Measuring geographical accessibility to rural and remote health care services: Challenges and considerations (original) (raw)
Related papers
Measuring Access to Primary Health Care: Use of a GIS-Based Accessibility Analysis
SAPI, 2014
Spatial analytical tools and analyses are key enabling instruments which can be used to efficiently plan for public-spaces such as health care facilities in a metropolitan context. Improving the levels of access to public-spaces through various planning approaches is necessary especially in light of the magnitude of development in metropolitan areas. However, planning for the provision of services in the health care sector is somewhat more complicated than planning for any other type of service. In the perfect world, health service delivery systems would be able to cater for all the health care needs of the entire population. However, realistically speaking, this has currently proven unattainable as the health care needs of people differ along many dimensions. Health care service planning requires consideration of a range of issues when looking at serving the health care needs of a spatially dispersed population. From the perspective of the provider, the challenge is therefore to optimally provide services in such a way that the health care needs of the greatest number of people are served. Recent increases in the availability of Geographical Information Systems (GIS) and associated modelling approaches have provided a good basis for the planning for the need of public services. Successful applications of these approaches have been useful in indicating average accessibility of an existing or potential service. However, it is increasingly realised that there has been a growing need for a paradigm shift in planning approaches. The spatial planning of primary health care services based on GIS accessibility analysis has only been used to a very limited extent in South Africa. In this study, facility utilisation rates in the form of headcounts are incorporated in a GIS-based accessibility analysis to assist in the spatial planning of health care services. Due to the absence of accurate patient databases and / or registers, GIS tools are used to determine three different scenarios of defining public primary health care demand. The three scenarios are tested in a GIS-based form of catchment area modelling. The results show no significant difference in the spatial extent of the catchment areas of facilities but a significant increase in the allocated demand from scenario 1 through to scenario 3. When compared to the facility headcounts, the total allocated demand in scenario 3 tends to be more strongly in line with the total number of facility headcounts recorded in the city showing a moderate positive correlation. This type of analysis promotes and facilitates the development of future facility plans in relation to actual demand and usage, and also improving current service provision access at overburdened focal points where previously not realised.
Applied Geography, 2009
Quantifying spatial accessibility in relation to the provision of rural health services has proven difficult. This article critically appraises the two-step floating catchment area (2SFCA) method, a recent solution for measuring primary care service accessibility across rural areas of Victoria, Australia. The 2SFCA method is demonstrated to have two fundamental shortcomings -specifically the use of only one catchment size for all populations, and secondly the assumption that proximity is undifferentiated within a catchment (especially problematic when the catchment is large). Despite its advantages over simple population-to-provider ratios, the 2SFCA method needs to be used with caution.
It is important for health planners to provide health services as effectively and equitably as possible for the development of quality living environments. The provision of adequate healthcare services, particularly in metropolitan areas, is becoming more difficult because of three developments: slow economic growth; the rapid growth of metropolitan areas and their subsequent increases in population. It is thus a challenge to provide what is considered a fair or socially just distribution of healthcare services to a population with changing healthcare needs. The spatial distribution of people and their varying need for healthcare services is a long-standing interest in the field of service planning, and provides a classic issue well suited for Geographical Information Systems (GIS) to analyse. Access is an important aspect in healthcare service planning. GIS-based accessibility analysis is a logical method that can be applied to test the degree to which access is obtained. Such successful applications of GIS-based analysis have been useful in indicating the accessibility of an existing or potential service. This has provided a good basis for the planning of healthcare services. However, it has been increasingly realised that there is a growing need for a paradigm shift in the planning process. In South Africa, primary healthcare (PHC) is a dual system made up of private and public healthcare facilities. Private PHC is expensive and only affordable to people with medical insurance. These people, most currently belonging to the middle and high income brackets, are theoretically also healthier than the rest of the population. But a small proportion of the population in the low income bracket also has medical aid or insurance. Hence, it is quite difficult to make a clear distinction of the low, middle and high income uninsured population when measuring access to public primary healthcare services. In this study, three different scenarios to calculate the uninsured population were generated and tested using a GIS-based form of catchment area analysis. The results from the catchment area analysis were compared with actual public PHC demand in the form of headcounts and further analysis of the origins of the patients was undertaken using a patient register. Results indicate that there is no significant difference in the spatial extent of the catchment areas of the facilities across the three demand scenarios but that there are significant differences in demand visits per scenario. A patient register and facility headcounts, both based on actual visits to public PHC facilities, were compared to the results of the catchment area analysis. The comparison results show that almost 45% of the patients did not use their closest facility as a first point of contact. The total allocated demand visits in scenario 3 was strongly in line with the total number of headcounts of the area, and thus is considered the most suitable calculation of uninsured population for implementation in a GIS-based accessibility analysis.
A Method For Evaluating The Geographic Accessibility Of Health Services
Professional Geographer, 1975
NALYSIS of the location of health ser-A vices is intricately related to planning for the delivery of medical care. The man-ner in which medical facilities are dis-tributed vis-A-vis the population distribu-tion has a demonstrated effect upon illness and therapeutic behavior. (I) ...
