Two-step Floating Catchment Area Research Articles

An Equity Evaluation on Accessibility of Primary Healthcare Facilities by Using V2SFCA Method: Taking Fukuoka City, Japan, as a Case Study

The primary healthcare facilities are among the most basic needs of the residents, huge in quantity and widespread. Their distributions are directly related to people’s health, which affects the sustainable development of cities. The accessibility calculation of primary level healthcare facilities and the equity evaluation of accessibility from the perspective of medical service category and urban population is very important for the decision-making of layout and configuration but has been ignored for a long time. This study took the primary healthcare facilities of Fukuoka city in Japan as research objects; it first used the variable two-step floating catchment area (V2SFCA) method to calculate the healthcare catchment areas (HCAs) of medical service providers and the population catchment area (PCAs) of medical demand locations, and then obtained the accessibility to primary healthcare facilities. Finally, the spatial disparities of accessibility were evaluated from three aspects: overall space distribution by using Global and Local Moran’s I, service quality, and the population to be served. The results showed that HCAs were from 500 m to 6400 m, PCAs ranged from 500 m to 3000 m, the use of variable catchments can improve the accuracy of accessibility assessment results; the accessibility of primary healthcare facilities was clustered and had significant spatial differences, which were high in urban center and low in suburban area; the obvious differences in the accessibility distribution characteristics of clinics in differential diagnosis and treatment departments led to different degrees of unsaturation in the types of medical services obtained by residents; although the elderly’s demand for basic medical care was many times higher than that of other age groups, the accessibility in high-demand areas was generally low, and the situation in severely high-demand areas was more serious. This work puts forward a multi-dimensional realistic evaluation system for equality accessibility of primary healthcare facilities, providing the data support for the medical resources and facilities’ allocation and the intensive land use.

Exploring Food Deserts in Seoul, South Korea during the COVID-19 Pandemic (from 2019 to 2021)

Since the coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization, our lifestyle (e.g., food culture) has changed. In particular, the food insecurity issue has exacerbated. To address this issue, this study aims to measure spatial accessibility to food outlets and identify food deserts in Seoul, South Korea during the COVID-19 pandemic (i.e., 2019–2021). To assess spatial access to food outlets, we used the enhanced two-step floating catchment area (E2SFCA) method. The results from the E2SFCA methods showed that spatial accessibility to restaurants increased, but access to grocery stores decreased. A noticeable change occurred in Gangnam and Seocho. The Gini coefficients indicated that equality in spatial accessibility to restaurants fluctuated (i.e., worsened from 2019 to 2020 and improved from 2020 to 2021), whereas equality in spatial accessibility to grocery stores improved. The results help to identify prioritized regions where additional food resources can be placed, especially for marginalized people who have limited access to food due to their socio-economic status.

Identifying the vulnerable regions of emergency medical services based on the three-stage of accessibility: a case study in Xi\u2019an, China

BackgroundEmergency department crowding is an obstacle in the process of obtaining emergency care services, which will lead to the increase of time cost. Most studies focused on the direct access to emergency medical resources, and few studies took the crowding of hospital emergency department as an evaluation index to reflect the convenience of obtaining emergency medical resources. It is a significance for the identification of areas with insufficient access to emergency service resources with this method.MethodsThis paper utilizes the improved potential model and the inverted Two-Step Floating Catchment Area method, combined with network map API service data to evaluate response time, delivery time and waiting time (for emergency department crowding) spent in different residential areas of Xi’an City in the process of emergency. Meanwhile, the vulnerable regions of gaining emergency medical resources are identified through the comprehensive analysis of the three stages of emergency.ResultsThe studies show that the residents in built-up area are more convenient to get ambulance service and arrive at care hospitals than those in suburban areas, but they may face greater hospital crowdedness. Although suburban residents are faced with low hospital crowdedness, they spend more time on getting ambulances and going to care hospitals. The accessibility of emergency medical resources varies greatly among residents in different regions, with 5.38% of the residents were identified in the high-risk area distributing in suburban residential areas in the south of the city center, 21.92% in the medium risk area in the southern mountainous areas and the periphery of the core suburban areas of the city, and 46.11% in the low-risk area which are mainly distributed in built-up areas in gaining emergency medical services.ConclusionsObviously, getting an ambulance and arriving at the nearest hospital quickly shows that it is conducive to access to emergency resources. However, the impact of hospital emergency crowding can not be ignored, especially in the area surrounded by high-grade hospitals in the central area of the city. In considering the spatial layout of emergency stations and emergency hospitals, the dislocation distribution of hospitals at different levels should be reasonably adjusted to balance the equity of residents in obtaining emergency medical resources.

