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Clark SD. Spatial disparities in access to NHS dentistry: a neighbourhood-level analysis in England. Eur J Public Health 2024:ckae099. [PMID: 38908020 DOI: 10.1093/eurpub/ckae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Over the past decade, access to National Health Service (NHS) dentistry in England has been problematic. There are increasing media reports of patients being unable to find treatment at a local NHS dentist. However, the extent of this issue varies by location and by the characteristics of the neighbourhood. The study uses official data sources on NHS dental provision and population. Travel accessibility is measured using car journey times. An advanced form of Floating Catchment Area accessibility is used, which accounts for supply competition, varying catchments, and distance decay. Spatial availability and accessibility indices are calculated. Ways in which the method can be used to explore various types of 'what-if' scenarios are outlined. Both availability and accessibility vary by the level of neighbourhood deprivation and the urban/rural nature of the neighbourhood. A case study, based on a real-world situation, shows the impact on the local neighbourhood of the closure of a dental practice. For all neighbourhoods, NHS dental provision is generally less than would be needed to provide basic dental care. The interpretation of outputs needs to take account of edge-effects near to Scotland and Wales. Possible improvements include the inclusion of other modes of travel and the exclusion of the population that does not want to access NHS care.
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Affiliation(s)
- Stephen D Clark
- School of Geography and Consumer Data Research Centre, University of Leeds, Leeds, United Kingdom
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Bonal M, Padilla C, Chevillard G, Lucas-Gabrielli V. A French classification to describe medical deserts: a multi-professional approach based on the first contact with the healthcare system. Int J Health Geogr 2024; 23:5. [PMID: 38419022 PMCID: PMC10900694 DOI: 10.1186/s12942-024-00366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Increasing inequalities in accessibility to primary care has generated medical deserts. Identifying them is key to target the geographic areas where action is needed. An extensive definition of primary care has been promoted by the World Health Organization: a first level of contact with the health system, which involves the co-presence of different categories of health professionals alongside the general practitioner for the diagnosis and treatment of patients. Previous analyses have focused mainly on a single type of provider while this study proposes an integrated approach including various ones to define medical deserts in primary care. METHOD Our empirical approach focuses on the first point of contact with the health system: general practitioners, proximity primary care providers (nurses, physiotherapists, pharmacies, laboratories, and radiologists), and emergency services. A multiple analysis approach was performed, to classify French municipalities using the information on the evolution and needs of health care accessibility, combining a principal component analysis and a hierarchical ascending classification. RESULTS Two clusters of medical deserts were identified with low accessibility to all healthcare professionals, socio-economic disadvantages, and a decrease in care supply. In other clusters, accessibility difficulties only concern a part of the health supply considered, which raises concern for the efficiency of primary care for optimal healthcare pathways. Even for clusters with better accessibility, issues were identified, such as a decrease and high needs of health care supply, revealing potential future difficulties. CONCLUSION This work proposes a multi-professional and multi-dimensional approach to medical deserts based mainly on an extensive definition of primary care that shows the relevance of the co-presence of various healthcare professionals. The classification also makes it possible to identify areas with future problems of accessibility and its potential consequences. This framework could be easily applied to other countries according to their available data and their health systems' specificities.
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Affiliation(s)
- Marie Bonal
- Institute for Research and Information in Health Economics (IRDES), 75019, Paris, France.
