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

Evaluating the spatial accessibility and spatial layout optimization of HIV/AIDS healthcare services in Shandong Province, China

Improving access to HIV/AIDS healthcare services is of great concern to government and policymakers striving to strengthen overall public health. How to reasonably allocate HIV/AIDS healthcare resources and maximize the equality of access to healthcare services across subdistrict areas has become an urgent problem to be solved. However, there is limited research on this topic in China. It is necessary to evaluate spatial accessibility to improve the accessibility and equity of HIV/AIDS healthcare services. In this study, the improved multi-modal two-step floating catchment area (2SFCA) and inverted 2SFCA (i2SFCA) methods are used to measure the spatial accessibility of HIV/AIDS healthcare services and the crowdedness of the healthcare sites in Shandong Province, China. Then, the theoretical supply and the optimal spatial distribution of resources are calculated and visualized by minimizing the accessibility gaps between demand locations. This study showed that the spatial accessibility of HIV/AIDS service resources in Shandong Province was concentrated and unevenly distributed, and the accessibility scores in the marginal areas of prefecture-level cities were significantly lower than those in other areas. Regions with a large number of doctors had significantly higher levels of spatial accessibility. The ART accessibility scores in the southwest of Shandong Province were higher than those in other regions. As the travel friction coefficient increased, the accessibility scores formed an approximately circular cluster distribution centered on the healthcare sites in geographical distribution. More ART drugs needed to be supplied in marginal areas and more doctors were needed to work on HIV/AIDS in urban areas to address the spatial distribution imbalance of HIV/AIDS healthcare services. This study profoundly analyzed the spatial accessibility of HIV/AIDS healthcare services and provided essential references for decision-makers. In addition, it gives a significant exploration for achieving the goal of equal access to HIV/AIDS healthcare services in the future.

Optimal site selection strategies for urban parks green spaces under the joint perspective of spatial equity and social equity

Urban park green spaces (UPGS) are a crucial element of social public resources closely related to the health and well-being of urban residents, and issues of equity have always been a focal point of concern. This study takes the downtown area of Nanchang as an example and uses more accurate point of interest (POI) and area of interest (AOI) data as analysis sources. The improved Gaussian two-step floating catchment area (G2SFCA) and spatial autocorrelation models are then used to assess the spatial and social equity in the study area, and the results of the two assessments were coupled to determine the optimization objective using the community as the smallest unit. Finally, the assessment results are combined with the k-means algorithm and particle swarm algorithm (PSO) to propose practical optimization strategies with the objectives of minimum walking distance and maximum fairness. The results indicate (1) There are significant differences in UPGS accessibility among residents with different walking distances, with the more densely populated Old Town and Honggu Tan areas having lower average accessibility and being the main areas of hidden blindness, while the fringe areas in the northern and south-western parts of the city are the main areas of visible blindness. (2) Overall, the UPGS accessibility in Nanchang City exhibits a spatial pattern of decreasing from the east, south, and west to the center. Nanchang City is in transition towards improving spatial and social equity while achieving basic regional equity. (3) There is a spatial positive correlation between socioeconomic level and UPGS accessibility, reflecting certain social inequity. (4) Based on the above research results, the UPGS layout optimization scheme was proposed, 29 new UPGS locations and regions were identified, and the overall accessibility was improved by 2.76. The research methodology and framework can be used as a tool to identify the underserved areas of UPGS and optimize the spatial and social equity of UPGS, which is in line with the current trend of urban development in the world and provides a scientific basis for urban infrastructure planning and spatial resource allocation.

Quantitative Evaluation of Spatial Accessibility of Various Urban Medical Services Based on Big Data of Outpatient Appointments

Equity of urban medical services affects human health and well-being in cities and is important in building 'just' cities. We carried out a quantitative analysis of the spatial accessibility of medical services considering the diverse demands of people of different ages, using outpatient appointment big data and refining the two-step floating catchment area (2SFCA) method. We used the traditional 2SFCA method to evaluate the overall spatial accessibility of medical services of 504 communities in Xiamen city, considering the total population and the supply of medical resources. Approximately half the communities had good access to medical services. The communities with high accessibility were mainly on Xiamen Island, and those with low accessibility were further from the central city. The refined 2SFCA method showed a more diverse and complex spatial distribution of accessibility to medical services. Overall, 209 communities had high accessibility to internal medicine services, 133 to surgery services, 50 to gynecology and obstetrics services, and 18 to pediatric services. The traditional method may over-evaluate or under-evaluate the accessibility of different types of medical services for most communities compared with the refined evaluation method. Our study can provide more precise information on urban medical service spatial accessibility to support just city development and design.

Spatial Accessibility and Equity Evaluation of Medical Facilities Based on Improved 2SFCA: A Case Study in Xi'an, China

Accurate evaluation of the accessibility of medical facilities is a prerequisite for the reasonable allocation of medical resources in a city. The accessibility of medical facilities depends not only on the distance to the supply and demand points, but also on the time spent in the process, and the supply capacity of the supply points. Taking Xi'an City of Shaanxi Province as an example, this paper comprehensively considers the facility supply capacity and introduces the selection probability function based on the two-step floating catchment area (2SFCA) method. In addition, in order to approximate the residents' acceptance of different types of hospitals for long-distance medical treatment in real situations, different levels of search radius were set for the different levels of hospitals, and ArcGIS was used to measure the accessibility and evaluate the spatial layout of medical facilities in the main urban area of Xi'an. The results show that there is a significant difference in the accessibility of medical facilities in the main urban area of Xi'an, and the accessibility tends to decrease gradually from the central city to the periphery. The inequity in the allocation of medical facilities in the main urban area of Xi'an is more obvious, with about 81.64% of people having access to 54.88% of medical resources. The accessibility evaluation model established by the improved 2SFCA method can obtain more accurate and objective evaluation results. This study can provide a reference basis for urban medical facilities' planning and rational spatial layout.

