Abstract
BackgroundAccess to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs).MethodsHainan Island was taken as an example to explore the utilization of modern spatial access techniques under China’s specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution’s tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated.ResultsOn Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions.ConclusionSpatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.
Highlights
In 2005, the 58th World Health Assembly issued a call for Universal Health Coverage (UHC), which is defined as access to key promotive, preventive, curative, and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access [1, 2]
Access to healthcare is central to the performance of healthcare systems around the world [4], and variability in healthcare access has been identified as a main cause for inequality in health outcomes [5]
The healthcare institutions were widely distributed across Hainan Island
Summary
In 2005, the 58th World Health Assembly issued a call for Universal Health Coverage (UHC), which is defined as access to key promotive, preventive, curative, and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access [1, 2]. Healthcare access is defined by five specific dimensions: 1) availability, 2) accessibility, 3) accommodation, 4) affordability, and 5) acceptability [6]. The first two dimensions are spatial in nature and refer to the number of providers available and travel impedances in reaching them, while the latter three dimensions are essentially non-spatial and reflect healthcare financing arrangements and cultural factors. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. Most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs)
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