Potential Spatial Accessibility Research Articles

Potential Spatial Accessibility to Cardiovascular Hospitals in Romania

Cardiovascular diseases (CVDs) represent the leading cause of death globally. Romania recorded the highest mortality rate due to CVDs in the EU in 2022, with 162,984 deaths, while the number of registered patients with CVDs surpassed 4 million. This study aims to measure the population’s potential spatial accessibility to cardiovascular hospitals in Romania, as timely access to such healthcare facilities is crucial to minimise avoidable mortality due to CVDs. Although distance is an essential parameter of spatial accessibility, time-based analysis is more reflective of real-world scenarios due to the unpredictability of travel. The potential spatial accessibility was measured using the Application Program Interface (API) offered through the Google Maps platform and a personal car as the transportation mode. The country’s cardiovascular hospital network comprises 161 units, of which 84 can provide complex care. Because all of them are located in urban areas, three different time slots were considered to distinguish between high and low traffic congestion situations. We created hierarchies of ten-minute and five km intervals for travel time and distance, respectively, to emphasize the population percentages with better or low potential spatial accessibility. Results showed that only 15% of the population can reach the nearest cardiovascular hospital in less than 20 min, and 23% must travel for over 60 min, while 45.7% live farther than 20 km from a cardiovascular hospital. Inhabitants living in remote areas, especially rural ones, are the most vulnerable, having to travel for the longest time and distance. Actions like improving the existing transport infrastructure and upgrading healthcare facilities and equipment are needed to ensure better medical care and an adequate response to population needs. This study can support local authorities in optimising spatial accessibility to cardiovascular care by identifying the most burdened hospitals in the context of low medical specialised staff and large catchment areas.

Revealed versus potential spatial accessibility of healthcare and changing patterns during the COVID-19 pandemic

BackgroundTimely access to healthcare is essential but measuring access is challenging. Prior research focused on analyzing potential travel times to healthcare under optimal mobility scenarios that do not incorporate direct observations of human mobility, potentially underestimating the barriers to receiving care for many populations.MethodsWe introduce an approach for measuring accessibility by utilizing travel times to healthcare facilities from aggregated and anonymized smartphone Location History data. We measure these revealed travel times to healthcare facilities in over 100 countries and juxtapose our findings with potential (optimal) travel times estimated using Google Maps directions. We then quantify changes in revealed accessibility associated with the COVID-19 pandemic.ResultsWe find that revealed travel time differs substantially from potential travel time; in all but 4 countries this difference exceeds 30 minutes, and in 49 countries it exceeds 60 minutes. Substantial variation in revealed healthcare accessibility is observed and correlates with life expectancy (⍴=−0.70) and infant mortality (⍴=0.59), with this association remaining significant after adjusting for potential accessibility and wealth. The COVID-19 pandemic altered the patterns of healthcare access, especially for populations dependent on public transportation.ConclusionsOur metrics based on empirical data indicate that revealed travel times exceed potential travel times in many regions. During COVID-19, inequitable accessibility was exacerbated. In conjunction with other relevant data, these findings provide a resource to help public health policymakers identify underserved populations and promote health equity by formulating policies and directing resources towards areas and populations most in need.

Inequities inspatial access to health services inGhanaian cities.

Consideration of health equity is fundamental to enhancing the health of those who are economically/socially disadvantaged. A vital characteristic of health equity and therefore health disparity is the level of spatial access to health services and its distribution among populations. Adequate knowledge of health disparity is critical to enhancing the optimal allocation of resources, identification of underserved populations and improving the efficiency and performance of the health system. The provision of such insight for sub-Saharan African (SSA) cities is a challenge and is severely limited in the literature. Accordingly, this study examined the disparities in potential spatial access to health services for four selected urban areas in Ghana based on: (1) the number of physicians per population; (2) access score based on a weighted sum of access components; (3) travel time to health services and (4) the combined evaluation of linkages between travel distance, settlement area, population and economic status. The overall spatial access to health services is low across all selected cities varying between 3.02 and 1.78 physicians per 10 000 persons, whereas the access score is between 1.70 and 2.54. The current number of physicians needs to be increased by about five times to satisfy the World Health Organization's standard. The low spatial access is not equitable across and within the selected cities, where the economically disadvantaged populations were found to endure longer travel distances to access health services. Inequities were found to be embedded within the selected cities where economically poor populations are also disadvantaged in their physical access to healthcare. The health facilities in all cities have reasonable travel distances separating them but are inadequately resourced with physicians. Thus, increasing the physician numbers and related resources at spatially targeted existing facilities would considerably enhance spatial access to health services.