Comparative study of using E2SFCA and 3SFCA methods for selected healthcare resources in Jordan during COVID-19 pandemic

ABSTRACT The objective of this study was to enhance the spatial accessibility of the local public in Amman city to select healthcare resources during the COVID-19 pandemic. The number of doctors and nurses in all public hospitals in all cities, particularly Amman, significantly increased. In this study, the spatial accessibility of Amman sub-districts was assessed using these resources to determine the extent to which residents had access to health resources during the pandemic when demand for healthcare capacity was increased. The spatial accessibility index was computed using the three-step floating catchment area (3SFCA) method, which rates these sub-districts with a degree of accessibility to healthcare services, considering spatial travel time and demand for healthcare services. The enhanced two-step floating catchment area (E2SFCA) approach was used to compare the 3SFCA scores and its spatial pattern by population environmental structure and income level. The integrated Gaussian weight of 3SFCA significantly decreased the study area's high estimate of the demand problem. The number of residential areas identified as being in a doctor’s healthcare shortage by 3SFCA and E2SFCA were three and four, respectively. For nurses, this equaled two and four, respectively.

Assessing the Equity of Accessibility to Urban Green Space: A Study of 254 Cities in China.

Urban green space has environmental benefits of purifying the air, reducing the heat island effect and providing the social and economic benefits of rest places and social platforms. An integrated and organized green space system is important for fully realizing the positive functions of an urban ecosystem. Previous studies have considered green space supply and demand, but few studies have examined large-scale, diverse and small-scale systems, making it difficult to conduct a comparative study of urban green space accessibility and equity under the same conditions (such as data sources and calculation methods). Using the two-step floating catchment area method, this study evaluates the equity of 254 urban green spaces in China within four ranges of accessibility: 1 km, 2.5 km, 5 km and 10 km. The study also considers urban house price in the research. The results show the following: (1) There are large differences in the accessibility of green space between different cities in China. Within the accessibility threshold of 10 km, the city with the most accessible urban green spaces has an accessibility level that is 27,813 times that of the city with the lowest accessibility. (2) Within the range of walking/cycling, there are significant inequalities in green space access in the 254 cities; the inequality of green space accessibility in most of the studied cities is at the “dangerous” level. (3) The two-step floating catchment area method indicates that the social superiority (high social class) represented by high housing prices is associated with a greater opportunity to access urban green space services. This paper highlights the main problems associated with the accessibility of urban green space in China and proposes targeted development recommendations. These recommendations provide a reference for urban managers to develop effective green space development policies and realize the optimal allocation of urban green space.

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.

Examining equity in accessibility to multi-tier healthcare services across different income households using estimated travel time

Accessibility equity is a critical factor in developing equitable and sustainable communities. Although numerous studies have analyzed accessibility inequity, few of them examined inter-group and intra-group inequity and made comparisons between private cars and public transit. In this paper, a Gaussian-based Two-step Floating Catchment Area method was applied to evaluate the spatial accessibility of multitier healthcare services among different income groups in Shanghai, China. The results show that high-income households have better access to healthcare services than low-income households. The gap between low- and high-income groups increases as the level of healthcare services rises. The Theil index was used to assess inequity between groups and within groups, as well as overall inequity. The inter-group inequity for public transit is greater than that for private cars, suggesting that accessibility by public transit is more unequally distributed across groups of people compared with private cars. Inter-group inequity increases with the tier of healthcare services. The bivariate local Moran index shows that underserved areas are found primarily in low-income neighborhoods. Overall, the research findings indicate the quality of public transit services might have a more significant impact on accessibility inequity than the spatial distribution of health services. This study provides valuable information for designing targeted policy provisions to improve equity and efficiency in healthcare access.

