Abstract
BackgroundReducing spatial access disparities to healthcare services is a growing priority for healthcare planners especially among developed countries with aging populations. There is thus a pressing need to determine which populations do not enjoy access to healthcare, yet efforts to quantify such disparities in spatial accessibility have been hampered by a lack of satisfactory measurements and methods. This study compares an optimised and the conventional version of the two-step floating catchment area (2SFCA) method to assess spatial accessibility to medical clinics in Montreal.MethodsWe first computed catchments around existing medical clinics of Montreal Island based on the shortest network distance. Population nested in dissemination areas were used to determine potential users of a given medical clinic. To optimize the method, medical clinics (supply) were weighted by the number of physicians working in each clinic, while the previous year's medical clinic users were computed by ten years age group was used as weighting coefficient for potential users of each medical clinic (demand).ResultsThe spatial accessibility score (SA) increased considerably with the optimisation method. Within a distance of 1 Km, for instance, the maximum clinic accessible for 1,000 persons is 2.4 when the conventional method is used, compared with 27.7 for the optimized method. The t-test indicates a significant difference between the conventional and the optimized 2SFCA methods. Also, results of the differences between the two methods reveal a clustering of residuals when distance increases. In other words, a low threshold would be associated with a lack of precision.ConclusionResults of this study suggest that a greater effort must be made ameliorate spatial accessibility to medical clinics in Montreal. To ensure that health resources are allocated in the interest of the population, health planners and the government should consider a strategy in the sitting of future clinics which would provide spatial access to the greatest number of people.
Highlights
Reducing spatial access disparities to healthcare services is a growing priority for healthcare planners especially among developed countries with aging populations
Within a distance of 1 Km, for instance, the maximum clinic accessible for 1,000 persons in one dissemination areas (DA), when it is estimated by the conventional method is approximately 2.404, compared with 27.706 physicians for 1,000 potential users when it is estimated by the optimized method
Our results concord with those reported in previous studies [47,48,49]. How may this location place be explained in the Canadian context where healthcare is free of charge for all citizens? even if all Canadians are covered by public health insurance, the number of patients is taken into account for the funding of each medical clinic and given the concentration of population in the central part of Montreal, physicians may choose these places to benefit from a higher density of potential clients
Summary
Reducing spatial access disparities to healthcare services is a growing priority for healthcare planners especially among developed countries with aging populations. Poor access to medical clinics may result in people with simple health problems not consulting a health professional and subsequently developing more complex Given these guidelines aimed at reducing barriers in access to health care, it is important to note that recent studies still report disparities in access to healthcare in Canada [4,9,10,11]. In Canada, as in many other developed countries, the geographic distribution of physicians does not necessarily match that of population since access to healthcare is affected by where physicians locate (supply) and where people reside (demand) Interpreting this distribution is difficult due to the multiple definitions of “access” and the lack of specifications on how access should be measured [5,12]. Accessibility can be grouped in four main categories: potential or revealed, spatial or aspatial [14,15]
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