The Contributions of Population Distribution, Healthcare Resourcing, and Transportation Infrastructure to Spatial Accessibility of Health Care

Population demand, healthcare resourcing, and transportation linkage are considered as major determinants of spatial access to health care. Temporal changes of the 3 determinants would result in gain or loss of spatial access to health care. As a remarkable milestone achieved by Targeted Poverty Reduction Project launched in China, the significant improvements in spatial access to health care served as an ideal context for investigating the relative contributions of these 3 determinants to the changes in spatial access to health care in a rural county. A national level poverty-stricken county, Chishui county from Guizhou province, China, was chosen as our study area. The enhanced two-step floating catchment area model and the chain substitution method were employed for analysis. The relative contributions of the 3 determinants demonstrated variations with villages. The relative contributions of healthcare resourcing were positive in all villages as indicated by sharp increases in healthcare resources. Population changes and transportation infrastructure expansion had both negative and positive effects on spatial access to health care for different villages. Decisionmakers should take into account the duration of travel time spent between where people live, where transport hubs are located, and where healthcare services are delivered in the process of formulating policies toward rural healthcare planning. For villages with poorly-established infrastructure, the optimization of population distribution and healthcare resourcing should be considered as the priority. A stronger marginal effect would be induced by transportation infrastructure expansion with increased spatial accessibility. This study provides empirical evidences to inform healthcare planning in low- and middle-income countries.

An SCM-G2SFCA Model for Studying Spatial Accessibility of Urban Parks

The urban park is the main leisure and entertainment place in residents' daily lives. The accessibility of parks is closely related to the physical and mental health of the residents. Although many scholars have conducted a great deal of research on the spatial accessibility of urban parks, they have rarely considered the supply competition among different parks and the impact of multiple travel modes on the spatial accessibility of parks. Therefore, based on Baidu map navigation data, in this paper, the park Baidu score is used to represent the competitive relationship among different parks, and the impact of multiple travel modes on the spatial accessibility of parks is considered. A supply competition and multiple travel modes Gaussian two-step floating catchment area (SCM-G2SFCA) model is established to evaluate the spatial accessibility of the parks in the Wuhou District, Chengdu, China. The results show that (1) compared with traditional methods, the SCM-G2SFCA model can obtain more accurate results using Baidu map navigation data. (2) There are obvious spatial differences in the accessibility distribution of the parks in the Wuhou District, Chengdu, with high accessibility in the south and low accessibility in the north. The Jinyang and Huaxing sub-districts in the southern suburbs have the highest park accessibility and can obtain more adequate park services. The Fangcaojie and Cujin sub-districts in the northern urban areas have the lowest park accessibility and are relatively lacking in park services. The research results of this study have important reference value for the rational planning of urban parks and the improvement of the spatial accessibility of urban parks in the Wuhou District of Chengdu and similar urban areas.

Evaluating spatial accessibility of cultural urban land use by using improved 2SFCA method in Xi'an, China

With rapid urbanization, contradictions between rapid economic development and a lack of spiritual culture become increasingly complicated. Accessibility is a useful spatial quantitative index to evaluate the spiritual and cultural construction of the city. Amongst various accessibility methods, the two-step floating catchment area (2SFCA) method is suitable for evaluating cultural urban land use (CULU) based on its advantage of flexibility and rationality. This study selects Xi'an as the representative ancient city. Based on comparing accessibility results between different travel modes (walk, bus, subway, and total), and analyzing through statistics, Z-score, and comparison of classification, comparison of a particular area, we obtain the characteristics of CULU accessibility in Xi'an. Firstly, for different travel modes, the distribution of CULU accessibility value in Xi'an is imbalanced, and the accessibility value of bus and subway is closely related to public transport resources. Secondly, CULU in Xi'an has apparent features of being dense in the center, sparse in the suburbs, and lack edge, which correspond to the development of the city. Finally, about 60% accessibility value is contributed by historical CULU, which reflects the typical characteristics of Xi'an as an ancient city with rich historical resources. This study profoundly analyses the attributes of CULU in Xi'an and provides essential data for decision-makers. Furthermore, it gives a significant exploration for building a CULU evaluation system in the future.

Incorporating Exercise Efficiency to Evaluate the Accessibility and Capacity of Medical Resources in Tibet, China

Accessibility and capacity of medical resources are key for the health care and emergency response, while the efficiency of the medical resources is very much limited by hypoxia in Tibet, China. Through introducing exercise efficiency, this study explores the accessibility of township residence to county-ship medical resources in Tibet using weighted mean travel time (WMT), and evaluates the medical capacity accordingly. The results show that: 1) the average travel time of township residence to county-level hospital is around 2 h by motor vehicle in Tibet. More than half of the population can not reach the county-ship hospital within 1 h, 33.24% of the population can not reach within 2 h, and 3.75% of the population can not reach within 6 h. 2) When considering the catchment of the medical resources and the population size, the WMT of the county-ship medical resources ranges from 0.25 h to 10.92 h. 3) After adjusted by travel time and exercise efficiency, the county-ship medical capacity became more unequal, with 38 out of 74 counties could not meet the national guideline of 1.8 medical beds per 1000. 4) In total, there are 17 counties with good WMT and sufficient medical resources, while 13 counties having very high WMT and low capacity of medical resources in Tibet. In the end, suggestions on medical resources relocation and to improve the capacity are provided. This study provides a method to incorporate exercise efficiency to access the accessibility and evaluate medical capacity that can be applied in high altitude ranges.

ELECTRONIC SUPPLEMENTARY MATERIAL

Supplementary material is available in the online version of this article at 10.1007/s11769-022-1321-1.

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

Measuring equality in access to urban parks: A big data analysis from Chengdu

Spatial equality of parks is a significant issue in environmental justice studies. In cities with high-density development and limited land resources, this study uses a supply-demand adjusted two-step floating catchment area model (2SFCA), paying attention to residents' subjective preferences and psychological accessibility. It assesses equality of access to urban parks from two dimensions: spatial equality and quantitative equality at a fine scale of 100 × 100 m grid resolution. The spatial equality of urban parks in Chengdu is measured under different transportation modes (walking, cycling, and driving) based on multi-source geospatial big data and machine learning approaches. The results show: (1) There were significant differences in the spatial distribution of park accessibility under different modes of transportation. The spatial distribution under walking was significantly influenced by the park itself, while the distribution of rivers significantly influenced the spatial distribution under cycling and driving; (2) Accessibility to urban parks was almost universally equal in terms of driving, relatively equal in terms of cycling, and seriously unequal in terms of walking; (3) Spatial local autocorrelation analysis shows that park accessibility tended to be significantly clustered, with little spatial variation; and (4) The supply and demand of urban parks were relatively equal. The results can help urban planners to formulate effective strategies to alleviate spatial inequality more reasonably and precisely. The applied research methods can further improve the system of scientific evaluation from a new perspective.

