immunity (NAI) have been a useful strategy to identify new malaria vaccine targets. However, retention of pediatric participants throughout longitudinal studies is essential for gathering comprehensive exposure and outcome data. Within the context of a 3-year cohort (N = 400) study involving monthly finger prick and bi-annual venous blood sample collections, we conducted qualitative surveys to assess factors impacting participant retention. Phase 1 was conducted 3 months after enrollment in July 2018 and phase 2, 12 months later. In phase 1, 236 parents/guardians participated in focus groups and three withdrawn participants and 10 community health volunteers (CHVs) in key informant interviews. Qualitative analysis indicated overall satisfaction with the study, with 61.8% (136/220 respondents) reporting no concerns. Focus group discussants associated attendance with benefits such as improved access to comprehensive healthcare services. Community health volunteers reported concerns over village rumors of inappropriate use of blood samples and dangers associated with venous blood draws. Phase 2 involved 205 parents/guardians and revealed continued satisfaction, with 46.3% (95/205) identifying no concerns, but expressed increasing worries regarding the amount of venous blood sample. This concern was reflected in an uptick of missed visits when venous blood samples were scheduled. Future studies will address parental concerns to determine whether community engagement and education measures increase study retention until completion.

Spatial-Temporal Accessibility and Inequality of Veterinary Service in Hong Kong: A Geographic Information System-Based Study

Veterinary services are vital to the welfare of pets and their owners. Previous studies examined multiple factors affecting pet owners' decision to consult veterinarians, yet few studied the spatial accessibility of veterinary services. This study is one of the pioneering studies on the spatial-temporal accessibility of veterinary service and how it is associated with social and spatial inequality in Hong Kong. We measured the spatial availability and accessibility of both general and 24/7 veterinary clinics (i.e., veterinary clinics offering service for 24 hours, seven days a week or providing emergency services outside of business hours) using Geographic Information System and principal component analysis. We found that the spatial distribution pattern of general and 24/7 veterinary clinics can be explained by the average district-to-district distances and the area of a district. In addition, social and spatial inequality of access to veterinary services were observed. The spatial accessibility of general veterinary clinics within walking distance is negatively correlated with household size and the number of public-housing and subsidized-housing households, but positively correlated with the number of private-housing households. The spatial availability and accessibility of 24/7 veterinary service are positively correlated with the number of private housing households and households with the highest monthly household income, and the latter also positively correlates with a population with a post-secondary degree, further shedding light on the social and spatial inequality issue that communities with wealthier households and highly educated populations have more accessibility to 24/7 veterinary services. Last, we argue that the need-based veterinary support tends to target remote rural areas while overlooking the new growth areas close to the traditional urban core but poor in accessibility to veterinary care. Therefore, a comprehensive investigation into the pet ownership landscape and their needs over space and time will be beneficial to construct a more robust animal welfare system in Hong Kong.

Using GIS to Understand the Influence of Hurricane Harvey on Spatial Access to Primary Care

Hurricanes can have a significant impact on the functioning and capacity of healthcare systems. However, little work has been done to understand the extent to which hurricanes influence local residents' spatial access to healthcare. Our study evaluates the change in spatial access to primary care physicians (PCPs) between 2016 and 2018 (i.e., before and after Hurricane Harvey) in Harris County, Texas. We used an enhanced 2-step floating catchment area (E2SFCA) method to measure spatial access to PCPs at the census tract level. The results show that, despite an increased supply of PCPs across the county, most census tracts, especially those in the northern and eastern fringe areas, experienced decreased access during this period as measured by the spatial access ratio (SPAR). We explain this decline in SPAR by the shift in the spatial distribution of PCPs to the central areas of Harris County from the fringe areas after Harvey. We also examined the socio-demographic impact in the SPAR change and found little variation in change among different socio-demographic groups. Therefore, public health professionals and disaster managers may use our spatial access measure to highlight the geographic disparities in healthcare systems. In addition, we recommend considering other social and institutional dimensions of access, such as users' needs, preferences, resource capacity, mobility options, and quality of healthcare services, in building a resilient and inclusive post-hurricane healthcare system.

Adult mental health and child maltreatment: An ecological study across rural-urban and economic continua with implications for post-pandemic human services

This ecological, county-level, cross-sectional study examines relationships between the mental health of adults (IV) and child maltreatment report rates (DV), as they vary by socioeconomic distress and rurality (n = 3015 counties), using the most recent available data from several linked sources. In a two-way model, maltreatment reports increased 20.1% for each additional half day of poor mental health in metro counties, 11.7% in nonmetro counties, and 13% in rural counties. Our zero-inflated negative binomial model, moderated by rurality and economic distress, showed a significant relationship between the number of poor mental health days and increased child maltreatment report rates in counties (χ²  = 145.52, p < 0.0001). Investment in prevention and treatment of adult mental health concerns is imperative, especially in light of the increase in mental health problems caused by the coronavirus disease 2019 pandemic and increased tension within national political debate. Our results indicate successful support of adult mental health will prevent child maltreatment and reduce the cyclical financial burden of child maltreatment and mental health concerns.

Isolating the Role of the Transport System in Individual Accessibility Differences: A Space-Time Transport Performance Measure

Accessibility differences across individuals are a core topic in the transport equity debate. Space-Time Accessibility measures (STAs) have often been used to show such differences, given their sensitiveness to individual spatial and temporal constraints. However, given their complexity, STAs cannot properly isolate the specific role of the transport system in individual accessibility differences, since it is mixed with several other spatial, individual and temporal factors. To isolate the role of the transport system, this study introduces a Space-Time Transport Performance measure (STTP) that (a) grounds on the individual daily schedule of fixed activities, (b) calculates the generalised transport costs each individual has to bear to perform such schedule, and (c) weights it against the Euclidean distance between the activities of such a schedule. STTP is tested together with STA for a small sample of individuals living and performing their daily activities within the 22nd district of Vienna. This test provides two main findings: first, individual differences registered by STTP tend to be smaller than those highlighted by STA, according to the former’s more narrowed and transport-specific approach. Second, individuals with the highest STA do not necessarily register the highest STTP (and vice versa). Indeed, some may experience limited transport performances when running their mandatory daily schedule, while registering a high degree of access to discretionary activities according to their constraints and opportunities at disposal (and vice versa). Considering these results, STTP may be seen as a complementary indicator to be used together with STA to analyse both general and transport-specific individual accessibility differences. Its role is particularly important for transport policy makers, who should understand which accessibility differences are directly linked to the performances of the transport system and could be remediated through transport policies.

Supply-demand matching of medical services at a city level under the background of hierarchical diagnosis and treatment - based on Didi Chuxing Data in Haikou, China

BACKGROUND

Implementation of the Healthy China Strategy and the hierarchical diagnosis and treatment system has injected new vitality into medical services. Given the insufficient supply of medical services and increasing demand for medical treatment, exploring the supply-demand pattern of medical services has become an urgent theoretical and practical problem to be solved. The equity of healthcare facilities has received widespread attention, but due to limited data, there is little research on the supply-demand pattern of medical services. This study focuses on evaluating the supply-demand matching pattern of medical services at different levels in Haikou City with big geographic data and promoting the realization of a balance between medical supply and demand.