Spatial Accessibility Assessment of Homecare Workers to the Older Population in the City of Zurich

Abstract. Access to homecare is paramount for the older population wishing not to move to retirement homes. In Zurich, the organization “Spitex Zürich” is the public homecare provider, allowing the older population to experience high-quality life at home through regular visits. A major factor for ensuring self-determined living for the older population consists of a detailed understanding of the spatial accessibility to Spitex locations. Therefore, this paper is concerned with applying four different FCA methods for assessing the spatial accessibility of Spitex homecare workers to people aged 65 + in Zurich through the road and bike networks. The modified-Huff-model-three-step-FCA method is found to be best suited for modeling potential spatial accessibility in Zurich. Spatial accessibility index values show similar geographical distributions regardless of transportation mode. The neighborhoods of Seebach and Hottingen are identified as regions with relatively low spatial accessibility. Our findings contribute to a better understanding of the interpretation and the measurement of spatial accessibility, thereby facilitating autonomous living for the older population residing in Zurich, ultimately increasing the inclusiveness of the city.

Reduction potentials for particulate emissions from household energy in India

Household access to clean energy is a priority for public health and the environment in low- and middle-income countries. However, past illustrative studies have explored benefits of replacing all polluting energy sources, a transition that is only theoretically possible. Factors that limit achievement of the entire theoretical reduction potential should be explored to inform programmatic decision making. We propose a hierarchy of reduction potentials for emissions from household energy, representing different implementation barriers. Following similar work in renewable energy, we propose four categories of reduction potentials beyond the theoretical maximum: distributional, technical, economic, and market. We apply this framework to household energy emissions using a high-resolution spatiotemporal emission inventory of India, a country chosen for its data availability and level of interest in mitigation. We explore distributional potential using distance from urban areas, technical potential by attributing emissions to energy services, and economic potential with a village- level proxy for likelihood of program success. For distributional potential (spatial accessibility), we find that applying reduction programs within 5 km of urban centers would achieve 36%–78% of the theoretical potential across seven regions in India; extension to 10 km yields reductions of 63%–90%. Technical and economic reduction potentials differ most greatly from theoretical potential in regions that contribute the most to national emissions. Even if some of the relationships underlying emission causes are not completely known, reflecting the factors that affect transitions can inform practitioners and programs seeking to scale and deliver clean energy solutions. We assert that including these important influences should be a goal of emission inventory development, beyond the simple quantification of baseline emissions.

Extending floating catchment area methods to estimate future hospital bed capacity requirements

A new hospital in north-west Sydney, Australia is to start construction in the year 2023. However, the number of emergency department beds/treatment spaces (EDBs) that it will contain is yet to be determined, as this region is expected to have relatively high population growth from year 2021 to year 2036. In this paper, floating catchment area (FCA) methods were employed to estimate the required number of EDBs for this new hospital.Metrics including spatial accessibility index and spatial equity were calculated based on the predicted populations for 2021 and 2036 using government sourced data. Specifically, potential spatial accessibility and horizontal spatial equity were employed for this paper.Mathematical optimisation was used to determine the most efficient distribution of EDBs throughout different hospitals in this region in 2036. The best allocation of capacity across the study area that simultaneously improved average spatial accessibility and improved spatial equity relative to the metrics of 2021 was found.Traditional methods of healthcare planning seldom consider the spatial location of populations or the travel cost to hospitals. This paper presents a novel method to how capacity of future services are determined due to population growth. These results can be compared to traditional methods to access the validity of the methods outlined in this paper.

Exploring the associations between cooling centre accessibility and marginalization in Montreal, Toronto, and Vancouver, Canada

Cooling centres provide respite, safety, and social support during extreme heat events for populations that do not have the resources to own or operate in‐home air conditioning. The objective of this study was to measure the spatial accessibility of cooling centres and analyze the associations between cooling centre access and marginalization in Montreal, Toronto, and Vancouver, Canada. The potential spatial accessibility of cooling centres within a 15‐minute walk was measured at the dissemination area scale using the two‐step floating catchment area method. A two‐stage modelling approach was used to analyze the associations between cooling centre access and marginalization. Approximately 62%, 58%, and 54% of the populations in Montreal, Toronto, and Vancouver had access to at least one cooling centre. In Montreal and Vancouver, high marginalization areas were more likely to have cooling centre access than low marginalization areas. Of the areas with cooling centre access, smaller access scores were observed in areas with high residential instability. Approximately one‐fifth of the areas in each city had no cooling centre access and high marginalization, and may be considered for future cooling centres or programs that improve accessibility to existing centres.

