Spatial Access by Public Transport and Likelihood of Healthcare Consultations at Hospitals

Abstract

As healthcare is a right in Canada, analyzing the distribution of spatial access to medical consultations, which are crucial for the prevention, diagnosis, and early treatment of illnesses, is fundamental to understanding health equity. Spatial accessibility can influence whether individuals can reasonably reach the services they seek. However, as an indicator of potential access, it does not guarantee realized access because of predisposing and need factors. This study examines the relationship between spatial accessibility to hospitals and the likelihood of consulting with a healthcare professional at a hospital in eight Canadian metropolitan regions while controlling for individual characteristics through multilevel regression modeling. Spatial accessibility was computed using the two-step floating catchment area (2SFCA) method. Self-reported consultations and socio-demographic characteristics were obtained from the Canadian Community Health Survey. We found that the likelihood of consultations differed between genders (female OR: 1.133, CI: 1.023–1.255; compared with male) and followed a positive household income gradient (high-income OR: 1.236, CI: 1.094–1.397; middle-income OR: 1.039, CI: 0.922–1.172; compared with low-income), but is not influenced by age. Living in areas with higher spatial accessibility was positively linked to consultations (OR: 1.014, CI: 1.000–1.028), even after controlling for perceived health (OR: 0.540, CI: 0.471–0.621), chronic conditions (OR: 1.738, CI: 1.587–1.904), and having a regular doctor (OR: 1.313, CI: 1.187–1.452). Policies that may improve spatial accessibility to healthcare services through increasing supply, managing demand, and enhancing level of public transport service should be considered to improve individuals’ ability to consult healthcare professionals, potentially leading to better health outcomes.