Investigating the impact of bank branch closures on access to financial services in the early stages of the COVID-19 pandemic

There is a longstanding policy interest in understanding the impacts of changes in access to public and private services in rural areas. To date much of the empirical analysis concerning changing patterns of accessibility has been predicated on assumptions regarding the mode of transport used to access such facilities. The availability of new and open sources of data, and the increasing sophistication of spatial analytical tools, has enabled alternative transportation modes to be included when investigating the impact of service changes. In this study a nationwide analysis of changes in public transport provision and bank closures has enabled the identification of those parts of Wales that were disproportionally impacted by the loss of financial services during the early years of the COVID-19 pandemic. Drawing on local scenarios which show the combined impact of such changes, the findings demonstrate how temporal variations in accessibility can be used to examine potential patterns of exclusion that arise from the loss of key services. We conclude by suggesting that any assessment of changes in accessibility needs a holistic approach that considers changes in the transport infrastructure alongside other facets of service provision to understand the full impact of such closures on rural communities.

An Improved Two-Step Floating Catchment Area (2SFCA) Method for Measuring Spatial Accessibility to Elderly Care Facilities in Xi'an, China

With the continuous aging of society, the demand among elderly citizens for care facilities is increasing. The accessibility of elderly care facilities is a significant indicator for evaluating whether the layout of urban elderly care facilities is reasonable, and research on the spatial accessibility of related facilities has become an important academic issue in recent years. In this paper, based on the lack of accurate measurement in calculating the spatial accessibility of existing elderly care facilities, we improve the mathematical model based on the two-step floating catchment area method (2SFCA) and introduce the probability function of the elderly population's choice, taking into account the influence of institutional capacity and service quality. In terms of the catchment radius, the calculation accuracy is improved by using the shortest distance along the route combined with the real road network instead of choosing the Euclidean distance. In addition, specific travel thresholds are set for the travel characteristics of the elderly. An evaluation model of the accessibility of urban elderly care facilities is constructed with the help of ArcGIS software to evaluate and analyze the accessibility of the current layout of urban elderly care facilities in Xi'an, China. The results show that the improved 2SFCA model is more effective in evaluating the spatial accessibility of elderly care facilities and has higher accuracy than the previous calculation model, which provides a methodological basis and academic reference for the specific planning of urban elderly care facilities.

Accessibility calculation and equality evaluation of medical facilities for COVID-19 pandemic treatment: A case study of the Wuhan metropolitan development zone

Medical facility equality is a critical metric for determining equal access to medical care. Their spatial distribution is important for effective pandemic treatment and daily prevention in cities. This paper used the Kernel Density Two-Step Floating Catchment Area (KD2SFCA) and shortest distance methods to calculate the accessibility of designated COVID-19 Fangcang hospitals and fever clinics in the Wuhan Metropolitan Development Zone. Their equality was evaluated by the Gini coefficient and Lorentz curve. Several results were obtained: (1) The facilities’ accessibility declines radial from the central to peripheral areas. (2) Most of the demand points in the study area can reach the medical facilities for COVID-19 pandemic treatment within 60 minutes. (3) For the spatial distribution of these facilities, the equality evaluated for different time thresholds differed significantly, with long time thresholds having better equality than for short time thresholds. (4) While the distances distribution of fever clinics is balanced, the equality gap in various areas remains enormous when considering population distribution. Suggestions for optimizing the spatial distribution of pandemic treatment medical facilities in Wuhan are proposed, and which will serve as references for the planning of Wuhan’s pandemic medical facilities in the future.

Examining the impact of COVID-19 vaccination rates on differential access to critical care

The measurement of potential access to health care has focused primarily on what might be called "place-based" access or the differential access among geographic locations rather than between different populations. The vaccination program to inoculate the population against the effects of the COVID-19 virus has created two different at-risk populations. This research examines the impact of COVID-19 vaccination rates on access to critical care for persons fully-vaccinated versus those not fully-vaccinated. In this situation, additional tools are necessary to understand: 1) if there is a significant difference in accessibility between different populations, 2) the magnitude of this difference and how it is distributed across accessibility levels, and 3) how the differences between groups are distributed across the state. A study of access to intensive care unit (ICU) beds by these two populations for the state of Illinois found that although there was a statistically significant difference in access, the magnitude of differences was small. A more important difference was being located in the Chicago Area of the state. The not-fully vaccinated in the Chicago Area had higher than expected spatial access due to the lower need for ICU beds by a higher percentage of fully vaccinated people.

Beyond Accessibility: A Multidimensional Evaluation of Urban Park Equity in Yangzhou, China

Evaluating park equity can help guide the advancement of sustainable and equitable space policies. Previous studies have mainly considered accessibility when evaluating park equity while ignoring the selectivity and convenience of entering parks and residents’ recognition of parks. Measuring equity based mainly on spatial thinking has resulted in the social aspects of parks receiving insufficient attention. In this study, we therefore integrated the spatial and social equity of parks and developed a multidimensional framework to evaluate park equity in four dimensions: accessibility (Ai), diversity (Di), convenience (Ci), and satisfaction (Si). Empirical analysis from Yangzhou, China showed that: (1) in Yangzhou’s built-up districts, 23.43% of the communities received high- or relatively high-level park access but 17.72% received little or no park access. (2) The Gini coefficient indicated that all three dimensions showed a mismatch with population distribution, except for satisfaction (Si), which showed a relatively reasonable match. (3) Park access was generally better in communities with better locations, environments, and facilities. High-income groups enjoyed significantly better park access than low- and middle-income groups. These findings could help urban planners and policymakers develop effective policies to reduce inequality in park access.

Spatial Access to Sexual Health Clinics Measured Through a Novel Accessibility Score in Toronto, Canada

BACKGROUND

Understanding spatial access to sexual health services will provide the foundation for future resource planning and allocation. The purpose of this study was to evaluate the potential geographic access to sexual health services in Toronto, Canada, by developing a novel accessibility index to sexual health clinics.

METHODS

We created an accessibility index using the 2-step floating catchment area method to quantify neighborhood-level access to sexual health clinics. The index assumed mixed modes of urban travel through walking and public transit, as well as through driving, and was estimated at the census tract level.

RESULTS

Census tracts were grouped into quantiles by the estimated accessibility score. Census tracts with higher accessibility scores were characterized as those with greater residential instability and lower dependency and ethnic concentration. The downtown core area has all census tracts categorized as medium, high, or very high (average [SD] score, 1.320 [0.312]), whereas the noncore area has 56.98%, 302 of 530 census tracts categorized as medium, high, or very high (average [SD] score, -0.105 [0.960]).

CONCLUSIONS

We demonstrated the benefit of using statistical methods to quantify the geographical access to sexual health services and identified neighborhoods with high and low levels of access. Findings from this study present an overview of the level of spatial access to sexual health clinics in Toronto based on clinic locations in 2018 and can be further used to characterize neighborhoods with a lower level of access and inform policy and planning decisions in the city.