Geography of Health Care Access: Measurement, Analyses and Integration
2016
In recent decades, the health care delivery system in the United States has been greatly transformed and more widely examined. Even with one of the most developed health care systems in the world, the United States still experiences great spatial disparity in health care access. Increasing diversity of class, culture, and ethnicity also has a significant impact on health disparity. The goal of this chapter is to address the spatial disparity of health care access using a network-based health accessibility index method (NHAIM) in a Geographic Information System (GIS) environment. Ensuring a desired level of accessibility for patients is the goal of the health care delivery system, through which health care service providers are supplied to populations in need. GIS is able to incorporate geographical physical barriers, network-based travel time, and transportation costs required for measuring access to health care services. In this study, we develop a NHAIM to examine the spatial disp...
Journal of Remote Sensing & GIS, 2023
This is a systematic review of literature on geographic access methods to primary care in non-urban settings. The review aimed to explore the use, application, and operationalization of FCA methods and their ability to identify variations in access in non-urban areas. The review included 32 papers on physical access to primary care, with most studies using secondary data and the E2SFCA method. The E2SFCA method was found to be more sensitive in identifying deficits in rural access. However, many studies lacked clear definitions and there was no clear consensus concerning the definition of a primary care provider. The conclusion suggests that healthcare policymakers and providers should consider rural populations’ unique transportation needs when designing healthcare access initiatives, and future research should compare these methods and develop recommendations for improving access to primary care for rural populations.
CONSAS , 2014
Geographical access is an important aspect of the health care planning process. GIS-based accessibility analysis is a logical method which can be applied to test the degree to which equitable access to services and facilities is obtained. The GIS analysis is, however, based on the assumption of rational choice, i.e. a person will always go to the closest facility. Inputs to the analysis are supply (facility capacity) and demand (population) estimates. In South Africa primary health care (PHC) is a dual system made up of private and public health care facilities. Private PHC is expensive and only affordable to affluent citizens or people with medical insurance, and does not form a part of this study. Two challenges regarding GIS-based accessibility analysis for public PHC services within a South African context that emerge are: (a) how accurate is a rational choice-based model compared to people's actual decisions; and, (b) what method is best in determining demand in the absence of accurate databases indicating public versus private health care usage? GIS demand profiling tools were applied to determine three distinct demand scenarios based on a combination of three variables: (a) household income category; (b) age; and, (c) average visits. A GIS-based form of catchment area modelling was used to determine catchment areas for each facility, allocating demand to the closest facility and limiting access based on facility capacity and access via a road network. Results indicate that there is no significant difference in the spatial extent of the catchment areas of the facilities across the three scenarios but that there is a significant demand increase per scenario: scenario 1 (6 711 292) < scenario 2 (6 828 738) < scenario 3 (7 120 648). An electronic tuberculosis (TB) patient register and facility headcounts based on actual visits were compared to the results of the catchment area modelling. The comparison results show that almost 45% of the patients did not use their nearest facility as a first point of contact. The headcounts showed that the method used for scenario 3 is ideal for determining primary health care demand. GIS is not the complete solution to understanding all the issues of access to public health care services but is a useful tool to support planning by spatially identifying where interventions are needed most, especially in the absence of accurate and geo-referenced patient registers.
The index of rural access: an innovative integrated approach for measuring primary care access
BMC Health Services Research, 2009
The problem of access to health care is of growing concern for rural and remote populations. Many Australian rural health funding programs currently use simplistic rurality or remoteness classifications as proxy measures of access. This paper outlines the development of an alternative method for the measurement of access to primary care, based on combining the three key access elements of spatial accessibility (availability and proximity), population health needs and mobility.
Medical Journal of Australia, 1999
To demonstrate the potential of GIS (geographic information system) technology and ARIA (Accessibility/Remoteness Index for Australia) as tools for medical workforce and health service planning in Australia. Design: ARIA is an index of remoteness derived by measuring road distance between populated localities and service centres. A continuous variable of remoteness from 0 to 12 is generated for any location in Australia. We created a GIS, with data on location of general practitioner services in non-metropolitan South Australia derived from the database of RUMPS (Rural Undergraduate Medical Placement System), and estimated, for the 1170 populated localities in South Australia, the accessibility/inaccessibility of the 109 identified GP services. Main outcome measures: Distance from populated locality to GP services. Results: Distance from populated locality to GP service ranged from 0 to 677 km (mean, 58 km). In all, 513 localities (43%) had a GP service within 20 km (for the majority this meant located within the town). However, for 173 populated localities (15%), the nearest GP service was more than 80km away. There was a strong correlation between distance to GP service and ARIA value for each locality (0.69; P<0.05). Conclusions: GP services are relatively inaccessible to many rural South Australian communities. There is potential for GIS and for ARIA to contribute to rational medical workforce and health service planning. Adding measures of health need and more detailed data on types and extent of GP services provided will allow more sophisticated planning.
Comparing Three GIS Techniques for Modelling Geographical Access to General Practitioners
Cartographica: The International Journal for Geographic Information and Geovisualization, 2004
Accessibility to health services is a social and economic issue that has many dimensions. This article compares three techniques for measuring geographical accessibility to general practitioners (family doctors). These techniques can be described as ratio, least-cost path, and allocation methods. The ratio method is the most common and simply measures the population-to-GP ratio for a given area. The least-cost path and allocation techniques rely on GIS network analysis and provide information on travel times and distances. The allocation analysis differs from least-cost path analyses because it considers the number of GPs available and this acts as a capacity constraint. The use of GIS network analysis can produce a number of different statistics on accessibility that can be visualized as a map. This article will argue that the use of a capacity constraint is important and that the population further than 30 minutes from a GP is an effective statistic for comparing the accessibility...