| | - Cindy Padilla
- Arènes-UMR 6051, RSMS-U 1309, Inserm, CNRS, EHESP, Univ Rennes, 35000, Rennes, France
| | - Guillaume Chevillard
- Institute for Research and Information in Health Economics (IRDES), 75019, Paris, France
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Neal SM. Correlating Access to Primary Medical Care and Veterinary Care Providers: A Novel Application of Spatial Gravity Modelling. Vet Sci 2023; 10:565. [PMID: 37756087 PMCID: PMC10534788 DOI: 10.3390/vetsci10090565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023] Open
Abstract
Increasingly, health professionals are recognizing the need for a more holistic, or One Health, approach to wellness. Companion animals share the lives and homes of many Americans, and yet little research exists on the intersection of disparities of access to veterinary care and access to human health care. This research aims to fill that gap by exploring the use of a spatial model that identifies the relationship of supply and demand while also considering reductions as a function of travel time to a care facility. Four counties in Alabama were analyzed at the census tract level to determine the supply of primary care physicians and veterinary care providers. This research provides a unique application of the Enhanced Two-Step Floating Catchment Area model by independently examining access to each type of care and then comparing both access supply values at the census level. Results indicated a statistically significant positive relationship between access to both types of care, implying areas with lower access to primary care have concomitantly low access to veterinary care. Implications for practice include the introduction of this methodological approach, identification of future parameter specification research to improve the approach, and identification of an area of significant concern in the One Health framework. Further, the results can inform solution strategies such as offering integrated care interventions for both humans and their companion animal household members with direct use for policymakers aimed at increasing equitable access to health care across the One Health spectrum.
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Affiliation(s)
- Sue M. Neal
- Department of Political Science, Arkansas State University, Jonesboro, AR 72467, USA;
- Veterinary Care Accessibility Project, Rochester, MI 48306, USA
- Center for GIS and Spatial Analysis, West Chester University, West Chester, PA 19383, USA
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Das M, Dutta B, Roy U, Das S, Rath S. Spatial accessibility modeling to healthcare facilities in the case of health shocks of Midnapore municipality, India. GEOJOURNAL 2023; 88:1-24. [PMID: 38625266 PMCID: PMC9919752 DOI: 10.1007/s10708-023-10838-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 04/17/2024]
Abstract
This research aims to identify the accessibility of the entire population, especially the slum population to existing healthcare facilities (HCF) as well as the slum neighborhoods having low geographic accessibility, and finally, to provide an analytical model for the people living in areas that are outside the coverage range of existing healthcare facilities (HCF) across the study area. Spatial data has been collected and used based on the road network, elevation, location of HCF, municipal boundary, slum point, and satellite images from various sources. Also, non-spatial data such as socioeconomic variables are collected from questionnaires survey within a particular period. The spatial analysis tool like as near, network analysis, and predictive analysis in the ArcGIS platform was used to examine geographic accessibility. The results of the spatial analysis show that the distribution of public healthcare facility centers in the study area has not been uniformly distributed. Across 84% of areas in the study area have sound spatial accessibility with traveling time coverage is about 12 min. However, 16% of areas have a traveling time of 12 to 30 min under low accessibility with existing slum neighborhoods. Therefore, the low spatial accessibility areas are demanding new healthcare facilities in the study area. The Analytical Hierarchy Process (AHP) is employed to find the most optimal and efficient locational suitability for building new healthcare facility centers. The finding of AHP analysis for site suitability of healthcare facilities revealed five major classes as most suitable (2%), suitable (5%), moderate (35%), poor (54%), and very poor (4%) in the study area. Moreover, the realistic framework of this study helps to measure geographic accessibility and suitability in any geographical area.
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Affiliation(s)
- Manas Das
- Dept. of Remote Sensing and GIS, Vidyasagar University, Midnapore, West Bengal 721102 India
| | - Bikash Dutta
- Assistant Professor, Dept. of Geography, Nistarini College, Purulia, West Bengal 723101 India
| | - Utpal Roy
- Associate Professor, Dept. of Geography, University of Calcutta, Kolkata, West Bengal 700073 India
| | - Sutapa Das
- Dept. of Economics, Vidyasagar University, Midnapore, West Bengal 721102 India
| | - Sutapa Rath
- Dept. of Geography, Vidyasagar University, Midnapore, West Bengal 721102 India
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Ab Hamid J, Juni MH, Abdul Manaf R, Syed Ismail SN, Lim PY. Spatial Accessibility of Primary Care in the Dual Public-Private Health System in Rural Areas, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3147. [PMID: 36833838 PMCID: PMC9959538 DOI: 10.3390/ijerph20043147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 06/18/2023]
Abstract
Disparities in access to health services in rural areas represent a global health issue. Various external factors contribute to these disparities and each root requires specific remedial action to alleviate the issue. This study elucidates an approach to assessing the spatial accessibility of primary care, considering Malaysia's dual public-private system specifically in rural areas, and identifies its associated ecological factors. Spatial accessibility was calculated using the Enhance 2-Step Floating Catchment Area (E2SFCA) method, modified as per local context. Data were secondary sourced from Population and Housing Census data and administrative datasets pertaining to health facilities and road network. The spatial pattern of the E2SFCA scores were depicted using Hot spot Analysis. Hierarchical multiple linear regression and geographical weight regression were performed to identify factors that affect E2SFCA scores. Hot spot areas revolved near the urban agglomeration, largely contributed by the private sector. Distance to urban areas, road density, population density dependency ratios and ethnic composition were among the associated factors. Accurate conceptualization and comprehensive assessment of accessibility are crucial for evidence-based decision making by the policymakers and health authorities in identifying areas that need attention for a more specific and localized planning and development.