Combining Temporal and Multi-Modal Approaches to Better Measure Accessibility to Banking Services

The UK, as elsewhere, has seen an accelerating trend of bank branch closures and reduced opening hours since the early 2000s. The reasons given by the banks are well rehearsed, but the impact assessments they provide to justify such programs and signpost alternatives have been widely criticized as being inadequate. This is particularly so for vulnerable customers dependent on financial services who may face difficulties in accessing remaining branches. There is a need whilst analyzing spatial patterns of access to also include temporal availability in relation to transport opportunities. Drawing on a case study of potential multi-modal accessibility to banks in Wales, we demonstrate how open-source tools can be used to examine patterns of access whilst considering the business operating hours of branches in relation to public transport schedules. The inclusion of public and private travel modes provides insights into access that are often overlooked by a consideration of service-side measures alone. Furthermore, findings from the types of tools developed in this study are illustrative of the additional information that could be included in holistic impact assessments, allowing the consequences of decisions being taken to close or reduce the operating hours of bank branches to be more clearly communicated to customers.

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.

Evaluations of Spatial Accessibility and Equity of Multi-Tiered Medical System: A Case Study of Shenzhen, China

The Chinese government has implemented a medical system reform to improve the equity of healthcare resources since 2009. We selected Shenzhen as our study area and evaluated the accessibility and equity of the multi-tiered medical system in China using a novel multi-tiered two-step floating catchment area (MT2SFCA) method. We proposed the benchmark and applied the independent variables of travel time and facility attractiveness, along with a combination of the two factors, as tolerances to determine the new logistic cumulative distribution decay functions. Community health centers (CHCs) and hospitals were included while integrating their features. Results revealed that the MT2SFCA method was able to determine the particular advantages of CHCs and hospitals in the multi-tiered medical system. The CHCs offset the lower accessibility of hospitals in suburban areas and hospitals balanced the regional inequity caused by the CHC. Travel time is the main consideration of patients who have access to CHCs, whereas facility features are the main considerations of patients who have access to hospitals. Notably, both CHCs and hospitals are crucial for the whole multi-tiered medical system. Finally, we suggested modifications in different travel modes, weights of contributing factors, and the validation of decay functions to improve the MT2SFCA method.

Trap of weights: The reuse of weights in the floating catchment area (FCA) methods to measuring accessibility

Background: Geographic weights are vital in the floating catchment area (FCA) method of accessibility measurements due to their simulation of spatial barriers in various ways. When modelling population demand, geographical weights with different distance decay coefficients can reflect diverse distance tolerances in facility utilization and could lead to erratic accessibility results. Quantifying accessibility as the sum of weighted supply-demand ratios can alleviate the distance decay coefficient's influence and generate stable geographic patterns. However, the effects of weighted ratios on different FCA models and resources have not been investigated. Methods: To identify impacts of weighted ratios on various FCA variants, this study contrasted the accessibility calculated from the sum of ratios (access) and the sum of weighted ratios (access ratios) within three prevalent FCA models: enhanced two-step FCA (E2SFCA), modified two-step FCA (M2SFCA), and three-step FCA (3SFCA). In addition, the accessibilities of various resources evaluate the stability of the weighted ratios' effect. This study therefore examined the accessibilities to primary schools, job opportunities, and major hospitals in Shanghai. Shanghai is a case study that provides lessons on using big data to measure accessibility in metropolitan areas. Results: Geographic weights can not only mitigate the impact of the distance decay coefficients, but can also eliminate model features, which reduces the performance of the M2SFCA's supply decay and the 3SFCA's population demand adjustment in accessibility results. Moreover, weighted ratios tend to overestimate accessibility in marginal communities that lie within fewer catchments, regardless of the resource type. This tendency can lead to an epistemological trap that creates an inaccurate and counter-intuitive perception of resource distribution in a given area. Conclusions: The results identify a gap between the methodological logic and the empirical perception in accessibility measurements. This study concludes that the use of geographic weights needs to be cautious and epistemologically consistent.

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.

Measuring the Differences of Public Health Service Facilities and Their Influencing Factors

The equitable distribution of public health facilities is a major concern of urban planners. Previous studies have explored the balance and fairness of various medical resource distributions using the accessibility of in-demand public medical service facilities while ignoring the differences in the supply of public medical service facilities. First aid data with location information and patient preference information can reflect the ability of each hospital and the health inequities in cities. Determining which factors affect the measured differences in public medical service facilities and how to alter these factors will help researchers formulate targeted policies to solve the current resource-balance situation of the Ministry of Public Health. In this study, we propose a method to measure the differences in influence among hospitals based on actual medical behavior and use geographically weighted regression (GWR) to analyze the spatial correlations among the location, medical equipment, medical ability, and influencing factors of each hospital. The results show that Wuhan presents obvious health inequality, with the high-grade hospitals having spatial agglomeration in the city-center area, while the number and quality of hospitals in the peripheral areas are lower than those in the central area; thus, the hospitals in these peripheral areas need to be further improved. The method used in this study can measure differences in the influence of public medical service facilities, and the results are consistent with the measured differences at hospital level. Hospital influence is not only related to the equipment and medical ability of each hospital but is also affected by location factors. This method illustrates the necessity of conducting more empirical research on the public medical service supply to provide a scientific basis for formulating targeted policies from a new perspective.

An equity and efficiency integrated grid-to-level 2SFCA approach: spatial accessibility of multilevel healthcare

BACKGROUND

Equity of healthcare spatial access is essential for the health outcomes of medical investments and the welfare of populations, and efficiency of medical resource allocation is important for obtaining a supply-demand equilibrium with lower cost and higher outputs with limited inputs. However, the literature that involves both equity and efficiency in its analysis of healthcare spatial allocation is rare, and the spatial accessibility of multilevel healthcare is difficult to measure by traditional methods in a large region with diversified population distribution.

METHODS

To assist in solving these issues, this paper aims to build an equity and efficiency integrated analytical framework by proposing a new "GTL-2SFCA" approach to analyze the spatial accessibility of multilevel healthcare; maximum and minimum floating catchments of different levels of healthcare were assigned to ensure a combination of universal search coverage and efficient hospitalization behavior simulation.