Spatial accessibility of township to county hospital and its disparity among age and urbanizing groups in Anhui, China- a GIS analysis

Investigating spatial accessibility of township to medical resources in provincial China is critical for policymakers to plan a more effective distribution of medical resources. However, accessibility of township to medical resources in provincial China has not been well studied. Accessibility of townships to hospitals in urban areas was calculated by Enhanced Two-step Floating Catchment Area (E2SFCA) by different age and urbanizing groups. Cold and hot spot analysis was used to recognize medical-shortage townships. The results showed that average percent of 65 + and 0–14 age groups in townships with below-average accessibility were 11.55% and 20.38%, higher than those in townships with above-average accessibility by 2 and 3.8 percentage points significantly, and when urbanization level fell from above 0.7 to 0.3–0.7 or below 0.3, accessibility declined by 27.39% or 51.32% significantly. There were 34 physiological medical-shortage townships with both significantly low accessibility and high percent of 65 + or 0–14 age group, and 13 economic medical-shortage townships with both significantly low accessibility and urbanization level. According to the results, spatial accessibility of children on the provincial or county boundaries in northern Anhui and elders and rural population in mountainous western and southern Anhui needed more attention from policymakers.

Supply-demand matching of medical services at a city level under the background of hierarchical diagnosis and treatment - based on Didi Chuxing Data in Haikou, China

BackgroundImplementation of the Healthy China Strategy and the hierarchical diagnosis and treatment system has injected new vitality into medical services. Given the insufficient supply of medical services and increasing demand for medical treatment, exploring the supply-demand pattern of medical services has become an urgent theoretical and practical problem to be solved. The equity of healthcare facilities has received widespread attention, but due to limited data, there is little research on the supply-demand pattern of medical services. This study focuses on evaluating the supply-demand matching pattern of medical services at different levels in Haikou City with big geographic data and promoting the realization of a balance between medical supply and demand.MethodsThis study utilizes spatial data of medical institutions, Didi Chuxing Data, and population density data. Firstly, use the two-step floating catchment area method and GIS spatial analysis to explore characteristics of the supply-demand patterns of medical services at different levels in Haikou. Secondly, we mine residents’ demand for medical treatment based on Didi Chuxing Data. Then combined with population density data, divide supply-demand matching of medical institutions into four types. Finally, propose optimization strategies for the problems.ResultsThe accessibility pattern of high-level medical institutions in Haikou presents high in the north and low in the south. The accessibility pattern of low-level medical institutions is the opposite. High-level medical institutions have a strong demand for medical treatment, which is less hampered by distance. The healthcare demand of low-level medical institutions is small, and they mainly are medium- and short-distance medical travel. The types of medical services at different levels are mainly “low supply - low demand” and “high supply - low demand” types.ConclusionsMedical services at different levels in Haikou are mainly in supply-demand imbalance. Therefore, we put forward optimization strategies to promote the equity of primary medical services, such as propelling the establishment and improvement of the hierarchical diagnosis and treatment system, building a new model of medical and health service supply, and strengthening balanced coverage of primary medical institutions. The mining of big geographic data is beneficial to alleviate the mismatch between medical supply and demand, although the data and methods need to be improved.

Evaluations of Spatial Accessibility and Equity of Multi-Tiered Medical System: A Case Study of Shenzhen, China.