Modeling Health Seeking Behavior Based on Location-Based Service Data: A Case Study of Shenzhen, China

Understanding residents’ health seeking behavior is crucial for the planning and utilization of healthcare resources. With the support of emerging location-based service (LBS) data, this study proposes a framework for inferring health seeking trips, measuring observed spatial accessibility to healthcare, and interpreting the determinants of health seeking behavior. Taking Shenzhen, China as a case study, a supply–demand ratio calculation method based on observed data is developed to explore basic patterns of health seeking, while health seeking behavior is described using a spatial analysis framework based on the Huff model. A total of 95,379 health seeking trips were identified, and their analysis revealed obvious differences between observed and potential spatial accessibility. In addition to the traditional distance decay effect and number of doctors, the results showed health seeking behavior to be determined by hospital characteristics such as hospital scale, service quality, and popularity. Furthermore, this study also identified differences in health seeking behavior between subgroups with different ages, incomes, and education levels. The findings highlight the need to incorporate actual health seeking behavior when measuring the spatial accessibility of healthcare and planning healthcare resources. The framework and methods proposed in this study can be applied to other contexts and other types of public facilities.

An External Patient Healthcare Index (EPHI) for Simulating Spatial Tendencies in Healthcare Seeking Behavior.

BackgroundHealthcare resources are always more limited compared with demand, but better matching supply with demand can improve overall resource efficiency. In countries like China where patients are free to choose healthcare facilities, over-utilization and under-utilization of healthcare resources co-exist because of unreasonable healthcare seeking behavior. However, scholarship regarding the spatial distribution of utilization for healthcare resources, resulting from unreasonable spatial tendencies in healthcare seeking, is rare.MethodsIn this article, we propose a new External Patient Healthcare Index (EPHI) to simulate the spatial distribution of utilization for healthcare resources, based on the Two-Step Floating Catchment Area (2SFCA) method, which is widely used to assess potential spatial accessibility. Instead of using individual-level healthcare utilization data which is difficult to obtain, the EPHI uses institution-level aggregated data, including numbers of inpatient/outpatient visits. By comparing the estimated utilization (based on local healthcare institution services provision) with the expected utilization (based on local population morbidity), guest patients (e.g., patients flowing in for treatment) and bypass patients (patients flowing out) can be identified. To test the applicability of this index, a case study was carried out on China's Hainan Island. The spatial tendencies of patients for inpatient and outpatient services were simulated, then incorporated with spatial access to healthcare resources to evaluate overall resource allocation efficiency, thus guiding future resource allocations and investment for policy makers and healthcare providers.ResultsThe EPHI revealed that bypass activities widely exist on Hainan Island in both inpatient and outpatient care, with patients tending to travel from less developed regions with fewer healthcare resources to more highly developed regions with more healthcare resources to receive healthcare. Comparison with spatial accessibility demonstrated how bypass activities on Hainan produced an under-utilization of doctors in less developed regions and over-utilization of doctors in more developed coastal regions.ConclusionsThis case study on Hainan Island demonstrates that this new index can very clearly identify both the sources and sinks of patient spatial tendencies. Combining these results with spatial accessibility of healthcare resources, how efficiently the available supply matches the utilization can be revealed, indicating wide-ranging applicability for local governments and policymakers.

Measuring COVID-19 vaccination coverage: an enhanced age-adjusted two-step floating catchment area model