RESULTS

The analytical framework was applied and tested in Hubei, China. Almost half of the residents (47.95%) and townships (44.98%) have access to both public general hospitals (PGHs) and primary healthcare centers (PHCs) services, 36.89% of the residents enjoy only one sufficient service, either PGHs or PHCs, and the remaining residents (15.16%) are faced with the risk of lacking access to both services. The results reveal that there are core-periphery effects of multilevel healthcare throughout Hubei and isolate clusters that have adequate access in the western region. The polarization effect of higher-level healthcare and the polycentric pattern of lower-level healthcare coexist. The multilevel healthcare shortage was identified in some areas in boundary and peripheral regions.

CONCLUSIONS

This study integrates equity and efficiency into the GTL-2SFCA framework, enriches the FCA series methodologies and provides a more operational solution for evaluating the access of residents in more sophisticated spatial units to each level of healthcare. By more significantly differing and quantifying the catchment area and distance decay effect, this methodology avoids overestimating or underestimating accessibility and discovers some imperceptible spatial inequities. This study has application value for researchers and decision-makers in other scenarios and regions with significant heterogeneity in medical resources and where the population has greater mobility.

Spatial Pattern and Spatial Heterogeneity of Chinese Elite Hospitals: A Country-Level Analysis

Elite hospitals represent the highest level of Chinese hospitals in medical service and management, medical quality and safety, technical level and efficiency, which are also one of the important indicators reflecting high-quality medical resources in the region, and their spatial allocation is directly related to the fairness of health resource allocation. We explored the allocation pattern of high-quality resources and its influencing factors in the development of China's health system using geographic weighted regression (GWR), Multi-scale Geographically Weighted Regression (MGWR), GWR and MGWR with Spatial Autocorrelation(GWR-SAR and MGWR-SAR), spatial lag model (SLM), and spatial error model (SEM). The results of OLS regression showed that city level, number of medical colleges, urbanization rate, permanent population and GDP per capita were its significant variables. And spatial auto-correlation of elite hospitals in China is of great significance. Further, its spatial agglomeration phenomenon was confirmed through SLM and SEM. Among them, the city level is the most important factor affecting the spatial allocation of elite hospitals in China. Its action intensity shows a solid and weak mosaic trend in the Middle East, relatively concentrated in some areas with medium intensity and concentrated in the West China. Obviously, China's elite hospitals are unevenly distributed and have evident spatial heterogeneity. Therefore, we suggest that we should pay attention to the spatial governance of high-quality medical resources, attract medical elites in the region, increase investment in medical education in the scarce areas of elite hospitals and develop tele-medicine service.

Trap of weights: The reuse of weights in the floating catchment area (FCA) methods to measuring accessibility

Background: Geographic weights are vital in the floating catchment area (FCA) method of accessibility measurements due to their simulation of spatial barriers in various ways. When modelling population demand, geographical weights with different distance decay coefficients can reflect diverse distance tolerances in facility utilization and could lead to erratic accessibility results. Quantifying accessibility as the sum of weighted supply-demand ratios can alleviate the distance decay coefficient's influence and generate stable geographic patterns. However, the effects of weighted ratios on different FCA models and resources have not been investigated. Methods: To identify impacts of weighted ratios on various FCA variants, this study contrasted the accessibility calculated from the sum of ratios (access) and the sum of weighted ratios (access ratios) within three prevalent FCA models: enhanced two-step FCA (E2SFCA), modified two-step FCA (M2SFCA), and three-step FCA (3SFCA). In addition, the accessibilities of various resources evaluate the stability of the weighted ratios' effect. This study therefore examined the accessibilities to primary schools, job opportunities, and major hospitals in Shanghai. Shanghai is a case study that provides lessons on using big data to measure accessibility in metropolitan areas. Results: Geographic weights can not only mitigate the impact of the distance decay coefficients, but can also eliminate model features,  which reduces the performance of the M2SFCA's supply decay and the 3SFCA's population demand adjustment in accessibility results. Moreover, weighted ratios tend to overestimate accessibility in marginal communities that lie within fewer catchments, regardless of the resource type. This tendency can lead to an epistemological trap that creates an inaccurate and counter-intuitive perception of resource distribution in a given area. Conclusions: The results identify a gap between the methodological logic and the empirical perception in accessibility measurements. This study concludes that the use of geographic weights needs to be cautious and epistemologically consistent.

Assessing consistency among indices to measure socioeconomic barriers to health care access

Many places within rural America lack ready access to health care facilities. Barriers to access can be both spatial and non-spatial. Measurements of spatial access, such as the Enhanced Floating 2-Step Catchment Area and other floating catchment area measures, produce similar patterns of access. However, the extent to which different measurements of socioeconomic barriers to access correspond with each other has not been examined. Using West Virginia as a case study, we compute indices based upon the literature and measure the correlations among them. We find that all indices positively correlate with each other, although the strength of the correlation varies. Also, while there is broad agreement in the general spatial trends, such as fewer barriers in urban areas, and more barriers in the impoverished southwestern portion of the state, there are regions within the state that have more disagreement among the indices. These indices are to be used to support decision-making with respect to placement of rural residency students from medical schools within West Virginia to provide students with educational experiences as well as address health care inequalities within the state. The results indicate that for decisions and policies that address statewide trends, the choice of metric is not critical. However, when the decisions involve specific locations for receiving rural residents or opening clinics, the results can become more sensitive to the selection of the index. Therefore, for fine-grained policy decision-making, it is important that the chosen index best represents the processes under consideration.

An Improved Accessibility-Based Model to Evaluate Educational Equity: A Case Study in the City of Wuhan

Limited studies focus on educational equity from the spatial accessibility perspective. This study combines survey data and big data and proposes a multi-mode Huff two-step floating catchment area (MMH2SFCA) method to calculate accessibility while considering multiple travel modes and school attractiveness. This method can also calculate education quality by extending the accessibility in each community. Results show that our proposed method can reliably identify the accessibility differences of schools across communities. The case study indicates an inequitable distribution of educational accessibility and quality. The communities with high accessibility are concentrated in the urban center and exurban zones surrounding schools, whereas high-quality areas are mainly concentrated in the urban center. Correlation analysis suggests that the educational quality of communities with high accessibility is not always high. The findings of this study can provide improvement for accessibility measurements and help explore a new research perspective for educational equity research.

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

Purpose

Rapid accessibility of (intensive) medical care can make the difference between life and death. Initial care in case of strokes is highly dependent on the location of the patient and the traffic situation for supply vehicles. In this methodologically oriented paper we want to determine the inequivalence of the risks in this respect.

Methods

Using GIS we calculate the driving time between Stroke Units in the district of Münster, Germany for the population distribution at day- & nighttime. Eight different speed scenarios are considered. In order to gain the highest possible spatial resolution, we disaggregate reported population counts from administrative units with respect to a variety of factors onto building level.