The Chinese government has implemented a medical system reform to improve the equity of healthcare resources since 2009. We selected Shenzhen as our study area and evaluated the accessibility and equity of the multi-tiered medical system in China using a novel multi-tiered two-step floating catchment area (MT2SFCA) method. We proposed the benchmark and applied the independent variables of travel time and facility attractiveness, along with a combination of the two factors, as tolerances to determine the new logistic cumulative distribution decay functions. Community health centers (CHCs) and hospitals were included while integrating their features. Results revealed that the MT2SFCA method was able to determine the particular advantages of CHCs and hospitals in the multi-tiered medical system. The CHCs offset the lower accessibility of hospitals in suburban areas and hospitals balanced the regional inequity caused by the CHC. Travel time is the main consideration of patients who have access to CHCs, whereas facility features are the main considerations of patients who have access to hospitals. Notably, both CHCs and hospitals are crucial for the whole multi-tiered medical system. Finally, we suggested modifications in different travel modes, weights of contributing factors, and the validation of decay functions to improve the MT2SFCA method.

Identifying Spatial Matching between the Supply and Demand of Medical Resource and Accessing Carrying Capacity: A Case Study of Shenzhen, China.

Previous Studies, such as the evaluation of the supply of and demand for regional medical resources and carrying capacity assessments, require further development. This paper aims to evaluate the carrying capacity and spatial distribution of medical resources in Shenzhen from the perspective of supply and demand, and to conduct a time-series variation of the coupling coordination degree from 1986 to 2019. The two-step floating catchment area method was employed to quantify the carrying capacity and coupling coordination degree method and spatial autocorrelation analysis were applied to analyze spatial distribution between supply and demand. The results were as follows. (1) The carrying capacity index in more than 50% of the districts was classified as low-grade. The percentage of regions with good grades was 8.27%. The regions with a high carrying capacity were distributed in the central and southeastern areas. (2) The coupling coordination continued to rise, increasing from 0.03397 in 1986 to 0.33627 in 2019. (3) The level of supply and demand for medical resources in Shenzhen increased from 1986 to 2019, and the highest degree of compatibility between the supply and the population size was largely concentrated in the western and eastern regions. This research can provide a theoretical reference for Shenzhen to rationally plan medical resources and improve the carrying capacity of medical resources.

Measuring Cluster-Based Spatial Access to Shopping Stores under Real-Time Travel Time

Shopping stores are an important part of retail facilities and indispensable public facilities in a city. They are not only concentrated in shopping malls, but also distributed independently throughout the city, and often agglomerated in space. This paper attempts to measure the rationality of the spatial layout of all shopping stores in the city. Residents will visit multiple shopping stores in one trip to meet their demands. Based on this characteristic, this paper studies shopping store clusters and proposes a cluster two-step floating catchment area (C-2SFCA) method to analyze the accessibility differences of shopping stores in urban areas. Using the case of Beijing within the Fifth Ring Road, this paper implements the C-2SFCA method in a study unit of traffic analysis zones (TAZ) considering three transport modes (car, public transport, walking) with the support of real-time travel time collected from an internet map. The results show that spatial accessibility differed greatly under different transport modes and also had an uneven distribution pattern. Among these three results, the spatial variation of public transport accessibility was the highest. The results can provide references for urban planners in facility configuration and decision-making.

Spatial Accessibility to Sports Facilities in Dongguan, China: a Multi-Preference Gaussian Two-Step Floating Catchment Area Method

Equitable access to sports services has drawn much attention from policymakers and planners in China, as rapid urbanization and lifestyle changes have caused the pandemic of inactivity. An accurate measure of accessibility will enable the spatial equity of public facility allocation. Existing approaches to measure the spatial accessibility of sports facilities tend to ignore the heterogeneity in potential users’ preferences for facilities, thereby causing a bias in the measurement of accessibility. This paper proposes a multi-preference Gaussian two-step floating catchment area (MG2SFCA) method to measure the spatial accessibility of sports facilities, taking into account different travel modes, catchment sizes, and facility preferences among different age groups. Empirically, we adopted the MG2SFCA method in examining the spatial accessibility of sports facilities among children, young working-age population, old working-age population, and elderly population under walking, cycling, and driving modes in Dongguan. The results indicated a significant spatial disparity in the accessibility to sports facilities, with better accessibility in the north and poorer accessibility in the south. Children have the best access to sports facilities, followed by old working-age population, young working-age population, and older population. In the comparison among different transport modes, the accessibility distribution of sports facilities in walking mode showed the greatest spatial variation, while accessibility in driving mode was the most balanced. The MG2SFCA method is superior to the traditional Gaussian 2SFCA method because the former can capture disadvantaged people’s actual needs for sports facilities more accurately than the latter.