METHODS

This study utilizes spatial data of medical institutions, Didi Chuxing Data, and population density data. Firstly, use the two-step floating catchment area method and GIS spatial analysis to explore characteristics of the supply-demand patterns of medical services at different levels in Haikou. Secondly, we mine residents' demand for medical treatment based on Didi Chuxing Data. Then combined with population density data, divide supply-demand matching of medical institutions into four types. Finally, propose optimization strategies for the problems.

RESULTS

The accessibility pattern of high-level medical institutions in Haikou presents high in the north and low in the south. The accessibility pattern of low-level medical institutions is the opposite. High-level medical institutions have a strong demand for medical treatment, which is less hampered by distance. The healthcare demand of low-level medical institutions is small, and they mainly are medium- and short-distance medical travel. The types of medical services at different levels are mainly "low supply - low demand" and "high supply - low demand" types.

CONCLUSIONS

Medical services at different levels in Haikou are mainly in supply-demand imbalance. Therefore, we put forward optimization strategies to promote the equity of primary medical services, such as propelling the establishment and improvement of the hierarchical diagnosis and treatment system, building a new model of medical and health service supply, and strengthening balanced coverage of primary medical institutions. The mining of big geographic data is beneficial to alleviate the mismatch between medical supply and demand, although the data and methods need to be improved.

Unmasking unexpected health care inequalities in China using urban big data: Service-rich and service-poor communities

Geographic accessibility plays a key role in health care inequality but remains insufficiently investigated in China, primarily due to the lack of accurate, broad-coverage data on supply and demand. In this paper, we employ an innovative approach to local supply-and-demand conditions to (1) reveal the status quo of the distribution of health care provision and (2) examine whether individual households from communities with different housing prices can acquire equal and adequate quality health care services within and across 361 cities in China. Our findings support previous conclusions that quality hospitals are concentrated in cities with high administrative rankings and developmental levels. However, after accounting for the population size an “accessible” hospital serves, we discern “pro-poor” inequality in accessibility to care (denoted as GAPSD) and that GAPSD decreases along with increases in administrative rankings of cities and in community ratings. This paper is significant for both research and policy-making. Our approach successfully reveals an “unexpected” pattern of health care inequality that has not been reported before, and our findings provide a nationwide, detailed benchmark that facilitates the assessment of health and urban policies, as well as associated policy-making.

A multicriteria decision analysis framework to measure equitable healthcare access during COVID-19

The ongoing novel coronavirus (COVID-19) pandemic has highlighted the need for individuals to have easy access to healthcare facilities for treatment as well as vaccinations. The surge in COVID-19 hospitalizations during 2020 also underscored the fact that accessibility to nearby hospitals for testing, treatment and vaccination sites is crucial for patients with fever or respiratory symptoms. Although necessary, quantifying healthcare access is challenging as it depends on a complex interaction between underlying socioeconomic and physical factors. In this case study, we deployed a Multi Criteria Decision Analysis (MCDA) approach to uncover the barriers and their effect on healthcare access. Using a least cost path (LCP) analysis we quantified the costs associated with healthcare access from each census block group in the Los Angeles metropolitan area (LA Metro) to the nearest hospital. Social vulnerability reported by the Centers for Disease Control and Prevention (CDC), the daily number of COVID-19 cases from the Los Angeles open data portal and built environment characteristics (slope of the street, car ownership, population density distribution, walkability, traffic collision density, and speed limit) were used to quantify overall accessibility index for the entire study area. Our results showed that the census block groups with a social vulnerability index above 0.75 (high vulnerability) had low accessibility owing to the higher cost of access to nearby hospitals. These areas were also coincident with the hotspots for COVID-19 cases and deaths which highlighted the inequitable exposure of socially disadvantaged populations to COVID-19 infections and how the pandemic impacts were exacerbated by the synergistic effect of socioeconomic status and built environment characteristics of the locations where the disadvantaged populations resided. The framework proposed herein could be adapted to geo-target testing/vaccination sites and improve accessibility to healthcare facilities in general and more specifically among the socially vulnerable populations residing in urban areas to reduce their overall health risks during future pandemic outbreaks.

Measuring Spatial Accessibility to Hospitals of Acute Myocardial Infarction in Multi Period Scale: A Case Study in Shijingshan District, Beijing, China

The hospital accessibility of Acute Myocardial Infarction (AMI) emergency treatment is of great importance, not only for improving the survival rate of patients but also for protecting the basic human right to health care. Traditional AMI emergency treatment research often does not consider ways to shorten the travel time to hospitals for AMI patients and does not reflect the actual time it takes to travel to hospitals, which is critical to AMI emergency treatment. To avoid these shortcomings, this study proposes a method of accessibility measurement based on Web Mapping API (Application Programming Interface) to obtain travel time to hospitals during different periods, then calculated the AMI hospital accessibility based on these detailed data. This study considered the Shijingshan District, Beijing, China, as an empirical case. The study discovered significant differences in the temporal and spatial characteristics of the AMI hospital accessibility on weekdays and weekends. The analysis revealed that travel time to hospitals and traffic congestion are the two main factors affecting AMI hospital accessibility. The research results shed new light on the accessibility of urban medical facilities and provide a scientific basis with which local governments can optimize the spatial structure of medical facilities.

The Promotional Effect of Health Education on the Medical Service Utilization of Migrants: Evidence From China

There were 376 million migrants in China by 2020, who made significant contributions to urban development. However, they used limited medical services and had lower self-reported health status than inflow city residents. Based on this, this study uses the cross-sectional data of the 2017 China Migrants Dynamic Survey (CMDS) to construct a multiple linear regression model to empirically study the role of health education in improving medical services utilization for migrants. It finds that compared to migrants without health education, the probability of the medical service utilization for migrants with health education has increased significantly, and counseling is more effective than other methods for health education. This promotion effect of health education has been established after a series of robustness tests. Furthermore, this study finds that the closer the migrants are to medical service resources, the greater the effect of health education on medical services utilization for migrants. The heterogeneity test shows that the effect of health education on medical services utilization for migrants is greater among the non-elderly and those with lower education levels. From the perspective of health education, the findings in this study provide empirical evidence to support the government in formulating policies to improve the utilization of medical services for migrants and reduce health inequality.

Multiscale Effects of Multimodal Public Facilities Accessibility on Housing Prices Based on MGWR: A Case Study of Wuhan, China

The layout of public service facilities and their accessibility are important factors affecting spatial justice. Previous studies have verified the positive influence of public facilities accessibility on house prices; however, the spatial scale of the impact of various public facilities accessibility on house prices is not yet clear. This study takes transportation analysis zone of Wuhan city as the spatial unit, measure the public facilities accessibility of schools, hospitals, green space, and public transit stations with four kinds of accessibility models such as the nearest distance, real time travel cost, kernel density, and two step floating catchment area (2SFCA), and explores the multiscale effect of public services accessibility on house prices with multiscale geographically weighted regression model. The results show that the differentiated scale effect not only exists among different public facility accessibilities, but also exists in different accessibility models of the same sort of facility. The article also suggests that different facilities should adopt its appropriate accessibility model. This study provides insights into spatial heterogeneity of urban public service facilities accessibility, which will benefit decision making in equal accessibility planning and policy formulation for the layout of urban service facilities.

