Measuring Primary Health Care Accessibility in Mississippi State Using an Extended Kernel Density 2SFCA Method

The accessibility of primary health care is fundamentally important to people’s life quality and wellbeing. Based on the block group level 2010 census data from the U.S. Census Bureau and primary health care data from Association of American Medical Colleges, this study focuses on measuring the primary health care accessibility using an extended kernel-density two Step Float Catchment Area method. The study area is the Mississippi State, which is ranked last state for health care. The objectives of this study are to calculate the accessibility and analyze the spatial and non-spatial disadvantages of communities in accessibility of primary health care of the Mississippi State. Results showed that the two-step floating catchment area integrated by a Gaussian function method is a viable method of calculating accessibility. Overall, urban and the fringe areas have higher spatial accessibility to primary health care, while lower accessibility areas are the suburban and rural areas. Relatively, Hinds County, Madison County, Rankin County, Lamer County, Forrest County, Jones County, Lauderdale County, and Lee County have higher accessibility, while some counties have lower accessibility, such as Marshall County, Winston County, Noxubee County, Wilkinson County, Smith County, and Greene County. From the factor analysis, those urban areas showed greater mobility disadvantages and higher health care needs. Besides, the attempts to integrate the health needs index and the mobility index with the spatial accessibility helps to balance accessibility with different non-spatial conditions. Additionally, this study provides implications for public policy about the health care distribution and the high health needs population

Examining Healthy Food Accessibility in Baton Rouge, Louisiana Using A Huff-modified 2SFCA Method

Food accessibility refers to people’s ability to access the service of food providers. Disparities in healthy food accessibility have long been a public health concern. This study proposes a new approach modified from the popular 2-Step Floating Catchment Area (2SFCA) method to measure spatial access. By incorporating a self-adaptive kernel density function extracted from the Huff Model, the proposed new method is termed the Huff-modified 2SFCA method. It is then applied to measure the healthy food accessibility in East Baton Rouge Parish, Louisiana. The research accounts for the economically disadvantaged groups that may walk or depend on public transit for transportation. Also, the relationships between spatial accessibility of healthy food and other demographic and socio-economic factors are examined. The results show that socio-economically disadvantaged neighborhoods tend to have higher accessibility scores to healthy foods but population without a private vehicle suffers from poor healthy food accessibility. The research clearly differentiates spatial and non-spatial factors in food accessibility and inequalities across the study area, thus helps planners to scientifically design strategies of improving healthy food access

Spatial accessibility and social inclusion: The impact of Portugal's last health reform

Health policies seek to promote access to health care and should provide appropriate geographical accessibility to each demographical functional group. The dispersal demand of health‐careservices and the provision for such services atfixed locations contribute to the growth of inequality intheir access. Therefore, the optimal distribution of health facilities over the space/area can lead toaccessibility improvements and to the mitigation of the social exclusion of the groups considered mostvulnerable. Requiring for such, the use of planning practices joined with accessibility measures. However,the capacities of Geographic Information Systems in determining and evaluating spatial accessibility inhealth system planning have not yet been fully exploited. This paper focuses on health‐care services planningbased on accessibility measures grounded on the network analysis. The case study hinges on mainlandPortugal. Different scenarios were developed to measure and compare impact on the population'saccessibility. It distinguishes itself from other studies of accessibility measures by integrating network data ina spatial accessibility measure: the enhanced two‐stepfloating catchment area. The convenient location forhealth‐care facilities can increase the accessibility standards of the population and consequently reducethe economic and social costs incurred. Recently, the Portuguese government implemented a reform thataimed to improve, namely, the access and equity in meeting with the most urgent patients. It envisaged,in terms of equity, the allocation of 89 emergency network points that ensured more than 90% of thepopulation be within 30 min from any one point in the network. Consequently, several emergency serviceswere closed, namely, in rural areas. This reform highlighted the need to improve the quality of the emergencycare, accessibility to each care facility, and equity in their access. Hence, accessibility measures becomean efficient decision‐making tool, despite its absence in effective practice planning. According to anapplication of this type of measure, it was possible to verify which levels of accessibility were decreased,including the most disadvantaged people, with a larger time of dislocation of 12 min between 2001 and 2011

Modeling Multimodal Access to Primary Care in an Urban Environment

Access to primary health care facilities is a key component of public health, and measuring that access is vital to understanding how to target interventions. Transportation is one dimension of access and measuring distance via multiple modes allows better understanding of how varied populations access health care, particularly those who do not have access to a personal vehicle. This work builds on the 2-Step Floating Catchment Area (2SFCA) method to include travel by car, bus, bicycle, and walking. Travel time data are sourced from OpenStreetMap and transit data incorporates stop and schedule information from the General Transit Feed Specification (GTFS). Open source data analysis tools are used to aid reproducibility in other geographic contexts. Modal weights are assigned to measure the population accessing each facility by each mode. Access values for Milwaukee County in Wisconsin, USA are presented, with clear differences shown among modes accessing primary healthcare. Car access is high and consistent across the county, while biking and walking access are more impacted by distance to destination. Transit access is unequal across the county with some tracts showing no access at all. The highly varied access results by mode emphasize the importance of measuring access and travel by non-car modes, particularly when targeting communities with high rates of no car ownership. Improvement of multimodal access measurement will allow for targeted interventions that account for the availability of modes in each community

Measuring Spatial Health Disparity Using a Network-Based Accessibility Index Method in a GIS Environment: A Case Study of Hillsborough County, Florida