Results

The overall accessibility of urban areas is better than in less urban districts using the base scenario. In that scenario 6.5% of the population at daytime and 6.8% at nighttime cannot be reached within a 30-min limit for the first care. Assuming a worse traffic situation, which is realistic at daytime, 18.1% of the population fail the proposed limit.

Conclusions

In general, we reveal inequivalence of the risks in case of a stroke depending on locations and times of the day. The ability to drive at high average speeds is a crucial factor in emergency care. Further important factors are the different population distribution at day and night and the locations of health care facilities. With the increasing centralization of hospital locations, rural residents in particular will face a worse accessibility situation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12942-021-00284-y.

Geographic access to COVID-19 healthcare in Brazil using a balanced float catchment area approach

The rapid spread of COVID-19 across the world has raised concerns about the responsiveness of cities and healthcare systems during pandemics. Recent studies try to model how the number of COVID-19 infections will likely grow and impact the demand for hospitalization services at national and regional levels. However, less attention has been paid to the geographic access to COVID-19 healthcare services and to hospitals' response capacity at the local level, particularly in urban areas in the Global South. This paper shows how transport accessibility analysis can provide actionable information to help improve healthcare coverage and responsiveness. It analyzes accessibility to COVID-19 healthcare at high spatial resolution in the 20 largest cities of Brazil. Using network-distance metrics, we estimate the vulnerable population living in areas with poor access to healthcare facilities that could either screen or hospitalize COVID-19 patients. We then use a new balanced floating catchment area (BFCA) indicator to estimate spatial, income, and racial inequalities in access to hospitals with intensive care unit (ICU) beds and mechanical ventilators while taking into account congestion effects. Based on this analysis, we identify substantial social and spatial inequalities in access to health services during the pandemic. The availability of ICU equipment varies considerably between cities, and it is substantially lower among black and poor communities. The study maps territorial inequalities in healthcare access and reflects on different policy lessons that can be learned for other countries based on the Brazilian case.

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.

Regional Variability in the Access to Cardiac Rehabilitation in Poland

Equitable access to cardiological rehabilitation services is one of the important elements in the effectiveness of the treatment of cardiovascular diseases as cardiological rehabilitation is an important part of circulatory system disease prevention and treatment. However, in many countries among others, Poland suffers from the underutilization of cardiac rehabilitation services. Cardiovascular diseases are the worldwide number one cause of mortality, morbidity, and disability and are responsible for the substantial increase in health care costs. Thus, the aim of the research was the analysis of geographical accessibility to cardiac rehabilitation services in Poland. Perkal’s method was employed in this research. The conducted research allowed to recognize the regional variation, but also made it possible to classify Polish voivodeships in terms of the level of availability achieved. This enables the identification of voivodeships that provide a good, or even very good, access to cardiology rehabilitation services and those characterized by low, or very low access. It was found that there was a slight regional variability in the access to cardiological rehabilitation services. However, the sufficient development of a rehabilitation infrastructure has been also recognized.

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.

Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China

BACKGROUND

Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies.

METHODS

Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement.

RESULTS

The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making.

CONCLUSIONS

The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

Background

The adequate allocation of inpatient care resources requires assumptions about the need for health care and how this need will be met. However, in current practice, these assumptions are often based on outdated methods (e.g. Hill-Burton Formula). This study evaluated floating catchment area (FCA) methods, which have been applied as measures of spatial accessibility, focusing on their ability to predict the need for health care in the inpatient sector in Germany.

Methods

We tested three FCA methods (enhanced (E2SFCA), modified (M2SFCA) and integrated (iFCA)) for their accuracy in predicting hospital visits regarding six medical diagnoses (atrial flutter/fibrillation, heart failure, femoral fracture, gonarthrosis, stroke, and epilepsy) on national level in Germany. We further used the closest provider approach for benchmark purposes. The predicted visits were compared with the actual visits for all six diagnoses using a correlation analysis and a maximum error from the actual visits of ± 5%, ± 10% and ± 15%.

Results

The analysis of 229 million distances between hospitals and population locations revealed a high and significant correlation of predicted with actual visits for all three FCA methods across all six diagnoses up to ρ = 0.79 (p < 0.001). Overall, all FCA methods showed a substantially higher correlation with actual hospital visits compared to the closest provider approach (up to ρ = 0.51; p < 0.001). Allowing a 5% error of the absolute values, the analysis revealed up to 13.4% correctly predicted hospital visits using the FCA methods (15% error: up to 32.5% correctly predicted hospital). Finally, the potential of the FCA methods could be revealed by using the actual hospital visits as the measure of hospital attractiveness, which returned very strong correlations with the actual hospital visits up to ρ = 0.99 (p < 0.001).

Conclusion

We were able to demonstrate the impact of FCA measures regarding the prediction of hospital visits in non-emergency settings, and their superiority over commonly used methods (i.e. closest provider). However, hospital beds were inadequate as the measure of hospital attractiveness resulting in low accuracy of predicted hospital visits. More reliable measures must be integrated within the proposed methods. Still, this study strengthens the possibilities of FCA methods in health care planning beyond their original application in measuring spatial accessibility.

Two-Step Floating Catchment Area Model-Based Evaluation of Community Care Facilities' Spatial Accessibility in Xi'an, China

Due to the rapid increase in the number of elderly people in Chinese cities, the development and planning of aged care facilities, and particularly community care facilities, which will gradually become the mainstream choice for the elderly in China, is becoming an important topic for urban sustainability. Previous studies have shown that the number and scale of aged care facilities in many cities are far from meeting the needs of the elderly and the overall occupation rate is low. Some of these cities are still expanding and some are undergoing urban renovation. In this process, the scientific planning of community care facilities to promote efficient use of facility resources has become an urgent problem that needs to be solved. In this study, the two-step floating catchment area (2SFCA) method and a potential model based on the Geographic Information System (GIS) were used to carry out a scientific evaluation of the spatial accessibility of community care facilities in the Beilin district of Xi'an. The aims were to explore the best quantitative research methods for assessing the distribution of Xi'an community care facilities' spatial accessibility, provide ideas for similar studies in the future, and further the understanding of spatial allocation of urban community care facilities resources.