Modeling of emergency support capacity and optimization of delivery service system for urban living materials under uncertain situations: a case study of Xi'an City during COVID-19 epidemic

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has brought a heavy burden and severe challenges to the global economy and society, forcing different countries and regions to take various preventive and control measures ranging from normal operations to partial or complete lockdowns. Taking Xi'an city as an example, based on multisource POI data for the government's vegetable storage delivery points, logistics terminal outlets, designated medical institutions, communities, etc., this paper uses the Gaussian two-step floating catchment area method (2SFCA) and other spatial analysis methods to analyze the spatial pattern of emergency support points (ESPs) and express logistics terminals in different situations. It then discusses construction and optimization strategies for urban emergency support and delivery service systems. The conclusions are as follows. (1) The ESPs are supported by large-scale chain supermarkets and fresh supermarkets, which are positively related to the population distribution.The spatial distribution of express logistics terminals is imbalanced, dense in the middle while sparse at the edges. 90% of express terminals are located within a 500 m distance of communities, however, some terminals are shared, which restrict their ability to provide emergency support to surrounding residents. (2) In general, accessibility increases as the number of ESPs increases; under normal traffic, as the distance threshold increases, the available ESPs increase but accessibility slightly decreases; with a traffic lockdown, the travel distance of residents is limited, and as ESPs increase, accessibility and the number of POIs covered significantly increase. (3) The spatial accessibility of the ESPs has a "dumbbell-shaped" distribution, with highest accessibility in the north and south, higher around the second ring road, slightly lower in the center, and lowest near the third ring road at east and west. (4) With the goal of "opening up the logistics artery and unblocking the distribution microcirculation", based on "ESPs + couriers + express logistics terminals + residents", this paper proposes to build and optimize the urban emergency support and delivery service system to improve the comprehensive ability of the city to cope with uncertain risks.

Siting of Healthcare Care Facilities Based on the Purpose of Their Operation, Demographic Changes, Environmental Characteristics, and the Impact on Public Health

A contemporary approach to the spatial design of healthcare care facilities faces numerous challenges at the crossroads of multidisciplinary topics of architecture and urbanism, healthcare, security, and organisational sciences. Due to the unique combination of uses, users and architectural expression, they are defined as urban nodes. With their inclusion, architects facilitate a better placing of healthcare facilities, indirectly improving human health. The purpose of the article is to seek guidelines for the siting of healthcare facilities to provide suitable and equal healthcare to different social structures, and for the optimal and fair spatial distribution of healthcare services. The descriptive method was used to review literature on the siting of healthcare facilities based on the purpose of their operation, demographic changes, environmental characteristics, and the impact on public health. This method was selected as it facilitates data acquisition from various sources and a comprehensive understanding of the topic discussed. The results of the research show how important the impact of the healthcare care facilities siting on human health and the wider social significance of the topic discussed is. The findings may provide guidelines and proposals for future spatial decisions.

Assessing Spatial Accessibility to Primary Health Care Services in Beijing, China

Primary health care has been emphasized as a pillar of China’s current round of health reforms throughout the previous decade. The purpose of this study is to analyze the accessibility of primary health care services in Beijing and to identify locations with a relative scarcity of health personnel. Seven ecological conservation districts, which are relatively underdeveloped, were selected in the study. The Gini coefficient and Lorenz curve, as well as the shortest trip time and modified two-step floating catchment area (M2SFCA) approach, are used to quantify inequalities in primary health care resources and spatial accessibility. The Gini coefficient of primary medical services was calculated as high as 0.705, showing a significant disparity in primary care services. A total of 81.22% of communities reached the nearest primary care institution within 15 min. The average accessibility of primary healthcare services, as measured by the number of health professionals per 1000 population, was 2.34 in the 1715 communities of seven ecological conservation districts. Three hundred and ninety-one communities (22.80%) were identified with relatively low accessibility. More primary health professionals should be allocated to Miyun, Mentougou, and Changping Districts. Overall, the primary healthcare resources were distributed unevenly in most districts. According to our study, expanding primary healthcare institutions, increasing the number of competent health professionals, and enhancing road networks will all be effective ways to increase spatial accessibility and reduce primary healthcare service disparity in Beijing.

How did micro-mobility change in response to COVID-19 pandemic? A case study based on spatial-temporal-semantic analytics

Cities worldwide adopted lockdown policies in response to the outbreak of coronavirus disease 2019 (COVID-19), significantly influencing people's travel behavior. In particular, micro-mobility, an emerging mode of urban transport, is profoundly shaped by this crisis. However, there is limited research devoted to understanding the rapidly evolving trip patterns of micro-mobility in response to COVID-19. To fill this gap, we analyze the changes in micro-mobility usage before and during the lockdown period exploiting high-resolution micro-mobility trip data collected in Zurich, Switzerland. Specifically, docked bike, docked e-bike, and dockless e-bike are evaluated and compared from the perspective of space, time and semantics. First, the spatial and temporal analysis results uncover that the number of trips decreased remarkably during the lockdown period. The striking difference between the normal and lockdown period is the decline in the peak hours of workdays. Second, the origin-destination flows are used to construct spatially embedded networks. The results suggest that the origin-destination pairs remain similar during the lockdown period, while the numbers of trips between each origin-destination pair is reduced due to COVID-19 pandemic. Finally, the semantic analysis is conducted to uncover the changes in trip purpose. It is revealed that the proportions of Home, Park, and Grocery activities increase, while the proportions of Leisure and Shopping activities decrease during the lockdown period. The above results can help planners and policymakers better make evidence-based policies regarding micro-mobility in the post-pandemic society.

Using the location-allocation P-median model for optimising locations for health care centres in the city of Jeddah City, Saudi Arabia

Considering spatial accessibility of health services is a critical part in the planning and management of health services. There is evidence that poor geographical locations can obstruct prompt basic health care services to some population sections. We developed a location-allocation P-median model for health centres after analysing their sites, demand location of health services and the road network in Jeddah, Saudi Arabia. This model attempts to optimize health care services network and to put forward location recommendations to maximise service coverage. Our model is shown to be useful as it provides a robust evidence base to urban planners and policymakers responsible for making spatial decisions for the development of the health sector. Besides, it follows the paradigm of new urbanism that encourages decentralisation of essential facilities including basic healthcare in cities, where emphasis is on offering all basic services within walkable distances of 15 min. or less.

