Abstract
Geographic accessibility of health services is one of the key dimensions affecting health care access, utilisation and may impact population health. We analysed countrywide space-time accessibility to primary health services by private car and multimodal walk-ride-walk travel chains of public transport in Finland. The analysis utilises register-based population grid cell data at 250m × 250 m resolution, road network with scheduled public transport data and geocoded locations of four types of primary health service. Our results show that the Finnish population reaches primary health services well, also by public transport, which is most beneficial in urban fringes, where health services are not immediately available. However, accessibility of services may be limited for some segments of the population, such as carless households located in remote areas, and teenagers who access health services independently. Distinct regional differences exist in accessibility, particularly in rural areas. The continuous pressure to reduce the number of service facilities may further deter service accessibility of these segments of the population. As this kind of transport disadvantage may create or reinforce social disadvantage and exclusion, as well as health inequalities, ensuring an equal access to primary health services is important.
Highlights
Geographic accessibility of health services has received increased attention in recent years due to the understanding that spatial barriers, among other obstacles between providers and population, may poten tially lead to lower health care utilisation and use of preventive services, contributing to differences in population health (Arcury et al 2005; Campbell et al 2001; Chen et al 2015)
The dimension of accessibility specif ically refers to the geographic relationship between health care services and their users, and unlike the other dimensions describing the fit be tween the two, the presence of geographic disparities in access to health care is virtually unavoidable: health care services and their customers are always separated by distance, and it is the location and the ability of customers to travel to overcome the friction of distance that determine their geographic accessibility to services
Geographic accessibility of primary health services is good for most people: at least 96% of people can reach any of the four types of primary health care service within 20 min by car (Table 1), which is comparable to typical travel time of shopping trips
Summary
Geographic accessibility of health services has received increased attention in recent years due to the understanding that spatial barriers, among other obstacles between providers and population, may poten tially lead to lower health care utilisation and use of preventive services, contributing to differences in population health (Arcury et al 2005; Campbell et al 2001; Chen et al 2015). As a special case of a gravity model, floating catchment area methods combining accessibility to supply and demand have been applied to measure geographic accessibility to health care, and primary care in particular, like in studies by Luo and Wang (2003), Delamater (2013) and Chen and Jia (2019) Another metric is potential path area, denoting the geographical extent where individuals can participate in activities subject to certain constraints (e.g. time) (Patterson & Farber, 2015): intuitively, individuals walking or using public transport have a smaller potential path area than those using a private car. An example is provided in Lee and Miller (2018) who analysed the effect of new public transit connections to health services in relation to existing car and public transports in Columbus, Ohio
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