Abstract
BackgroundOptimal healthcare access improves the health status and decreases health inequalities. Many studies demonstrated the importance of spatial access to healthcare facilities in health outcomes, particularly using the enhanced two-step floating catchment area (E2SFCA) method. The study objectives were to build a hospital facility access indicator at a fine geographic scale, and then to assess the impact of spatial accessibility to inpatient hospital and non-hospital care services on the length of hospital stay (LOS).MethodsData concerning older adults (≥75 years) living in the Nord administrative region of France were used. Hospital spatial accessibility was computed with the E2SFCA method, and the LOS score was calculated from the French national hospital activity and patient discharge database. The relationship between LOS and spatial accessibility to inpatient hospital care and to three non-hospital care types (general practitioners, physiotherapists, and home-visiting nurses) was analyzed with linear regression models.ResultsThe mean number (standard deviation) of beds per 10,000 inhabitants was 19.0 (10.69) in Medical, Surgical and Obstetrics (MCO) facilities and 5.58 (2.19) in Postoperative and Rehabilitation Care (SSR) facilities, highlighting important variations within the region. Accessibility to hospital services was higher in large urban areas, despite the dense population and higher demand. In 2014, the mean LOS scores were 0.26 for MCO and 0.85 for SSR, but their geographical repartition was non-homogeneous. The linear regression analysis revealed a strong negative and significant association between LOS and non-hospital care accessibility.ConclusionsThis is the first study to measure spatial accessibility to inpatient hospital care in France using the E2SFCA method, and to investigate the relationship between healthcare utilization (LOS score) and spatial accessibility to inpatient hospital care facilities and three types of non-hospital care services. Our findings might help to make decisions about deploying additional beds and to identify the best locations for non-hospital care services. They might also contribute to improve access, and to ensure the best coordination and sustainability of inpatient and outpatient services, in order to better cover the population’s healthcare needs. International studies using multiple consensual indicators of healthcare outcomes and accessibility and sophisticated modeling methods are needed.
Highlights
Optimal healthcare access improves the health status and decreases health inequalities
Data sources and statistical unit Various data sources were combined for the present study: Methodology First, the Enhanced two-Step Floating Catchment Area (E2SFCA) method was implemented to compute the hospital spatial accessibility by combining geographical, supply and demand factors
To compare the spatial distribution of the [ISA_MCO]_hospital (a) and [ISA_SSR]_hospital (b) values per 10,000 inhabitants (Fig. 1) within the Nord administrative region, scores were categorized in five classes, using the Jenks Natural Breaks algorithm [57]
Summary
Optimal healthcare access improves the health status and decreases health inequalities. Ensuring a high degree of healthcare access improves people’s health status and decreases health inequalities. On the other hand, realized access describes the actual use of the available healthcare services/facilities [13] and the real interactions with the healthcare system [14]. Penchansky and Thomas [15] grouped barriers that limit the passage from potential to realized access in five dimensions: availability, accessibility, affordability, acceptability, and accommodation. These authors showed that potential and realized access are two separated, but closely related notions. On the other hand, realized access could influence the spatial organization of healthcare services. Many studies have assessed the potential access to healthcare services and care utilization [16, 17]. The links between potential and realized access must be investigated because they can bring crucial insights that can be used to better understand the demands by healthcare users and to inform healthcare providers and political actors
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