BackgroundThere are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas. This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad, the second-most populous city in Iran.MethodsThe 2021 age structure of the urban census tracts was integrated into the enhanced two-step floating catchment area model to improve accuracy. The model was developed based on three different access scenarios: only public hospitals, only public healthcare centres and both (either hospitals or healthcare centres) as potential vaccination facilities. The weighted decision-matrix and analytic hierarchy process, based on four criteria (i.e. service area, accessibility index, capacity of vaccination centres and distance to main roads), were used to choose potential vaccination centres looking for the highest suitability for residents. Global Moran’s index (GMI) was used to measure the spatial autocorrelation of the accessibility index in different scenarios and the proposed model.ResultsThere were 26 public hospitals and 271 public healthcare centres in the study area. Although the exclusive use of public healthcare centres for vaccination can provide the highest accessibility in the eastern and north-eastern parts of the study area, our findings indicate that including both public hospitals and public healthcare centres provide high accessibility to vaccination in central urban part. Therefore, a combination of public hospitals and public healthcare centres is recommended for efficient vaccination coverage. The value of GMI for the proposed model (accessibility to selected vaccination centres) was calculated as 0.53 (Z = 162.42, P < 0.01). Both GMI and Z-score values decreased in the proposed model, suggesting an enhancement in accessibility to COVID-19 vaccination services.ConclusionsThe periphery and poor areas of the city had the least access to COVID-19 vaccination centres. Measuring spatial access to COVID-19 vaccination centres can provide valuable insights for urban public health decision-makers. Our model, coupled with geographical information systems, provides more efficient vaccination coverage by identifying the most suitable healthcare centres, which is of special importance when only few centres are available.Graphic abstract

Mental health crisis and spatial accessibility to mental health services in the city of Toronto: A geographic study

Abstract: Mental illness includes a wide range of disorders that affect mood, thinking, behaviour and overall wellbeing. One in five Canadians has mental health care needs, many of which are unmet. Within the City of Toronto, the provision of specialized mental health care is delivered by over 100 public and private community service organisations and over 700 physicians with a psychiatric specialization - each providing community-based general or specialised care to residents in need. Research has shown that travel distance is an enabling factor of health service utilisation, thus equitable spatial access to services remains a key priority. Using spatial quantitative methods, this study examines potential spatial accessibility to both general and specialized mental health services within the City of Toronto, and levels of statistical association between access to care and prevalence of mental health crisis events. The main datasets analyzed including geo-referenced Census data and occurrence data on mental health crisis (represented by apprehensions under the Mental Health Act undertaken by the Toronto Police Service). The enhanced two-step floating catchment area (E2SFCA) method is used to model spatial accessibility to mental health services based four modes of transportation: driving, walking, cycling and public transit. Areas that are underserved by mental health specialists and mental health community services are identified and shown to have different socioeconomic characteristics. The study reveals spatially explicit patterns of access to various mental health services in Toronto, providing detailed data to inform the planning of and policy on mental health care delivery concerning severe mental health crisis.

Different configurations of the two-step floating catchment area method for measuring the spatial accessibility to hospitals for people living with disability: a cross-sectional study

BackgroundPoor spatial accessibility to hospital services is associated with higher morbidity and mortality rates among people living with disability. Improved methods to evaluate spatial accessibility are needed. This study measured the potential spatial accessibility of people living with disability by applying four configurations of the two-step floating catchment area (2SFCA) method to recommend the best model for use in health services research.Methods2SFCA and an enhanced version (E2SFCA) were used to measure hospital accessibility for people living with disability. We also developed and embedded a non-spatial severity index into the two 2SFCA models. We used 16,186 records of people living with disability experience to evaluate the methodological performance across 68 neighbourhoods of the city of Ahvaz, located in south-western Iran. The models’ performance were measured through correlation of the four accessibility scores with the distance to closest hospital for each neighbourhood centroid.ResultsAmong the four models used to measure spatial accessibility, the E2SFCA integrated with the severity index displayed the best performance. Most people with disabilities lived in neighbourhoods located in the South-western and central areas of the city. Interestingly, south-western neighbourhoods had poor hospital accessibility score and were identified as unmet need areas for access to health services.ConclusionsInclusion of the severity factor in the E2SFCA improved access measurements. Identifying areas with poor levels of hospital accessibility can help policymakers design tailored interventions and improve accessibility to hospital-based care in urban settings for people living with disability.

Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization

BackgroundHealthcare accessibility, a key public health issue, includes potential (spatial accessibility) and realized access (healthcare utilization) dimensions. Moreover, the assessment of healthcare service potential access and utilization should take into account the care provided by primary and secondary services. Previous studies on the relationship between healthcare spatial accessibility and utilization often used conventional statistical methods without addressing the scale effect and spatial processes. This study investigated the impact of spatial accessibility to primary and secondary healthcare services on length of hospital stay (LOS), and the efficiency of using a geospatial approach to model this relationship.MethodsThis study focused on the ≥ 75-year-old population of the Nord administrative region of France. Inpatient hospital spatial accessibility was computed with the E2SFCA method, and then the LOS was calculated from the French national hospital activity and patient discharge database. Ordinary least squares (OLS), spatial autoregressive (SAR), and geographically weighted regression (GWR) were used to analyse the relationship between LOS and spatial accessibility to inpatient hospital care and to three primary care service types (general practitioners, physiotherapists, and home-visiting nurses). Each model performance was assessed with measures of goodness of fit. Spatial statistical methods to reduce or eliminate spatial autocorrelation in the residuals were also explored.ResultsGWR performed best (highest R2 and lowest Akaike information criterion). Depending on global model (OLS and SAR), LOS was negatively associated with spatial accessibility to general practitioners and physiotherapists. GWR highlighted local patterns of spatial variation in LOS estimates. The distribution of areas in which LOS was positively or negatively associated with spatial accessibility varied when considering accessibility to general practitioners and physiotherapists.ConclusionsOur findings suggest that spatial regressions could be useful for analysing the relationship between healthcare spatial accessibility and utilization. In our case study, hospitalization of elderly people was shorter in areas with better accessibility to general practitioners and physiotherapists. This may be related to the presence of effective community healthcare services. GWR performed better than LOS and SAR. The identification by GWR of how these relationships vary spatially could bring important information for public healthcare policies, hospital decision-making, and healthcare resource allocation.

Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county.

ObjectivesAn Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data.MethodsWe obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types.ResultsA total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26–35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race.ConclusionsDisparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.

Using the variable two-step floating catchment area method to measure the potential spatial accessibility of urban emergency shelters

As a public service facility that provides relief, resettlement, and evacuation services to disaster-affected people, emergency shelters play a vital role in helping people cope with disaster events. The measurement of spatial accessibility of existing emergency shelters is a key task in improving emergency shelter services and minimizing property losses and deaths. In this study, considering the differences in emergency shelters’ service capacities and population distribution, we developed a two-step floating catchment area (2SFCA) method with a variable service radius and evacuation radius to describe emergency shelter accessibility in Lanzhou’s core area and compared with the traditional 2SFCA method. Furthermore, we used bivariate local Moran's I to identify the spatial relationships between emergency shelter accessibility and population density. The results show that the traditional 2SFCA method underestimates accessibility in densely populated areas with dispersed emergency shelters. Shelter accessibility in Lanzhou’s core area is unevenly distributed, with the lowest levels of accessibility in densely populated areas. There is an obvious spatial mismatch between the accessibility of emergency shelters and the population density, and the central and western part of Chengguan has a serious shortage of emergency shelters. This study provides important information for the planning and construction of emergency shelters.

A Spatial Analysis on Charter School Access in the New York Metropolitan Area

Background Extant literature has consistently indicated that access to charter school markets is shaped by social geography. Given interest in location shown by charter schools and parents, estimating potential spatial access to charter schools has become instrumental in understanding equal opportunities for charter school enrollment in metropolitan areas with preexisting residential segregation. Purpose By considering the increasing significance of sociogeography, this article asks whether students have equal opportunities for potential spatial access to charter schools across communities and how disparities in charter school access are related to housing patterns. Setting This study focuses on 122 charter schools in the New York metropolitan region, a highly segregated metropolitan area in the United States where charter schools are a primary component of education reform. Research Design The first part of this study illustrates patterns of spatial accessibility of the area's charter schools, within a 20-minute commuting time, to students aged 5–13 years by employing the enhanced two-step floating catchment area method using a Gaussian function. The next part of the study tests the hypothesis that students are able to access charter schools equitably and irrespective of their place of residence. The spatial lag regression model is used to compare distributions of potential spatial accessibility with 15 demographic and socioeconomic variables. Findings Even after controlling for disproportionate population sizes by census tract, the potential need for charter schools is matched inequitably with the supply of educational service providers. The spatial lag regression results indicate that children in areas less accessible to charter schools within a convenient travel period tend to be exposed to communities with more populations of color, higher unemployed groups, and less expensive housing. Conclusions The findings offer empirical evidence that access to charter school differs depending on demographic and socioeconomic attributes, in significant combination with geography, illuminating charter school location strategies in real-world contexts. Though charter schools have been promoted as a vehicle to offer significant equity advantages across politically designed and strictly operated school attendance boundaries, charter schools in metropolitan New York exercise a distinct and profound form of pseudo-zoning by use of location strategies to exclude certain children who may be considered less desirable.