Incorporating broadband durability in measuring geographic access to health care in the era of telehealth: A case example of the 2-step virtual catchment area (2SVCA) Method

The COVID-19 (coronavirus disease 2019) pandemic has expanded telehealth utilization in unprecedented ways and has important implications for measuring geographic access to healthcare services. Established measures of geographic access to care have focused on the spatial impedance of patients in seeking health care that pertains to specific transportation modes and do not account for the underlying broadband network that supports telemedicine and e-health. To be able to measure the impact of telehealth on healthcare access, we created a pilot augmentation of existing methods to incorporate measures of broadband accessibility to measure geographic access to telehealth. A reliable measure of telehealth accessibility is important to enable policy analysts to assess whether the increasing prevalence of telehealth may help alleviate the disparities in healthcare access in rural areas and for disadvantaged populations, or exacerbate the existing gaps as they experience "double burdens."

Spatial Accessibility Assessment of Prehospital EMS with a Focus on the Elderly Population: A Case Study in Ningbo, China

The spatial accessibility of prehospital EMS is particularly important for the elderly population’s physiological functions. Due to the recent expansion of aging populations all over the globe, elderly people’s spatial accessibility to prehospital EMS presents a serious challenge. An efficient strategy to address this issue involves using geographic information systems (GIS)-based tools to evaluate the spatial accessibility in conjunction with the spatial distribution of aging people, available road networks, and prehospital EMS facilities. This study employed gravity model and empirical Bayesian Kriging (EBK) interpolation analysis to evaluate the elderly’s spatial access to prehospital EMS in Ningbo, China. In our study, we aimed to solve the following specific research questions: In the study area, “what are the characteristics of the prehospital EMS demand of the elderly?” “Do the elderly have equal and convenient spatial access to prehospital EMS?” and “How can we satisfy the prehospital EMS demand of an aging population, improve their spatial access to prehospital EMS, and then ensure their quality of life?” The results showed that 37.44% of patients admitted to prehospital EMS in 2020 were 65 years and older. The rate of utilization of ambulance services by the elderly was 27.39 per 1000 elderly residents. Ambulance use by the elderly was the highest in the winter months and the lowest in the spring months (25.90% vs. 22.38%). As for the disease spectrum, the main disease was found to be trauma and intoxication (23.70%). The mean accessibility score was only 1.43 and nearly 70% of demand points had scored lower than 1. The elderly’s spatial accessibility to prehospital EMS had a central-outward gradient decreasing trend from the central region to the southeast and southwest of the study area. Our proposed methodology and its spatial equilibrium results could be taken as a benchmark of prehospital care capacity and help inform authorities’ efforts to develop efficient, aging-focused spatial accessibility plans.

Reducing exposure to COVID-19 by improving access to fever clinics: an empirical research of the Shenzhen area of China

Background

The current 2019 coronavirus disease (COVID-19) pandemic is hitting citizen’s life and health like never before, with its significant loss to human life and a huge economic toll. In this case, the fever clinics (FCs) were still preserved as one of the most effective control measures in China, but this work is based on experience and lacks scientific and effective guidance. Here, we use travel time to link facilities and populations at risk of COVID-19 and identify the dynamic allocation of patients’ medical needs, and then propose the optimized allocation scheme of FCs.

Methods

We selected Shenzhen, China, to collect geospatial resources of epidemic communities (ECs) and FCs to determine the ECs’ cumulative opportunities of visiting FCs, as well as evaluate the rationality of medical resources in current ECs. Also, we use the Location Set Covering Problem (LSCP) model to optimize the allocation of FCs and evaluate efficiency.

Results

Firstly, we divide the current ECs into 3 groups based on travel time and cumulative opportunities of visiting FCs within 30 min: Low-need communities (22.06%), medium-need communities (59.8%), and high-need communities (18.14%) with 0,1–2 and no less than 3 opportunities of visiting FCs. Besides, our work proposes two allocation schemes of fever clinics through the LSCP model. Among which, selecting secondary and above hospitals as an alternative in Scheme 1, will increase the coverage rate of hospitals in medium-need and high-need communities from 59.8% to 80.88%. In Scheme 2, selecting primary and above hospitals as an alternative will increase the coverage rate of hospitals in medium-need and high-need communities to 85.29%, with the average travel time reducing from 22.42 min to 17.94 min.

Conclusions

The optimized allocation scheme can achieve two objectives: a. equal access to medical services for different types of communities has improved while reducing the overutilization of high-quality medical resources. b. the travel time for medical treatment in the community has reduced, thus improving medical accessibility. On this basis, during the early screening in prevention and control of the outbreak, the specific suggestions for implementation in developing and less developed countries are made.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06831-4.

A Review of Recent Spatial Accessibility Studies That Benefitted from Advanced Geospatial Information: Multimodal Transportation and Spatiotemporal Disaggregation

Spatial accessibility provides significant policy implications, describing the spatial disparity of access and supporting the decision-making process for placing additional infrastructure at adequate locations. Several previous reviews have covered spatial accessibility literature, focusing on empirical findings, distance decay functions, and threshold travel times. However, researchers have underexamined how spatial accessibility studies benefitted from the recently enhanced availability of dynamic variables, such as various travel times via different transportation modes and the finer temporal granularity of geospatial data in these studies. Therefore, in our review, we investigated methodological advancements in place-based accessibility measures and scrutinized two recent trends in spatial accessibility studies: multimodal spatial accessibility and temporal changes in spatial accessibility. Based on the critical review, we propose two research agendas: improving the accuracy of measurements with dynamic variable implementation and furnishing policy implications granted from the enhanced accuracy. These agendas particularly call for the action of geographers on the full implementation of dynamic variables and the strong linkage between accessibility and policymaking.

Assessing Health Resources Equipped with Hemodynamic Rooms in the Portuguese-Spanish Borderland: Cross-Border Cooperation Strategies as a Possible Solution

Portugal and Spain share one of the greatest European borderland areas. This fact has direct impacts on a large territory and consequently on the communities’ living in it. Still, even if the border areas represent an essential fraction of the territory, planning policies have not resulted in specific cooperation programs that could enable sharing general leisure and recreation assets and infrastructures and collaboration in critical domains—i.e., the case of the health sector. The present study aims to assess the territorial accessibility to the hemodynamic rooms by the potential population of the Spanish-Portuguese transition areas that may suffer an acute myocardial infarction. Contextually, this study employed a spatial interaction model based on the three-step floating catchment area method (method-3SFCA). By applying these methods, it was possible to develop a map of accessibility to health infrastructures equipped with hemodynamics rooms on both sides of the border that may answer the Spanish-Portuguese border populations’ needs. Besides, while granting valuable information for decision-makers regarding the need to develop new infrastructures to guarantee that even considering cross border cooperation, everyone gets access to a hemodynamics room within the critical intervention period.

Psychometric evaluation of the perceived access to health care questionnaire

BACKGROUND AND OBJECTIVE

Access to health care is a universal concern. Therefore, this study was conducted to develop a questionnaire to assess the Perceived Access to Health care based on Penchansky and Thomas's definition of access and the assessment of its psychometric properties.

METHOD

The initial questionnaire contains 31 items developed based on a deductive approach with an extensive review of the related literature. Content validity, face validity, construct validity, internal consistency, and instrument reliability were further examined. Data analysis was conducted using SPSS software version 24, R software version 4, and lavaan package.