Evaluating spatial accessibility to healthcare services from the lens of emergency hospital visits based on floating car data

ABSTRACT Public medical facilities that are closely related to the health of residents have been recognised as one of the most crucial elements in sustainable urban planning. For the sake of social equality of medical services (especially for emergency medical conditions), the spatial distributions of medical resources need to be accurately measured and continuously optimized. This study presents an effective method to examine night emergency hospital visit and analyse its spatiotemporal characteristics using float car data (FCD). By extracting the hospital service areas, the two-step floating catchment area (2SFCA) methodology was improved to calculate hospital accessibility. Then, the balance between hospital accessibility and population density was analysed. In addition, we investigated the relationship between individual hospital choice preferences and hospital level and analysed several factors that affect individual choices. These results help us understand the special requirements and need of emergency hospital travel in cities and identify areas where medical resources are scarce. They can be used as guidance for urban hospital planning and construction. And the approach of hospital access behaviour investigation and the improved 2SFCA method can also provide insights for other activity-based travel behaviour research.

Contraception Deserts: The Effects of Title X Rule Changes on Access to Reproductive Health Care Resources

AbstractHistorically, access to contraception has been supported in a bipartisan way, best exemplified by consistent congressional funding of Title X—the only federal program specifically focused on providing affordable reproductive health care to American residents. However, in an era of partisan polarization, Title X has become a political and symbolic pawn, in part because of its connection to family planning organizations like Planned Parenthood. The conflicts around Title X highlight the effects of intertwining abortion politics and contraception policy, particularly as they relate to reproductive justice and gendered policy making. Family planning organizations like Planned Parenthood have responded to these battles by bowing out of the Title X network. To what extent have contraception deserts—places characterized by inequitable access to Title X—developed or expanded in response to policy changes related to contraception and reproductive health? What is the demographic makeup of these spaces of inequality? We leverage data from the Office of Population Affairs and the U.S. Census Bureau and use the integrated two-step floating catchment area method to illustrate the effects of a major change in the Title X network in 10 states. Our results reveal the widespread human ramifications of increasing constraints on family planning organizations as a result of quiet but insidious federal bureaucratic rule changes.

Identifying spatial mismatches between the supply and demand of recreation services for sustainable urban river management: a case study of Jinjiang River in Chengdu, China

Urban river recreation services (URRS) are very important for improving the quality of urban life. Understanding the balance between the supply and demand of URRS can facilitate sustainable urban river management. First, we analyzed the spatial patterns of the URRS supply and demand in Jinjiang River. We then identified spatial mismatches from three dimensions (river recreation spaces, residential communities, and the service region) by using the Gaussian two-step floating catchment area (2SFCA) method. Finally, we revealed the main influencing factors and their interactions. The results showed that: (1) the URRS supply gradually increased from upstream to downstream; (2) the URRS demand in the midstream was the strongest, followed by the downstream and upstream; (3) the supply-demand mismatches were severe, with 50.29% of the URRS region in short supply; and (4) the main influencing factors included distance to the city center, supply of river recreation spaces, and riverfront distance. Road density, residential community density, and distance to the city center could enhance the impact of other factors. Our research can improve the quantity and distribution of urban riverfront green spaces, as well as provide a reference for urban residential layout or planning.