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Affiliation(s)
- Jabrullah Ab Hamid
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Blok B2, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, Shah Alam 40170, Selangor, Malaysia
| | - Muhamad Hanafiah Juni
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Rosliza Abdul Manaf
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
| | - Sharifah Norkhadijah Syed Ismail
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
- Research Institute on Ageing (MyAgeing), Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang 43400, Selangor, Malaysia
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Fowler D, Middleton P, Lim S. Extending floating catchment area methods to estimate future hospital bed capacity requirements. Spat Spatiotemporal Epidemiol 2022; 43:100544. [PMID: 36460455 DOI: 10.1016/j.sste.2022.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
A new hospital in north-west Sydney, Australia is to start construction in the year 2023. However, the number of emergency department beds/treatment spaces (EDBs) that it will contain is yet to be determined, as this region is expected to have relatively high population growth from year 2021 to year 2036. In this paper, floating catchment area (FCA) methods were employed to estimate the required number of EDBs for this new hospital. Metrics including spatial accessibility index and spatial equity were calculated based on the predicted populations for 2021 and 2036 using government sourced data. Specifically, potential spatial accessibility and horizontal spatial equity were employed for this paper. Mathematical optimisation was used to determine the most efficient distribution of EDBs throughout different hospitals in this region in 2036. The best allocation of capacity across the study area that simultaneously improved average spatial accessibility and improved spatial equity relative to the metrics of 2021 was found. Traditional methods of healthcare planning seldom consider the spatial location of populations or the travel cost to hospitals. This paper presents a novel method to how capacity of future services are determined due to population growth. These results can be compared to traditional methods to access the validity of the methods outlined in this paper.
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Affiliation(s)
- Daniel Fowler
- School of Civil and Environmental Engineering, Faculty of Engineering, UNSW, Kensington Campus, The University of New South Wales, New South Wales 2052, Australia.
| | - Paul Middleton
- South Western Emergency Research Institute (SWERI), Ingham Institute, 1 Campbell Street, Liverpool, New South Wales 2170, Australia
| | - Samsung Lim
- School of Civil and Environmental Engineering, Faculty of Engineering, UNSW, Kensington Campus, The University of New South Wales, New South Wales 2052, Australia; Biosecurity Program, The Kirby Institute, Faculty of Medicine and Health, The University of New South Wales, New South Wales 2052, Australia
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Liu X, Seidel JE, McDonald T, Patel AB, Waters N, Bertazzon S, Shahid R, Marshall DA. Rural–Urban Disparities in Realized Spatial Access to General Practitioners, Orthopedic Surgeons, and Physiotherapists among People with Osteoarthritis in Alberta, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137706. [PMID: 35805363 PMCID: PMC9266058 DOI: 10.3390/ijerph19137706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 01/27/2023]
Abstract
Rural Canadians have high health care needs due to high prevalence of osteoarthritis (OA) but lack access to care. Examining realized access to three types of providers (general practitioners (GPs), orthopedic surgeons (Ortho), and physiotherapists (PTs)) simultaneously helps identify gaps in access to needed OA care, inform accessibility assessment, and support health care resource allocation. Travel time from a patient’s postal code to the physician’s postal code was calculated using origin–destination network analysis. We applied descriptive statistics to summarize differences in travel time, hotspot analysis to explore geospatial patterns, and distance decay function to examine the travel pattern of health care utilization by urbanicity. The median travel time in Alberta was 11.6 min (IQR = 4.3–25.7) to GPs, 28.9 (IQR = 14.8–65.0) to Ortho, and 33.7 (IQR = 23.1–47.3) to PTs. We observed significant rural–urban disparities in realized access to GPs (2.9 and IQR = 0.0–92.1 in rural remote areas vs. 12.6 and IQR = 6.4–21.0 in metropolitan areas), Ortho (233.3 and IQR = 171.3–363.7 in rural remote areas vs. 21.3 and IQR = 14.0–29.3 in metropolitan areas), and PTs (62.4 and IQR = 0.0–232.1 in rural remote areas vs. 32.1 and IQR = 25.2–39.9 in metropolitan areas). We identified hotspots of realized access to all three types of providers in rural remote areas, where patients with OA tend to travel longer for health care. This study may provide insight on the choice of catchment size and the distance decay pattern of health care utilization for further studies on spatial accessibility.