RESULTS

The initial questionnaire was examined using qualitative content validity, and the necessary modifications were applied to each item. The content validity ratio (CVR) was approved in 30 items with a value greater than 0.78, and one item with a CVR value lower than 0.78 was removed. In the case of the content validity index (CVI), 29 items were approved with a CVI value of greater than 0.79, and one item with a CVI value between 0.70 and 0.79 was revised. In qualitative face validity, all items were approved by a panel of experts and the participants. All 30 items with an impact score index higher than 1.5 were approved for the next steps. The confirmatory factor analysis results showed that the six-factor model of access to health care has an appropriate fit. Cronbach's alpha coefficient for the questionnaire was calculated 0.86. The value of Cronbach's alpha for the dimensions of availability, accessibility, affordability, accommodation, acceptability, and awareness were 0.61, 0.76, 0.66, 0.60, 0.80, and 0.76, respectively. The Intraclass Correlation Index (ICC) value for reliability (test-retest) of the whole instrument was calculated 0.94 using the two-way mixed absolute agreement method.

CONCLUSION

The success of health programs depends on eliminating barriers to access to provided health care services. One of the most critical barriers to understanding access is a perception of limited access. This questionnaire might be used further to understand perceived health care access in different global contexts.

Spatial accessibility assessment of COVID-19 patients to healthcare facilities: A case study of Florida

During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the "equal access" assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.

Spatial Behavior of Cancer Care Utilization in Distance Decay in the Northeast Region of the U.S

PURPOSE

Spatial behavior of patients in utilizing health care reflects their travel burden or mobility, accessibility for medical service, and subsequently outcomes from treatment. This paper derives the best-fitting distance decay function to capture the spatial behaviors of cancer patients in the Northeast region of the U.S., and examines and explains the spatial variability of such behaviors across sub-regions.

PRINCIPAL RESULTS

(1) 46.8%, 85.5%, and 99.6% of cancer care received was within a driving time of 30, 60 and 180 minutes, respectively. (2) The exponential distance decay function is the best in capturing the travel behavior of cancer patients in the region and across most sub-regions. (3) The friction coefficient in the distance decay function is negatively correlated with the mean travel time. (4) The best-fitting function forms are associated with network structures. (5) The variation of the friction coefficient across sub-regions is related to factors such as urbanicity, economic development level, and market competition intensity.

MAJOR CONCLUSIONS

The distance decay function offers an analytic metric to capture a full spectrum of travel behavior, and thus a more comprehensive measure than average travel time. Examining the geographic variation of travel behavior needs a reliable analysis unit such as organically defined "cancer service areas", which capture relevant health care market structure and thus are more meaningful than commonly-used geopolitical or census area units.

Exploring Equity in Healthcare Services: Spatial Accessibility Changes during Subway Expansion

The unequal allocation of healthcare resources raises many fundamental problems, one of which is how to address inequity in population health. This paper focuses on disparities in public transport healthcare accessibility, with a special focus on an expanding subway system. Based on a vulnerability index, including factors that are likely to limit healthcare opportunities, a two-step floating catchment area method was used to assess the distribution of supply and demand for healthcare. Quantity, quality, and walking distance accessibility were aggregated into hexagonal grids. The Theil index was used to measure inequity and understand the influence of subways on spatial disparities in healthcare accessibility. The ongoing construction of the subway has heterogeneous impacts on healthcare accessibility for different parts of the city and exacerbates spatial inequity in many areas. In an environment where people in peri-urban areas are excluded from healthcare access because of low subway coverage, the results suggest that the potential for subways to address inaccessibility is limited. The findings highlight the requirement of efficient public transport services and are relevant to researchers, planners, and policymakers aiming to improve accessibility to healthcare, especially for populations who dwell in winter cities.

Validating Gravity-Based Market Share Models Using Large-Scale Transactional Data

Customer patronage behavior has been widely studied in market share modeling contexts, which is an essential step toward estimating retail sales and finding new store locations in a competitive setting. Existing studies have conducted surveys to estimate merchants' market share and factors of attractiveness to use in various proposed mathematical models. Recent trends in Big Data analysis allow us to better understand human behavior and decision making, potentially leading to location models with more realistic assumptions. In this article, we propose a novel approach for validating the Huff gravity market share model, using a large-scale transactional dataset that describes customer patronage behavior at a regional level. Although the Huff model has been well studied and widely used in the context of sales estimation, competitive facility location, and demand allocation, this article is the first in validating the Huff model with a real dataset. Our approach helps to easily apply the model in different regions and with different merchant categories. Experimental results show that the Huff model fits well when modeling customer shopping behavior for a number of shopping categories, including grocery stores, clothing stores, gas stations, and restaurants. We also conduct regression analysis to show that certain features such as gender diversity and marital status diversity lead to stronger validation of the Huff model. We believe we provide strong evidence, with the help of real-world data, that gravity-based market share models are viable assumptions for retail sales estimation and competitive facility location models.

Integrating Socioeconomic Status and Spatial Factors to Improve the Accessibility of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation

Health promotion empowers people, communities, and societies to take charge of their own health and quality of life. To strengthen community-based support, increase resource accessibility, and achieve the ideal of aging, this study targets the question of maximum equity with minimum values, taking distances and spatial and non-spatial factors into consideration. To compare disparities in the accessibility of community care resources and the optimization of allocation, methods for community care resource capacity were examined. This study also investigates units based on basic statistical area (BSA) to improve the limitation of larger reference locations (administrative districts) that cannot reflect the exact locations of people. The results show the capacity redistribution of each service point within the same total capacity, and the proposed method brings the population distribution of each demand to the best accessibility. Finally, the grading system of assessing accessibility scarcity allows the government to effectively categorize the prior improvement areas to achieve maximum equity under the same amount of care resources. There are 2046 (47.26%) and 396 (9.15%) BSAs that should be improved before and after optimization, respectively. Therefore, integrating socioeconomic status and spatial factors to assess accessibility of community-based care resources could provide comprehensive consideration for equal allocation.

Mapping the Accessibility of Medical Facilities of Wuhan during the COVID-19 Pandemic

In December 2019, the coronavirus disease 2019 (COVID-19) pandemic attacked Wuhan, China. The city government soon strictly locked down the city, implemented a hierarchical diagnosis and treatment system, and took a series of unprecedented pharmaceutical and non-pharmaceutical measures. The residents’ access to the medical resources and the consequently potential demand–supply tension may determine effective diagnosis and treatment, for which travel distance and time are key indicators. Using the Application Programming Interface (API) of Baidu Map, we estimated the travel distance and time from communities to the medical facilities capable of treating COVID-19 patients, and we identified the service areas of those facilities as well. The results showed significant differences in service areas and potential loading across medical facilities. The accessibility of medical facilities in the peripheral areas was inferior to those in the central areas; there was spatial inequality of medical resources within and across districts; the amount of community healthcare centers was insufficient; some communities were underserved regarding walking distance; some medical facilities could be potentially overloaded. This study provides reference, in the context of Wuhan, for understanding the spatial aspect of medical resources and residents’ relevant mobility under the emergency regulation, and re-examining the coordination of emergency to improve future planning and utilization of medical facilities at various levels. The approach can facilitate policymakers to assess potential loading of medical facilities, identify low-accessibility areas, and deploy new medical facilities. It also implies that the accessibility analysis can be rapid and relevant even only with open-source data.