Supply-demand adjusted two-steps floating catchment area (SDA-2SFCA) model for measuring spatial access to health care

Spatial accessibility to health care plays a vital role in the evaluation of medical resource equality. A widely used method of spatial accessibility is the Two-Step Floating Catchment Area (2SFCA) method. However, the 2SFCA model (and its later variants) implicitly assumes that each doctor has the same attraction (unlimited resources) to care seekers and each care seeker's need is the same; it does not consider insurance that doctors accept or patients' different needs by age and gender. In fact, patients usually choose doctors within their insurance network and seniors and females usually have higher health care needs/demands than others. Here we present an improvement to the 2SFCA method to address these shortcomings. On the supply side, we allocate each doctor's resource equally to the insurance plans that he/she accepts. On the demand side, we adjusted the population based on their health care needs by age and gender and estimated the population holding each insurance based on the insurance's market share (assuming each insurance's market share is a reasonable representation of the population using that insurance). Next we calculate the accessibility score of each insurance plan following the 2SFCA approach and sum them at each population location as the accessibility at that location. We call the new improved approach Supply-Demand Adjusted 2SFCA. The results indicate that the SDA-2SFCA model could better reflect the actual supply and demand situation of health care and thus provide a better measure of spatial accessibility to health care. The SDA-2SFCA model can help researchers and government agencies better allocate limited resources to the neediest areas.

Evaluating the performance of GIS methodologies for quantifying spatial accessibility to healthcare in Multi-Island Micro States (MIMS).

There has been limited information on spatial accessibility to healthcare in Multi-island Micro States (MIMS). This is partly due to the application of methodologies that do not sufficiently consider the dynamic or unique characteristics of MIMS. The objective of the paper is to evaluate the performance of different Geographic Information Systems (GIS) methodologies for quantifying spatial accessibility to public healthcare in Multi-island States (MIMS). Spatial accessibility was measured using three GIS-based methodologies: Temporally Available Two-Step Floating Catchment Area (TA2SFCA) and traditional models [Two-Step Floating Catchment Area (2SFCA) and the Gravity Model]. Unlike the Gravity Model and the 2SFCA which only used population and health facilities locations along with travel times to quantify spatial accessibility, the TA2SFCA also included information on the hours of operations and health schedules in its assessment. These additional variables were used to develop the time windows to assess differences in capacity among available service sites. TA2SFCA results showed that spatial accessibility was linked to a 'traveling doctor' dynamic with access to healthcare services reflecting changes in the supply of services. As such, the Gravity Model and 2SFCA which did not account for this peculiarity were inadequate for measuring spatial accessibility in MIMS. The TA2SFCA addressed both the temporal and spatial aspects of health which were most reflective of the health system of these islands. Given the spatial-temporal dynamics, improving accessibility to healthcare requires periodic assessments and reassessments of health service delivery since this is affected by operating times and changes in capacity. Furthermore, there is the need for more research to develop methodologies that are more reflective or sensitive to MIMS dynamics.

Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act.

The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. American Community Survey data representing Oregon adults. Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand). Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.

Assessing Spatial Accessibility to Primary Health Care Services in Beijing, China.

Primary health care has been emphasized as a pillar of China’s current round of health reforms throughout the previous decade. The purpose of this study is to analyze the accessibility of primary health care services in Beijing and to identify locations with a relative scarcity of health personnel. Seven ecological conservation districts, which are relatively underdeveloped, were selected in the study. The Gini coefficient and Lorenz curve, as well as the shortest trip time and modified two-step floating catchment area (M2SFCA) approach, are used to quantify inequalities in primary health care resources and spatial accessibility. The Gini coefficient of primary medical services was calculated as high as 0.705, showing a significant disparity in primary care services. A total of 81.22% of communities reached the nearest primary care institution within 15 min. The average accessibility of primary healthcare services, as measured by the number of health professionals per 1000 population, was 2.34 in the 1715 communities of seven ecological conservation districts. Three hundred and ninety-one communities (22.80%) were identified with relatively low accessibility. More primary health professionals should be allocated to Miyun, Mentougou, and Changping Districts. Overall, the primary healthcare resources were distributed unevenly in most districts. According to our study, expanding primary healthcare institutions, increasing the number of competent health professionals, and enhancing road networks will all be effective ways to increase spatial accessibility and reduce primary healthcare service disparity in Beijing.