Measuring Spatial Patterns of Health Care Facilities and Their Relationships with Hypertension Inpatients in a Network-Constrained Urban System

There is evidence of a strong correlation between inequality in health care access and disparities in chronic health conditions. Equal access to health care is an important indicator for overall population health, and the urban road network has a significant influence on the spatial distribution of urban service facilities. In this study, the network kernel density estimation was applied to detect the hot spots of health care service along the road network of Shenzhen, and we further explored the influences of population and road density on the aggregate intensity distributions at the community level, using spatial stratified heterogeneity analyses. Then, we measured the spatial clustering patterns of health care facilities in each of the ten districts of Shenzhen using the network K-function, and the interrelationships between health care facilities and hypertension patients. The results can be used to examine the reasonability of the existing health care system, which would be valuable for developing more effective prevention, control, and treatment of chronic health conditions. Further research should consider the influence of nonspatial factors on health care service access.

Inequality and Influencing Factors of Spatial Accessibility of Medical Facilities in Rural Areas of China: A Case Study of Henan Province

The equalization of medical services has received increasing attention, and improving the accessibility of medical facilities in rural areas is key for the realization of fairness with regard to medical services. This study studies the rural areas of Henan Province, China, and uses unincorporated villages as the basic unit. The spatial pattern of accessibility in rural areas was comprehensively analyzed via geographic information system spatial analysis and coefficient of variation. The spatial heterogeneity of relevant influencing factors was assessed by using the geographically weighted regression model. The results show that: (1) The distance cost of medical treatment in rural areas is normally distributed, and most areas are within a range of 2-6 km. (2) The accessibility in rural areas has clear spatial differences, is significantly affected by terrain, and shows characteristics of significant spatial agglomeration. The eastern and central regions have good spatial accessibility, while the western regions have poor spatial accessibility. Furthermore, regions with poor accessibility are mainly located in mountainous areas. (3) The spatial equilibrium of accessibility follows a pattern of gradual deterioration from east to west. The better accessibility-unbalanced type is mostly located in the center of Henan Province, while the poor accessibility-unbalanced type is concentrated in mountainous areas. (4) The area, elevation, residential density, and per capita industrial output are positively correlated with spatial accessibility, while road network density and population density are negatively correlated.

Using floating catchment area (FCA) metrics to predict health care utilization patterns

BACKGROUND

Floating Catchment Area (FCA) metrics provide a comprehensive measure of potential spatial accessibility to health care services and are often used to identify geographic disparities in health care access. An unexplored aspect of FCA metrics is whether they can be useful in predicting where people actually seek care. This research addresses this question by examining the utility of FCA metrics for predicting patient utilization patterns, the flows of patients from their residences to facilities.

METHODS

Using more than one million inpatient hospital visits in Michigan, we calculated expected utilization patterns from Zip Codes to hospitals using four FCA metrics and two traditional metrics (simple distance and a Huff model) and compared them to observed utilization patterns. Because all of the accessibility metrics rely on the specification of a distance decay function and its associated parameters, we conducted a sensitivity analysis to evaluate their effects on prediction accuracy.

RESULTS

We found that the Three Step FCA (3SFCA) and Modified Two Step FCA (M2SFCA) were the most effective metrics for predicting utilization patterns, correctly predicting the destination hospital for nearly 74% of hospital visits in Michigan. These two metrics were also the least sensitive to changes to the distance decay functions and parameter settings.

CONCLUSIONS

Overall, this research demonstrates that FCA metrics can provide reasonable predictions of patient utilization patterns and FCA utilization models could be considered as a substitute when utilization pattern data are unavailable.

Spatial Equity of Multilevel Healthcare in the Metropolis of Chengdu, China: A New Assessment Approach

The spatial equity of the healthcare system is an important factor in assessing how the different medical service demands of residents are met by different levels of medical institutions. However, previous studies have not paid sufficient attention to multilevel healthcare accessibility based on both the divergence of hierarchical healthcare supplies and variations in residents’ behavioral preferences for different types of healthcare. This study aims to propose a demand-driven “2R grid-to-level” (2R-GTL) method of analyzing the spatial equity in access to a multilevel healthcare system in Chengdu. Gridded populations, real-time travel distances and residents’ spatial behavioral preferences were used to generate a dynamic and accurate healthcare accessibility assessment. The results indicate that significant differences exist in the spatial accessibility to different levels of healthcare. Approximately 90% of the total population living in 57% of the total area in the city can access all three levels of healthcare within an acceptable travel distance, whereas multilevel healthcare shortage zones cover 42% of the total area and 12% of the population. A lack of primary healthcare is the most serious problem in these healthcare shortage zones. These results support the systematic monitoring of multilevel healthcare accessibility by decision-makers. The method proposed in this research could be improved by introducing nonspatial factors, private healthcare providers and other cultural contexts and time periods.

Measuring spatio-temporal accessibility to emergency medical services through big GPS data

Medical accessibility is an important indicator for evaluating the effectiveness of public health services. However, the previous medical accessibility studies mainly focus on spatial accessibility without considering temporal variation in population distribution which is significant for evaluating access to emergency medical service (EMS). This paper proposes a model of spatio-temporal accessibility to EMS called ST-E2SFCA based on adapting the enhanced two-step floating catchment area (E2SFCA) method. We apply our method to the greater Tokyo area for a large volume of GPS dataset with millions of users and compare the accessibility difference over space and time. To evaluate our model, we also analyze the distinction of our model over different weight sets and compare the performance of ST-E2SFCA with the traditional E2SFCA. The result shows that our method can illustrate the temporal difference and is suitable for measuring the spatio-temporal accessibility to EMS, thus can guide the hospital location selection and urban planning.

Spatial Accessibility to Primary Healthcare Services by Multimodal Means of Travel: Synthesis and Case Study in the City of Calgary

Universal access to primary healthcare facilities is a driving goal of healthcare organizations. Despite Canada's universal access to primary healthcare status, spatial accessibility to healthcare facilities is still an issue of concern due to the non-uniform distribution of primary healthcare facilities and population over space-leading to spatial inequity in the healthcare sector. Spatial inequity is further magnified when health-related accessibility studies are analyzed on the assumption of universal car access. To overcome car-centric studies of healthcare access, this study compares different travel modes-driving, public transit, and walking-to simulate the multi-modal access to primary healthcare services in the City of Calgary, Canada. Improving on floating catchment area methods, spatial accessibility was calculated based on the Spatial Access Ratio method, which takes into consideration the provider-to-population status of the region. The analysis revealed that, in the City of Calgary, spatial accessibility to the primary healthcare services is the highest for the people with an access to a car, and is significantly lower with multimodal (bus transit and train) means despite being a large urban centre. The social inequity issue raised from this analysis can be resolved by improving the city's pedestrian infrastructure, public transportation, and construction of new clinics in regions of low accessibility.