Patients with geographic barriers to health care access are prescribed a higher proportion of drugs with pharmacogenetic testing guidelines

Pharmacogenetic (PGx) testing may be particularly beneficial in medically underserved populations by reducing the number of appointments required to optimize drug therapy and increasing the effectiveness of less expensive off-patent drugs. The objective of this study was to identify patient populations with poor health care access and assess prescribing trends for drugs with published PGx testing guidelines. We used electronic health record data from 67,753 University of Florida Health patients, geographic access scores calculated via the 2-step floating catchment area method, and a composite measure of socioeconomic status. Comparing the poorest (Q4) and greatest (Q1) access score quartiles, poor geographic access was significantly associated with fewer prescriber encounters (incidence rate ratio [IRR] 0.88, 95% confidence interval [CI] 0.86-0.91), fewer total unique drugs (IRR 0.92, 95% CI 0.9-0.95), and fewer PGx guideline drugs (IRR 0.94, 95% CI 0.9-0.99). After correcting for number of unique drugs, patients in low-access areas were prescribed a greater proportion of PGx guideline drugs (IRR 1.08, 95% CI 1.04-1.13). We detected significant interactions between Black race and access score. Compared to Q1, Black patients with Q4 access scores were disproportionately affected and had fewer encounters (IRR 0.76, 95% CI 0.7-0.82) and a higher proportion of PGx drugs (IRR 1.26, 95% CI 1.13-1.41), creating further disparity. Overall, these results suggest that improved geographic access to PGx testing may allow prescribers to make more efficient use of limited opportunities to optimize therapy for drugs with PGx testing guidelines.

Divided by choice? For-profit providers, patient choice and mechanisms of patient sorting in the English National Health Service

This paper studies patient choice of provider following government reforms in the 2000s, which allowed for-profit surgical centers to compete with existing public National Health Service (NHS) hospitals in England. For-profit providers offer significant benefits, notably shorter waiting times. We estimate the extent to which different types of patients benefit from the reforms, and we investigate mechanisms that cause differential benefits. Our counterfactual simulations show that, in terms of the value of access, entry of for-profit providers benefitted the richest patients twice as much as the poorest, and white patients six times as much as ethnic minority patients. Half of these differences is explained by healthcare geography and patient health, while primary care referral practice plays a lesser, though non-negligible role. We also show that, with capitated reimbursement, different compositions of patient risks between for-profit surgical centers and existing public hospitals put public hospitals at a competitive disadvantage.

Use of geographical information systems in multiple sclerosis research: A systematic scoping review

INTRODUCTION

Geographical information system (GIS) and spatial analysis have an emerging role in the understanding and management of health-related outcomes. However, there is a knowledge gap about the extent to which GIS has supported multiple Sclerosis (MS) research. Therefore, this review aimed to explore the types of GIS applications and the complexity of their visualisation in MS research.

METHODS

A systematic scoping review was conducted based on York's five-stage framework. PubMed, Scopus and Web of Science were searched for relevant studies published between 2000 and 2020 using a comprehensive search strategy based on the main concepts related to GIS and MS. Grounded, inductive analysis was conducted to organize studies into meaningful application areas. Further, we developed a tool to assess the visualisation complexity of the selected papers.

RESULTS

Of 3,723 identified unique citations, 42 papers met our inclusion criteria for the final review. One or more of the following types of GIS applications were reported by these studies: (a) thematic mapping (37 papers); (b) spatial cluster detection (16 papers); (c) risk factors detection (16 papers); and (d) health access and planning (two papers). In the majority of studies (88%), the score of visualisation complexity was relatively low: three or less from the range of zero to six.

CONCLUSIONS

Although the number of studies using GIS techniques has dramatically increased in the last decade, the use of GIS in the areas of MS access and planning is still under-researched. Additionally, the capacity of GIS in visualising complex nature of MS care system is not yet fully investigated.

Towards healthy China 2030: Modeling health care accessibility with patient referral

One primary action plan in the Healthy China 2030 initiative is to build innovativepatient referral models for health care reform in China. To ensure people have sufficient and equitable health care access when the patient referral policy is enforced, a systematic evaluation of its effects on the health care system is needed. In this paper, we focus on one health policy metric, the health care accessibility, by considering the patient transfer between different levels of health care facilities under the context that the need for specialized treatment cannot be fulfilled by a low-level facility. We then propose three conceptual patient referral models and a hierarchical two-step floating catchment area method to evaluate health care accessibility in different patient referral scenarios. A case study of hospitals in Beijing, China has been conducted to justify the proposed model, revealing the spatial inequality of health care accessibility. We find that while the patient referral can leverage health care resources to a certain extent, such effects are only prominent in areas with good coverage of health care facilities; and the efficiency of the health care system can be compromised in areas with limited health care provisioning. To this end, the study provides scientific evidence for the planning and reform of the health care policy in the Healthy China 2030 initiative.

The effect of population distribution measures on evaluating spatial accessibility of primary health-care institutions: A case study from China

Improvement of the equality of geographical allocation of limited health-care resources requires an accurate evaluation of spatial accessibility of the facilities. The adoption of appropriate population distribution measures is one of the leading factors affecting such an evaluation. Using primary health-care institutions in Hainan, China as an example, this study aimed to explore the disparities embedded in spatial accessibility evaluations based on six common measures of population distribution, namely community/ village population (VillagePop), average population distribution (AveragePop), population distribution by night-time light intensity (NighttimelightPop) together with the public population databases LandScan, WorldPop and PoiPop for construction of the weights. The enhanced two-step floating catchment area method, two-way analysis of variance (ANOVA), Dunnett test, root mean square error and the mean absolute error were employed to assess and compare spatial accessibilities based on these different population distribution measures. The spatial accessibility of primary health-care institutions in Hainan was found to vary when plotted using the various population distribution measures mentioned. As indicated by the statistical outcomes of both ANOVA and the Dunnett test, using the spatial accessibility calculated by VillagePop as reference, those calculated by AveragePop and PoiPop were found to be significantly different. In addition, the spatial accessibilities calculated by AveragePop and PoiPop demonstrated higher error rates in the identification of underserved areas compared with the reference. Considering the limitations of public population databases, the adoption of night-time light data is highly recommended for estimating population distribution in the absence of high-resolution data.

Quantifying spatial accessibility of general practitioners by applying a modified huff three-step floating catchment area (MH3SFCA) method

BACKGROUND

It is necessary to ensure sufficient healthcare. The use of current, precise and realistic methods to model spatial accessibility to healthcare and thus improved decision-making is helping this process. Generally, these methods-which include the family of floating catchment area (FCA) methods-incorporate a number of criteria that address topics like access, efficiency, budget, equity and the overall system utilization. How can we measure spatial accessibility? This paper investigates a sophisticated approach for quantifying the spatial accessibility of general practitioners. (GPs). Our objective is the investigation and application of a spatial accessibility index by an improved Huff three-step floating catchment area (MH3SFCA) method.