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Affiliation(s)
- Xiaoxiao Liu
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
| | - Judy E. Seidel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Terrence McDonald
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Alka B. Patel
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Nigel Waters
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Department of Civil Engineering, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Environmental Science and Policy, College of Science, George Mason University, Fairfax, VA 22030, USA
| | - Stefania Bertazzon
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Rizwan Shahid
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Applied Research and Evaluation Services, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- Department of Geography, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Deborah A. Marshall
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (X.L.); (J.E.S.); (T.M.); (A.B.P.)
- McCaig Bone and Joint Health Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 1N4, Canada; (S.B.); (R.S.)
- Correspondence: ; Tel.: +1-403-210-6377; Fax: +1-403-210-9574
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Shaltynov A, Rocha J, Jamedinova U, Myssayev A. Assessment of primary healthcare accessibility and inequality in north-eastern Kazakhstan. GEOSPATIAL HEALTH 2022; 17. [PMID: 35546728 DOI: 10.4081/gh.2022.1046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
Out of the many aspects of health care, the concept of physical accessibility is a priority that not only encompasses availability of health care resources, but also requires that they are easily accessible for all. To assess this factor as expressed in terms of the number of available physicians in the north-eastern part of Kazakhstan, we used the enhanced two-step float catchment area in a geographic information system approach. The Gini index and the Lorentz curve were used to evaluate the economic inequality within this region. Based on the data obtained, we developed models to increase the availability of health care considering allocation of additional primary health care resources. A low to zero index was found to be typical for most rural settlements, which currently make up less than 15% of the total population. We also identified a correlation between the index of accessibility and that of inequality, which indicates that areas with high accessibility show a more equitable distribution of resources. The developed location/ allocation models of additional primary health care resources can be useful in implementing government initiatives to improve the availability of primary health care in rural areas.
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Affiliation(s)
| | - Jorge Rocha
- Institute of Geography and Spatial Planning, University of Lisboa.
| | - Ulzhan Jamedinova
- Epidemiology and Biostatistics Department, Semey Medical University, Semey City.
| | - Ayan Myssayev
- Department of the Science and Human Resources, Ministry of Healthcare of the Republic of Kazakhstan, Nur-Sultan City.
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Zhang S, Song X, Zhou J. An equity and efficiency integrated grid-to-level 2SFCA approach: spatial accessibility of multilevel healthcare. Int J Equity Health 2021; 20:229. [PMID: 34666773 PMCID: PMC8524218 DOI: 10.1186/s12939-021-01553-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Shaoyao Zhang
- College of Geography and Resources Science, Sichuan Normal University, Chengdu, 610066, China
| | - Xueqian Song
- School of Management, Chengdu University of Information Technology, Chengdu, 610225, China.
| | - Jie Zhou
- School of Foreign Languages, Chengdu University of Information Technology, Chengdu, 610225, China
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Exploring Equity in Healthcare Services: Spatial Accessibility Changes during Subway Expansion. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2021. [DOI: 10.3390/ijgi10070439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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