Assessing spatial accessibility to maternity units in Shenzhen, China.

BackgroundAs the population is ageing rapidly in Beijing, the residential care sector is in a fast expansion process with the support of the municipal government. Understanding spatial accessibility to residential care resources by older people supports the need for rational allocation of care resources in future planning.MethodsBased on population data and data on residential care resources, this study uses two Geographic Information System (GIS) based methods – shortest path analysis and a two-step floating catchment area (2SFCA) method to analyse spatial accessibility to residential care resources.ResultsSpatial accessibility varies as the methods and considered factors change. When only time distance is considered, residential care resources are more accessible in the central city than in suburban and exurban areas. If care resources are considered in addition to time distance, spatial accessibility is relatively poor in the central city compared to the northeast to southeast side of the suburban and exurban areas. The resources in the northwest to southwest side of the city are the least accessible, even though several hotspots of residential care resources are located in these areas.ConclusionsFor policy making, it may require combining various methods for a comprehensive analysis. The methods used in this study provide tools for identifying underserved areas in order to improve equity in access to and efficiency in allocation of residential care resources in future planning.

The issue of reducing spatial disparities is one of the most pressing concerns for policymakers and planners, which consider a crucial focus in planning and public service, especially accessibility to healthcare. Accessibility and proximity are the principal keys to providing good public service. Therefore, a healthcare system that meets the requirements of availability and affordability will be useless if spatial accessibility is not provided equally to all demands (population). Many technics and methods exist to quantify accessibility, including the two-step floating catchment area (2SFCA) method, its widely used to measure healthcare accessibility based on the travel distance threshold. This research paper aims to use the 2SFCA method to measure the spatial healthcare accessibility in Batna City because the 2SFCA method offers to measure accessibility on both spatial and functional levels. The spatial level will consider the threshold distances between the health demand (population) and the health provider location (healthcare facilities); moreover, functional accessibility is measured based on facility to population ratio that will give a better overview of Batna's healthcare provider. As a result, the optimal threshold distance that offers balanced results between the spatial accessibility score and other WHO ratios will be a distance between 1000- and 1500-meters travel distance. In addition, the central census districts have a higher access score than the rest of the city's districts; most census districts that do not have accessibility (12% of the population) to healthcare facilities are concentrated in the southwest of Batna city.

BackgroundQuantifying spatial access to care—the interplay of accessibility and availability—is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research.MethodsA two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step.ResultsWe identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes.ConclusionsGravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods—both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.

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.

Spatial accessibility for deploying mobile lung cancer screenings in a rural state using two-step floating catchment spatial analysis in Oklahoma, United States 2025

Re-conceptualizing accessibility to parks in multi-modal cities: A Variable-width Floating Catchment Area (VFCA) method

As an important component of urban disaster prevention and mitigation systems, the balance and equity of emergency shelter distribution can be measured based on spatial accessibility utilizing the two-step floating catchment area (2SFCA) method. However, there are some issues in previous studies on emergency shelter accessibility evaluated by the 2SFCA method: (1) the high discretization of population distribution data and the travel cost being measured base on Euclidean distance; (2) ignoring the difference between shelter and population catchment sizes. To address these issues, we propose an improved 2SFCA method that computes the shelter and population catchments respectively to evaluate the emergency shelter accessibility in Changchun, China. We compare the proposed improved 2SFCA method to the original 2SFCA method. The results indicate that the catchment size and shelter accessibility calculated by the proposed method are more realistic and objective. The improved 2SFCA method is applicable method for evaluating the shelter accessibility and can provide advice for the planning and management of emergency shelters in the future.

The gentlemen's club, international control of drugs and alcohol : by Kettil Bruun, Lynn Pan, and Ingemar Rexed The University of Chicago Press (5801 Ellis Avenue, Chicago, Illinois 60637), 1975, 338 pp., hardcover — $12.50

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.

Accessibility is a term used to define the relative ease by which activities or services, such as work, recreation, shopping, education or healthcare, can be accessed from a given location. It is an important locational amenity for residents. This study examines accessibility to over 100 pharmacies in Baton Rouge, Louisiana, in 2010. Accessibility to a pharmacy is critical for a community as it is the prime source to get medication and other health services. First, two Geographic Information Systems (GIS) based methods, namely the proximal area method and the two-step floating catchment area (2SFCA) method, are used to measure the spatial accessibility to pharmacies for residents at the census block group level. Second, the disparities of spatial accessibility across major racial-ethnic groups are examined in order to assess whether minorities disproportionally suffer from poorer access. Finally, a statistical test is developed to verify whether the racial-ethnic disparities in accessibility are statistically significant. The study indicates that higher percentages of African-Americans are located in areas with shorter travel time to their nearest pharmacies than Whites, but the pharmacies in these areas serve more people (i.e., fewer pharmacies per 10,000 residents). Seniors, particularly those of 75 years or older, tend to be disproportionally concentrated in areas with pharmacies that are closer and less crowded. The results have significant implications for public policy.