METHODS

We modify and implement the huff model three-step floating catchment area (MH3SFCA) method and exemplary calculation of the spatial accessibility indices for the test study area. The method is extended to incorporate a more realistic way to model the distance decay effect. To that end, instead of a binary approach, a continuous approach is employed. Therefore, each distance between a healthcare site and the population is incorporated individually. The study area includes Swabia and the city of Augsburg, Germany. The data for analysis is obtained from following data sources: (1) Acxiom Deutschland GmbH (2020) provided a test dataset for the locations of general practitioners (GPs); (2) OpenStreetMap (OSM) data is utilized for road networks; and (3) the Statistische Ämter des Bundes und der Länder (German official census 2011) provided a population distribution dataset stemming from the 2011 Census.

RESULTS

The spatial accessibility indices are distributed in an inhomogeneous as well as polycentric pattern for the general practitioners (GPs). Differences in spatial accessibility are found mainly between urban and rural areas. The transitions from lower to higher values of accessibility or vice versa in general are smooth rather than abrupt. The results indicate that the MH3SFCA method is suited for comparing the spatial accessibility of GPs in different regions. The results of the MH3SFCA method can be used to indicate over- and undersupplied areas. However, the absolute values of the indices do not inherently define accessibility to be too low or too high. Instead, the indices compare the spatial relationships between each supply and demand location. As a result, the higher the value of the accessibility indices, the higher the opportunities for the respective population locations. The result for the study area are exemplary as the test input data has a high uncertainty. Depending on the objective, it might be necessary to further analyze the results of the method.

CONCLUSIONS

The application of the MH3SFCA method on small-scale data can provide an overview of accessibility for the whole study area. As many factors have to be taken into account, the outcomes are too complex for a direct and clear interpretation of why indices are low or high. The MH3SFCA method can be used to detect differences in accessibility on a small scale. In order to effectively detect over- or undersupply, further analysis must be conducted and/or different (legal) constraints must be applied. The methodology requires input data of high quality.

How to improve access to health care for Roma living in social exclusion: a concept mapping study

Background

Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic.

Methods

We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation).

Results

Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies.

Conclusions

Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01396-4.

Accessibility Assessment of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation

Equity in accessible healthcare is crucial for measuring health equity in community care policy. The most important objective of such a policy in Taiwan is empowering people and communities by improving health literacy and increasing access to healthcare resources. Using the nearest-neighbor two-step floating catchment area method, this study performed an accessibility assessment for community care resources before and after supply capacity optimization. For the target of maximum equity when allocating community care resources, taking maximum values, mean values and minimum values of the distances into consideration, three analytical allocation solutions for supply capability optimization were derived to further compare disparities in geographical accessibility. Three indicators, namely, the Gini coefficient, median minus mean and mean-squared error, were employed to assess the degree of optimization of geographical accessibility scores at the locations of the demand population and to determine the degree of geographic inequities in the allocation of community care resources. Our study proposed a method in which the minimum value of the distance is adopted as the approximate representation of distances between the service point and the locations of demand to determine the minimum value for supply capacity optimization. The study found that the method can effectively assess inequities in care resource allocation among urban and rural communities.

A Spatio-Temporal Analysis of the Health Situation in Poland Based on Functional Discriminant Coordinates

The aim of this study was to investigate if the provinces of Poland are homogeneous in terms of the observed spatio-temporal data characterizing the health situation of their inhabitants. The health situation is understood as a set of selected factors influencing inhabitants' health and the healthcare system in their area of residence. So far, studies concerning the health situation of selected territorial units have been based on data relating to a specific year rather than longer periods. The task of assessing province homogeneity was carried out in two stages. In stage one, the original spatio-temporal data space (space of multivariate time series) was transformed into a functional discriminant coordinates space. The resulting functional discriminant coordinates are synthetic measures of the health situation of inhabitants of particular provinces. These measures contain complete information regarding 8 diagnostic variables examined over a period of 6 years. In the second stage, the Ward method, commonly used in cluster analysis, was applied in order to identify groups of homogeneous provinces in the space of functional discriminant coordinates. Sixteen provinces were divided into four clusters. The homogeneity of the clusters was confirmed by the multivariate functional coefficient of variation.

An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China

Spatial accessibility to medical services (SAMS) is one of the most important indicators to examine the convenience for people to get access to medical services. In China, the difficulty in getting access to medical services is a commonly appreciated social problem. To mitigate this problem, Chinese government established the hierarchical diagnosis and treatment system (HDTS) in 2005. However, there is no existing study to examine the HDTS from the perspective of SAMS. This paper therefore introduces an integrative method to analyze SAMS in adopting HDTS. The introduced integrative method is developed by referring to the existing 2SFCA method, a commonly applied method for analyzing SAMS, and the characteristics of HDTS are taken into consideration. The application of the integrative method is demonstrated with reference to a Chongqing case. The research findings suggest that: 1) A new method to evaluate SAMS in the context of HDTS is needed; 2) The integrative method developed in this study is proven effective for analyzing SAMS in the context of HDTS through the case study; 3) The case results reveal that the implementation of HDTS can significantly improve the overall SAMS performance in Chongqing; 4) The desirable referral rate of HDTS is 1.24% in the case study by comparing the SAMS performance between different referral rates.

Methods of Measuring Spatial Accessibility to Health Care in Uganda

Ensuring everyone has access to health care regardless of demographic, geographic and social economic status is a key component of universal health coverage. In sub-Saharan Africa, where populations are often sparsely distributed and services scarcely available, reducing distances or travel time to facilities is key in ensuring access to health care. This chapter traces the key concepts in measuring spatial accessibility by reviewing six methods—Provider-to-population ratio, Euclidean distance, gravity models, kernel density, network analysis and cost distance analysis—that can be used to model spatial accessibility. The advantages and disadvantages of using each of these models are also laid out, with the aim of choosing a model that can be used to capture spatial access. Using an example from Uganda, a cost distance analysis is used to model travel time to the nearest primary health care facility. The model adjusts for differences in land use, weather patterns and elevation while also excluding barriers such as water bodies and protected areas in the analysis. Results show that the proportion of population within 1-h travel times for the 13 regions in the country varies from 64.6% to 96.7% in the dry period and from 61.1% to 96.3% in the wet period. The model proposed can thus be used to highlight disparities in spatial accessibility, but as we demonstrate, care needs to be taken in accurate assembly of data and interpreting results in the context of the limitations.

Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals

BACKGROUND

Access as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades. Most previous studies considered one-way trips, either getting ambulances to patients or transporting patients to hospitals. This research assesses spatiotemporal access to EMS at the shequ (the smallest administrative unit) level in Wuhan, China, attempting to fill a gap in literature by considering and comparing both trips in the evaluation of EMS access.

METHODS

Two spatiotemporal access measures are adopted here: the proximity-based travel time obtained from online map services and the enhanced two-step floating catchment area (E-2SFCA) which is a gravity-based model. First, the travel time is calculated for the two trips involved in one EMS journey: one is from the nearest EMS station to the scene (i.e. scene time interval (STI)) and the other is from the scene to the nearest hospital (i.e. transport time interval (TTI)). Then, the predicted travel time is incorporated into the E-2SFCA model to calculate the access measure considering the availability of the service provider as well as the population in need. For both access measures, the calculation is implemented for peak hours and off-peak hours.