Measure of accessibility to postal services in France: A potential spatial accessibility approach applied in an urban region

AbstractIn a context where the demand and supply of mail and parcel delivery services are undergoing major changes due to the widespread use of the Internet and digital communications, this paper focuses on the accessibility of postal services through the physical retail network. The accessibility constraints applied to the outlets network of Le Groupe La Poste (the French postal operator responsible for the universal postal service and three other services of general economic interest) are based on a “simplified” approach that considers accessibility only in terms of time or distance‐time. This paper proposes to measure potential spatial accessibility by applying postal supply and potential demand dimensions using a two‐step floating catchment area (2SFCA) analysis. Based on an equilibrium between supply and demand through distance function, this method, which is often used in studies of the accessibility of health services, is transposed and adapted into the field of postal activities. It aims to measure accessibility by taking into account the population and population/provider ratio, considering standard postal services provided at service points. While until recently the 2SFCA methods were mostly applied in healthcare contexts, some applications have been developed in non‐health‐related services over the last decade. This paper proposes an original contribution to analysing variations in the accessibility of postal services. Referring to the “primary postal services” (sales of stamps, letters or parcels postage, remittance of postal items, and so on), it outlines the conditions that activities (or services) must satisfy in order to use the floating catchment area method.

Patient-centred method to evaluate the spatial accessibility of primary health care in a case study in Shanghai.

Quantitative methodology investigating medical resource accessibility does not incorporate patients' feelings about the adequacy and fairness of primary health care (PHC). In this study we quantified the spatial accessibility of PHC from the patient perspective. The main obstacles regarding access to PHC services are: (1) distance from the medical facility; and (2) waiting times after reaching the facility. The total time cost to access PHC is calculated as the sum of the time cost to access the PHC facility and the time cost waiting to receive health care; the total time cost was used in this study to reflect the potential spatial accessibility (i.e. probable entry into the healthcare system) of PHC. In Shanghai, it took residents approximately 13min to reach the nearest primary care facility, with an approximate 23min wait time after arriving at the facility. Thus, the spatial accessibility of PHC in Shanghai is approximately 36min. The method of assessing the spatial accessibility of PHC from the perspective of patients is more explanatory and easier to interpret. In the case of Shanghai, the regional accessibility of PHC is much better than its regional availability. Relevant managers should focus on increasing the resource supply capacity of existing facilities providing primary care in the suburbs of Shanghai.

An age-integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas.

This study aimed to develop an age-included approach to measure the potential accessibility to Emergency medical services (EMS) across urban and suburban areas of Mashhad city in Iran. We used an improved version of two-step floating catchment area (2SFCA) and enhanced 2SFCA (E2SFCA) methods to measure the potential accessibility to EMS services with inclusion of age factor. This enabled us to better model accessibility of the older population to the EMS. We used 22 800 records of EMS enquiries from July to September 2018 to evaluate and assess the potential improvement in access to the EMS with incorporating age in the model. Suburb areas had less potential accessibility compared with central urban due to the high density of EMS stations in the city center areas. Our model showed slight improvement in potential accessibility measurement as a result of the proposed age-integrated method. An age-integrated index of accessibility method takes into account the age distribution of the population in service area is highly associated with actual measures of accessibility to EMS services. Identifying areas with poor access to EMS will help policymakers to design better policy planning to allocate resources and improve provision of EMS services.

Spatial Potential Accessibility of Playgrounds in Barcelona City

There has been an extensive tradition of geographical studies7 conducted to analyse the access to urban parks or green spaces. Several studies deploy approaches to measure the potential spatial accessibility and congestion of children’s playgrounds in urban areas. Identifying inequalities in terms of spatial access to children’s playgrounds is an important issue that could be useful for urban planners. The main objective of this paper is to measure the potential spatial accessibility and congestion of playgrounds in Barcelona City. A second objective is to analyse the factors that may explain differences between neighbourhoods in spatial access to playgrounds. Several analyses were carried out. First, two indicators of spatial potential accessibility are computed at the census tract level. Next, a mapping technique is used based on a cross tabulation of the quintiles of two indicators. A typology of census tracts can then be developed according to the various possible combinations between playground accessibility and congestion. Third, two spatial models—spatial lag and spatial error—are estimated in order to introduce socioeconomic factors into the explanation of accessibility and congestion. Finally, a multinomial logistic model is estimated to explain the typology of Barcelona census tracts based on potential playground congestion and accessibility. The results show that in Barcelona City, there are no important spatial disparities in terms of access to children’s playgrounds.