- Research Article
- 10.4000/1662e
How scale matters for healthcare accessibility: implications for territorial planning in France
- Jan 01, 2026
- Cybergeo
- Cindy M Padilla + 3 more +3
Analyzing healthcare accessibility though geographic approaches enables decision-makers to identify priority areas and allocate resources more effectively. Changes in scale not only modify the characteristics of the spaces under observation, but also affect the assessment that informs social, political, or economic decision-making.This paper examines and visualizes how shifts in scale influence the definition of healthcare accessibility in France — considering general practitioners, primary care providers, and services— as well as supply dynamics and socio-health needs. The study compares three spatial scales: municipalities, and two supra-municipal scales —territoires de vie santé used by the public authorities to define medically underserved areas, and Inter-municipal Cooperation (EPCI), employed by policymakers for local projects. A three-step method comprising scoring, principal component analysis and clustering, was applied to synthesize the multidimensional concept of healthcare accessibility. Scale-related discrepancies were analyzed using join-count autocorrelation indicators, Sankey diagrams, and Theil’s indices.The results identify seven classes of accessibility at the municipal level and five classes at the EPCI or territoire de vie santé levels. The spatial distribution of these classes reveals greater variability at the municipality scale than at higher levels of aggregation. The territoire de vie santé level retains the advantage of capturing diverse configurations of healthcare accessibility, while exhibiting lower heterogeneity within each area compared to the EPCI level. These findings underscore the importance of spatial contiguity and homogeneity in healthcare accessibility for mitigating information loss in multiscale aggregation processes.
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