IntroductionInaccessibility due to terrain and lack of transport leaves mothers travelling for long hours before reaching a facility to deliver a child. In the present article we analyzed the issue of spatial inaccessibility and inequity of maternal health services in the Indian Sundarbans where complex topography and repeated climatic adversities make access to health services very difficult.MethodsWe based the article on the health-GIS study conducted in the Patharpratima Block of the Sundarbans in the year 2012. The region has 87 villages that are inhabited, of which 54 villages are in the deltaic (river locked) region and 33 villages are located in the non-deltaic region of the block. We mapped all public and private maternal health facilities and road and water transport network. For measuring inaccessibility, we use the enhanced two-step floating catchment area method (E2SFCA). For assessing inequity in spatial access, we developed an area-based socioeconomic score and constructed a concentration curve to depict inequity. We used ARC GIS 10.3.1 and Stata 11 software for our analysis.ResultsThe maternal health facilities are primarily located in the non-deltaic region of the block. On an average it takes 33.81 min to reach the closest maternal health facility. Fifty-two villages out of eighty seven villages have access scores less than the score calculated using Indian Primary Health Standards. Ten villages cannot access any maternal health facility; twenty-six villages have access scores of less than one doctor for 1000 pregnant women; fifty-six villages have access scores less than the block average of 3.54. The access scores are lower among villages in the deltaic region compared to the non-deltaic region. The concentration curve is below the line of equality showing that access scores were lower among villages that were socio-economically disadvantaged.ConclusionsMaternal health facilities are not equitably accessible to the populations that are disadvantaged and living in the remote pockets of the study region. Provision of a referral transport system along with a resilient infrastructure of roads is critical to improve access in these islands.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0376-y) contains supplementary material, which is available to authorized users.

BackgroundSpatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies.MethodsBased on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement.ResultsThe method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making.ConclusionsThe results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

IntroductionThere is scarce information about the allocation of health resources in Syria. Pre-existing inequalities were further intensified after the 2011 conflict which displaced over 50% of the population. This study...

Opioid dependence and opioid related deaths are a public health problem which the United States Centers of Disease Control have declared an epidemic. While opioid agonist therapy for opioid addiction has been accepted as the most effective treatment for opioid dependence among academics, and office based buprenorphine treatment has been available in the Unites States for over 10 years, OB buprenorphine faces many barriers to widespread adoption. Empirical data on the geographic distribution of physicians able to prescribe buprenorphine and the prescribing patterns of those physicians show considerable unevenness in access and utilization of treatment services. Federal-level policies have recently been implemented to expand access to opioid agonist therapy, but the medium and long term impacts of these policy changes on individual outcomes, public health, and geographic access equity are not yet clear. This dissertation compares two recent federal level policies on expanding access to buprenorphine treatment: raising the regulatory limit on the number of patients a provider can treat (implemented July, 2016), and extending prescribing privileges to nurse practitioners and physician assistants (implemented February, 2017), using an empirically supported Agent Based Simulation model. Policies are assessed by a novel, at-a-glance, quantitative access equity metric: the Spatial Potential Access Gini Index, in addition to year-end treatment utilization, opioid overdose deaths, and the amount of illicit medication diversion. In the simulation, expanding access by increasing the patient limit did not result in more equitable spatial access, while extending prescribing to NPs and PAs increased both utilization and spatial access equity. This is likely due to empirically supported model assumptions that NPs and PAs providing primary care often serve in medically underserved areas including rural and remote regions. Extending prescribing to these practitioners opens up new treatment locations changing the spatial distribution of treatment opportunities. Changing patient limits does not change the overall spatial distribution of services, so spatial access equity does not change even if overall treatment supply gets better or worse. The primary contribution of this work is the Spatial Potential Access Lorenz Curve and the Spatial Potential Access Gini Index, measures that aggregate individual-level Spatial Potential Access Scores commonly used in health care geography to map and identify areas of access disparity within a region. The equitability of Spatial Potential Access is calculated by using the Lorenz Curve, which is commonly used to characterize the distribution of wealth or income in a society, from which a Gini Index is

A commuter-based two-step floating catchment area method for measuring spatial accessibility of daycare centers