Measuring accessibility to health care services for older bus passengers: A finer spatial resolution

Abstract

Health care accessibility is a vital indicator for evaluating areas where there are medical shortages. However, due to the lack of population data with a satisfactory spatial resolution, efforts to accurately measure health care accessibility among older individuals have been hampered to some extent. To address this issue, we attempt to measure accessibility to health care services for older bus passengers in Nanjing, China, using a finer spatial resolution. More specifically, based on one month's worth of bus smart card data, a framework for identifying the home stations (i.e., a passenger's preferred station near their residence) of older passengers is developed to measure the aggregate demand at the bus stop scale. On this basis, a measurement that integrates the Gaussian two-step floating catchment area (2SFCA) and the adjusted 2SFCA methods (referred to as the adjusted Gaussian 2SFCA method) is proposed to measure accessibility to health care services for older people. The results show that: (1) almost all home stations experience inflated demand, especially those located in the suburbs; (2) despite abundant health care resources, home stations in urban districts are rarely identified as high accessibility stations, due to high demand densities among the older population; and (3) more attention should be paid to two types of home stations – those with a medical institution and those with bed shortages, respectively. The first type is predominantly distributed in the periphery of the city, in the suburbs where the travel time required to access the nearest health care service by bus is longer. The second type is mostly located in the outskirts of urban districts and in the central area of one suburb. These findings could help policy makers to implement more appropriate measures to design and reallocate health care resources.