Abstract
BackgroundMuch of spatial access research measures the proximity to health service locations. We advance this research by focusing on whether health service funding is within walkable reach of neighborhoods with high hardship. This is made possible by a new administrative data source: financial contracts data for those human services that are delivered by nonprofits under contract with the government.MethodsIn a prototypical spatial access study we apply a classic 2-step floating area catchment model for walkable network access to analyze 2018 data about contracted nonprofit health services funded by the Chicago Department of Public Health (CDPH). CDPH collected the data for the purpose of this study.ResultsWe find that the common container approach of aggregating contract amounts by provider headquarter locations in a given area (ignoring satellite service sites) underestimates the share of funding that goes to Chicago neighborhoods with higher hardship. Once service sites and spatial access are taken into account, a larger share of CDPH funds was found to be within walkable reach of Chicago’s high hardship areas. This was followed by low hardship areas (which could be driven by more headquarter locations there that do serve areas throughout the city). Medium hardship areas trail both, perhaps warranting closer attention. We explore these results by program type and neighborhood with a spatial decision support system developed for the health department.ConclusionsThe typical approach for analyzing human service contracts based on headquarters is misleading -- in fact, we find that results are reversed when service sites and walkable access are taken into account. This prototype provides an alternative framework for avoiding these misleading results.
Highlights
Each year, government spends more than a trillion dollars [1, 2] in combined federal, state, and local funds to support hundreds of thousands of local service providers in a highly decentralized system of service provision in the U.S Each city, county, and state manages its own system of allocating contracts to human service providersKoschinsky et al BMC Health Services Research (2022) 22:45 contracting and spatial access research
Of the $30.4M in Chicago Department of Public Health (CDPH) contracts to delegates with specific service sites, 70% are related to HIV, 16% of funding goes to health promotion, including supporting primary care at federally qualified health clinics (FQHCs) and violence prevention funding, 6% for MICAH, including WIC and adolescent health programs, 5% for health protection and 3% for chronic disease
A prototype spatial access analysis for health services contract data The methodology and results are part of a prototypical analysis that could be extended to research with a bigger picture perspective once contract data become available across jurisdictions and across departments
Summary
In a prototypical spatial access study we apply a classic 2-step floating area catchment model for walkable network access to analyze 2018 data about contracted nonprofit health services funded by the Chicago Department of Public Health (CDPH). CDPH collected the data for the purpose of this study.
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