RESULTS

Both methods showed a marked decrease in EMS access during peak traffic hours, and differences in spatial patterns of ambulance and hospital access. About 73.9% of shequs can receive an ambulance or get to the nearest hospital within 10 min during off-peak periods, and this proportion decreases to about 45.5% for peak periods. Most shequs with good ambulance access but poor hospital access are in the south of the study area. In general, the central areas have better ambulance, hospital and overall access than peripheral areas, particularly during off-peak periods.

CONCLUSIONS

In addition to the impact of peak traffic periods on EMS access, we found that good ambulance access does not necessarily guarantee good hospital access nor the overall access, and vice versa.

Modelling Potential Geographical Access of the Population to Public Hospitals and Quality Health Care in Romania

The geographical accessibility to hospitals relies on the configuration of the hospital network, spatial impedance and population distribution. This paper explores the potential geographic accessibility of the population to public hospitals in Romania by using the Distance Application Program Interface (API) Matrix service from Google Maps and open data sources. Based on real-time traffic navigation data, we examined the potential accessibility of hospitals through a weighted model that took into account the hospital competency level and travel time while using personal car transportation mode. Two scenarios were generated that depend on hospitals' level of competency (I-V). When considering all categories of hospitals, access is relatively good with over 80% of the population reaching hospitals in less than 30 min. This is much lower in the case of hospitals that provide complex care, with 34% of the population travelling between 90 to 120 min to the nearest hospital classed in the first or second category of competence. The index of spatial accessibility (ISA), calculated as a function of real travel time and level of competency of the hospitals, shows spatial patterns of services access that highlight regional disparities or critical areas. The high concentration of infrastructure and specialised medical personnel in particular regions and large cities limits the access of a large part of the population to quality health services with travel time and distances exceeding optimal European level values. The results can help decision-makers to optimise the location of health services and improve health care delivery.

Urban Public Green Space Equity against the Context of High-Speed Urbanization in Wuhan, Central China

This study examines the relationship between equity of public green space and urban expansion/sprawl under high-speed urbanization. Equity of urban public green space indicates the degree to which urban public green spaces are distributed spatially in an equal way, with regard to the spatial variation of residents’ “need” for green space. In emerging economies such as China, especially in developing or underdeveloped cities such as Wuhan, central China, rapid urban growth challenges the capacity of the state to provide infrastructure and services for its urbanites equally. In order to research the relationship between industrial development and green space equity under the background of rapid urbanization, the use of quantitative methods to more accurately measure the degree of spatial inequality is essential. In this study, the accessibility of urban public green space in Wuhan is examined based on the two-step floating catchment area method (2SFCA) method at multilevel radius; the urban public green space accessibility of Wuhan in 2013 and 2016 are acquired, and the link between changes in accessibility of urban public green spaces and urban expansion in Wuhan is discussed. It is found that industrial development takes precedence over green space. With its vigorous development, industrial land attracts increasing population, resulting in the drastic decline of the service capacity of green spaces, which is not conducive to the long-term development of the city.

Association of time to diagnosis with socioeconomic position and geographical accessibility to healthcare among symptomatic COVID-19 patients: A retrospective study in Hong Kong

Early diagnosis is important to control COVID-19 outbreaks. This study aimed to assess how individual and area socioeconomic position and geographical accessibility to healthcare services were associated with the time to diagnosis among symptomatic COVID-19 patients in Hong Kong. Multivariable generalized linear regression was used to estimate the associations while adjusting for sociodemographic characteristics and case classification. This study found living in public rental housing and living in an area with low education were associated with longer time to diagnosis in the first wave of infections. Specifically, the risk of delayed diagnosis for public rental housing residents was mitigated by the higher density of public clinics/hospitals but was slightly increased by the higher density of private medical practitioners nearby. No such relations were found in the second wave of infections when the surveillance measures were enhanced. Given the grave impact of pandemics around the world, our findings call on taking inequalities into account when public health policies are being devised.

Assessment on Distributional Fairness of Physical Rehabilitation Resource Allocation: Geographic Accessibility Analysis Integrating Google Rating Mechanism

Identifying and treating co-existing diseases are essential in healthcare for the elderly, while physical rehabilitation care teams can provide interdisciplinary geriatric care for the elderly. To evaluate the appropriateness of demand and supply between the population at demand and physical rehabilitation resources, a comparative analysis was carried out in this study. Our study applied seven statistical indices to assess five proposed methods those considered different factors for geographic accessibility analysis. Google ratings were included in the study as a crucial factor of choice probability in the equation for calculating the geographic accessibility scores, because people's behavioral decisions are increasingly dependent on online rating information. The results showed that methods considering distances, the capacity of hospitals, and Google ratings' integrally generated scores, are in better accordance with people's decision-making behavior when they determine which resources of physical rehabilitation to use. It implies that concurrent considerations of non-spatial factors (online ratings and sizes of resource) are important. Our study proposed an integrated assessment method of geographical accessibility scores, which includes the spatial distribution, capacity of resources and online ratings in the mechanism. This research caters to countries that provide citizens with a higher degree of freedom in their medical choices and allows these countries to improve the fairness of resource allocation, raise the geographic accessibilities of physical rehabilitation resources, and promote aging in place.

Measuring Spatial Accessibility of Urban Fire Services Using Historical Fire Incidents in Nanjing, China

The measurement of spatial accessibility of fire services is a key task in enhancing fire response efficiency and minimizing property losses and deaths. Recently, the two-step floating catchment area method and its modified versions have been widely applied. However, the circle catchment areas used in these methods are not suitable for measuring the accessibility of fire services because each fire station is often responsible for the fire incidents within its coverage. Meanwhile, most existing methods take the demographic data and their centroids of residential areas as the demands and locations, respectively, which makes it difficult to reflect the actual demands and locations of fire services. Thus, this paper proposes a fixed-coverage-based two-step floating catchment area (FC2SFCA) method that takes the fixed service coverage of fire stations as the catchment area and the locations and dispatched fire engines of historical fire incidents as the demand location and size, respectively, to measure the spatial accessibility of fire services. Using a case study area in Nanjing, China, the proposed FC2SFCA and enhanced two-step floating catchment area (E2SFCA) are employed to measure and compare the spatial accessibility of fire incidents and fire stations. The results show that (1) the spatial accessibility across Nanjing, China is unbalanced, with relatively high spatial accessibility in the areas around fire stations and the southwest and northeast at the city center area and relatively low spatial accessibility in the periphery and boundary of the service coverage areas and the core of the city center; (2) compared with E2SFCA, FC2SFCA is less influenced by other fire stations and provides greater actual fire service accessibility; (3) the spatial accessibility of fire services is more strongly affected by the number of fire incidents than firefighting capabilities, the area of service coverage, or the average number of crossroads (per kilometer). Suggestions are then made to improve the overall spatial access to fire services.