Measuring geographical accessibility to rural and remote health care services: Challenges and considerations

Abstract

This research is focused on methodological challenges and considerations associated with the estimation of the geographical aspects of access to healthcare with a focus on rural and remote areas. With theassumption that GIS-based accessibility measures for rural healthcare services will vary across geographic units of analysis and estimation techniques, which could influence the interpretation of spatial access to ruralhealthcare services. Estimations of geographical accessibility depend on variations of the following three parameters: 1) quality of input data; 2) accessibility method; and 3) geographical area. This research investigated thespatial distributions of physiotherapists (PTs) in comparison to family physicians (FPs) across Saskatchewan, Canada. The three-steps floating catchment areas (3SFCA) method was applied to calculate the accessibilityscores for both PT and FP services at two different geographical units. A comparison of accessibility scores to simple healthcare provider-to-population ratios was also calculated. The results vary considerably depending onthe accessibility methods used and the choice of geographical area unit for measuring geographical accessibility for both FP and PT services. These findings raise intriguing questions regarding the nature and extent oftechnical issues and methodological considerations that can affect GIS-based measures in health services research and planning. This study demonstrates how the selection of geographical areal units and different methodsfor measuring geographical accessibility could affect the distribution of healthcare resources in rural areas. These methodological issues have implications for determining where there is reduced access that will ultimatelyimpact health human resource priorities and policies.