Using a GIS to support the spatial reorganization of outpatient care services delivery in Italy

BACKGROUND

Studying and measuring accessibility to care services has become a major concern for health care management, particularly since the global financial collapse. This study focuses on Tuscany, an Italian region, which is re-organizing its inpatient and outpatient systems in line with new government regulations. The principal aim of the paper is to illustrate the application of GIS methods with real-world scenarios to provide support to evidence-based planning and resource allocation in healthcare.

METHODS

Spatial statistics and geographical analyses were used to provide health care policy makers with a real scenario of accessibility to outpatient clinics. Measures for a geographical potential spatial accessibility index using the two-step floating catchment area method for outpatient services in 2015 were calculated and used to simulate the rationalization and reorganization of outpatient services. Parameters including the distance to outpatient clinics and volumes of activity were taken into account.

RESULTS

The spatial accessibility index and the simulation of reorganization in outpatient care delivery are presented through three cases, which highlight three different managerial strategies. The results revealed the municipalities where health policy makers could consider a new spatial location, a shutdown or combining selected outpatient clinics while ensuring equitable access to services.

CONCLUSIONS

A GIS-based approach was designed to provide support to healthcare management and policy makers in defining evidence-based actions to guide the reorganization of a regional health care delivery system. The analysis provides an example of how GIS methods can be applied to an integrated framework of administrative health care and geographical data as a valuable instrument to improve the efficiency of healthcare service delivery, in relation to the population's needs.

Temporal availability of public health care in developing countries of the Caribbean: An improved two-step floating catchment area method for estimating spatial accessibility to health care

Due to restrictions on personnel availability, the service capacity at a health facility may vary day to day based on an established schedule. This temporal variability influences a user's choice set, modifying their possible choices. As a result, the spatial accessibility of public health care may be constantly reshaped rather than being a relatively static experience as commonly represented in place-based spatial accessibility literature. Building on the latest advances in the two-step floating catchment method, this study presents further advancements through the inclusion of health facility schedules to better represent health care availability in the assessment of accessibility. The results show that the proposed method reveals communities with relatively poor accessibility that are hidden with many existing methods. By exposing the available care within time windows, a more accurate picture of the services available to be accessed is revealed. The findings suggest that improvement in the number of doctor hours at health facilities may reduce the disparities found in accessibility scores for communities. Further, in public health care systems similarly structured, the spatial configuration of facilities with doctors can be considered at the administrative level to ensure adequate levels of access across the jurisdiction.

Spatial Accessibility of Primary Care in England: A Cross-Sectional Study Using a Floating Catchment Area Method

OBJECTIVE

To analyze the general practitioners (GPs) with regard to the degree of urbanization, social deprivation, general health, and disability.

DATA SOURCES

Small area population data and GP practice data in England.

STUDY DESIGN

We used a floating catchment area method to measure spatial GP accessibility with regard to the degree of urbanization, social deprivation, general health, and disability.

DATA COLLECTION

Data were collected from the Office for National Statistics and the general practice census and analyzed using a geographic information system.

PRINCIPAL FINDINGS

In all, 25.8 percent of the population in England lived in areas with a significant low GP accessibility (mean z-score: -4.2); 27.6 percent lived in areas with a significant high GP accessibility (mean z-score: 7.7); 97.8 percent of high GP accessibility areas represented urban areas, and 31.1 percent of low GP accessibility areas represented rural areas (correlation of accessibility and urbanity: r = 0.59; p<.001). Furthermore, a minor negative correlation with social deprivation was present (r = -0.19; p<.001). Results were confirmed by a multivariate analysis.

CONCLUSION

This study showed substantially differing GP accessibility throughout England. However, socially deprived areas did not have poorer spatial access to GPs.

Understanding temporal change of spatial accessibility to healthcare: An analytic framework for local factor impacts

Population demand, health service supply, and the linkages between them (e.g., transport infrastructure) are important factors that determine spatial accessibility to healthcare at a place. These three factors vary differently over time and location, leading to temporal changes and spatial disparities in access to healthcare. Few analytic methods have been developed to measure local impacts of these factors on healthcare accessibility over time, which are essential to alleviating health disparities and evaluating intervention programs. We propose a spatially explicit analytic framework to measure local factor impacts over time by adopting a chain substitution method from economics. The analysis is illustrated by a case study of spatial accessibility to physicians in Florida, USA, from 1990 to 2010. For each census block group, the results show the impact of local population change, physician relocation, and road-network expansion on the loss and gain of healthcare accessibility over time. The leading impact factor are identified for each census block group through comparison, and spatial clusters of factor impacts are discovered. To the literature of healthcare accessibility, this article presents a promising start of factor impact analysis and offers new perspectives in exploring spatial processes underlying people's access to healthcare.

Potential accessibility scores for hospital care in a province of Japan: GIS-based ecological study of the two-step floating catchment area method and the number of neighborhood hospitals

BACKGROUND

For achieving equity of the accessibility to primary healthcare, measuring potential geographical accessibility is essential. The provider-to-population ratio is the most frequently used measure. However, it is difficult to be used in closer region because it does not take into consideration the people and health services beyond its boundary. In order to overcome this problem, we measured the potential access to hospital, using both distance measures and the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to compare the number of hospitals in the neighborhood and the E2SFCA score with regard to the amount and equity for access to hospitals.

METHODS

This descriptive study used publicly available data from 2010. The E2SFCA score and number of neighborhood hospitals were obtained from Tochigi province in Japan using a geographic information system. Dataset of four measures by each census tract was obtained. The measures were E2SFCA score, number of hospitals within the 5 km range, number of hospitals within the 10 km range, and number of hospitals within the 15 km range. Correlation and disparity analyses with the Lorenz curve and Gini coefficient were performed.

RESULTS

The measures were obtained in a smaller area than municipality considering adjacent areas using a geographical approach. The E2SFCA score was 5.3 [3.2-7.3] hospitals/million (median [quantile range]), compared to 5.6 hospitals/million in total for the given district. The median number of hospitals within the 5 km, 10 km, and 15 km ranges were 1, 39, and 47, respectively. There was no hospital within the 5 km range in one third of the blocks. Both the number of hospitals within the 10 km range and those within the 15 km range were well correlated. Regional difference became smaller as the distance to count the number of hospitals increased. The gap between small number of hospitals and the high E2SFCA score indicated the location of community hospital in depopulated areas.

CONCLUSIONS

The E2SFCA method is superior for analyzing spatial access to hospital, because it provides information in the closer sub-regions. Regional differences were hardly seen in access to hospital beyond the 10 km range. Further studies in other regions and countries are needed for precise assessment.