In recent decades, the health care delivery system in the United States has been greatly transformed and more widely examined. Even with one of the most developed health care systems in the world, the United States still experiences great spatial disparity in health care access. Increasing diversity of class, culture, and ethnicity also has a significant impact on health disparity. The goal of this paper is to address the spatial disparity of health care access using a network-based health accessibility index method (NHAIM) in a Geographic Information System (GIS) environment. Ensuring a desired level of accessibility for patients is the goal of the health care delivery system, through which health care service providers are supplied to populations in need. GIS plays an increasing role in understanding and analyzing accessibility to health care by incorporating geographical physical barriers, network-based travel time, and transportation costs required for access to health care services. In this study, we develop a NHAIM to examine the spatial disparity in health care access in Hillsborough County, Florida, determining the locations of registered medical doctors and facilities using data from Medical Quality Assurance Services (MQA) and the U.S. Census. This research reveals the spatial disparity of health care accessibility and availability in this region and provides an effective method for capturing health care accessibility surplus and shortage areas for future health care service planning

Enhanced Huff Model for Estimating Park and Ride (PnR) Catchment Areas in Perth, WA

A train station catchment area delineates the spatial territory from which the users of a train station are drawn. The size and shape of this catchment can be influenced by a variety of factors, such as the transport network, the location of stations and the service quality they offer, as well as the land use density and diversity in the transport corridor. Although numerous studies have been conducted to understand the size of catchment areas, limited research has focused on determining the spatial boundary (shape) of train station catchments. This paper develops a framework for deriving a spatial boundary of a Park and Ride (PnR) catchment area by incorporating the Huff model and Geographic Information Systems (GIS) technologies. The approach is staged, firstly determining the PnR station choice as a function of the attractiveness of a train station and the cost of access between the origin (such as a suburb) and the destination of a trip (such as the Perth CBD). Linear referencing method is then applied to re-define the origins to train stations based on the derived station choice probability. Finally, the spatial boundary of a catchment area is determined according to the adjusted origins, using GIS technologies. The model outputs were evaluated against licence plate survey of station users, where the Kappa coefficient (0.74) and overall accuracy (0.88) statistic suggested that the model's results are robust. The paper then shows how catchment area data can be used to better manage travel demand and plan design solutions aimed at increased accessibility to train stations

An automated approach to enrich OpenStreetMap data on footways

Urbanization and the rising global life expectancy are shaping the 21st century, and an increasing number of the older and disabled population is expected, emphasizing the need of developing age-friendly and accessible cities for all. The disabled population encounters barriers in accessing public services that able-bodied people do not, especially on footways. OpenStreetMap (OSM) data is applied in many routing applications for disabled people but does still lack a considerable amount of accessibility information, for example, only less than 2% of OSM footpaths in the city of Zurich contain inclination information. This thesis aims to enrich OSM footpaths in the city of Zurich automatically with inclination information derived from a Digital Elevation Model (DEM) and investigate the influence of inclination-enriched data on spatial accessibility. The spatial accessibility of three population groups (younger adults, older adults, and manual wheelchair users) to six main service providers (Healthcare Services, Daily Shopping, Public Services, Education, Leisure and Sports, Food and Drinks) was analysed using three different Floating Catchment Area (FCA) methods including 2SFCA, E2SFCA, and KD2SFCA. OSM footpaths were successfully enriched with inclination information using a high-resolution DEM. Results of the spatial accessibility analysis showed differences in the influence of accessibility enriched footpath data per population group, where manual wheelchair users were most affected in their spatial accessibility. Results from the 2SFCA method showed smallest areas that changed but a higher magnitude in change than the other two FCA methods, which yielded similar results. Furthermore, deprived areas concerning accessibility in the city of Zurich were found for all population groups and service providers in different areas of the city. The accessibility enriched footpath data can be used in spatial accessibility analysis, however, the data was not uploaded to OSM, as in other studies that applied an automated enrichment of OSM data. It can be concluded that mobility-impaired people such as manual wheelchair users are most affected by accessibility inhibiting barriers such as inclination. Furthermore, deprived areas concerning spatial accessibility are mainly found in areas where low accessibility and high demand and supply concur or when accessibility and supply are low. The results of this thesis confirmed the vulnerability of the mobility-impaired population in accessing public facilities, which strengthens the need for further research and development of an accessible city for all. Moreover, first insights in areas with lower spatial accessibility in the city of Zurich were made, which gives a basis for more in-depth research in this matter. The applied methods can be replicated if the necessary data is available

Spatial disparities in health center utilization in Huye District (Rwanda)

Bisher wurden die Einzugsgebiete der Gesundheitszentren mit den administrativen Grenzen des Sektors, in dem das Gesundheitszentrum liegt, gleichgesetzt. Das Hauptanliegen dieser Arbeit ist es, die tatsächlichen Einzugsgebiete zu erfassen und bisher verwendete methodische Ansätze auf ihre Eignung zu testen, Einzugsgebiete für Gesundheitszentren möglichst realistisch zu modellieren. Darüber hinaus sollen Gründe für räumliche Unterschiede in der Inanspruchnahme von Gesundheitszentren ermittelt werden. Fragenbögen, die mit Patienten in den Gesundheitszentren ausgefüllt wurden, sowie aus Registrierungsbüchern erfasste Daten geben Aufschluss über die räumlichen Unterschiede bei der Inanspruchnahme und dienen als Referenzdaten für die weiteren Analysen. Die Studie zeigt, dass keine der getesteten Methoden dazu geeignet ist, die Einzugsgebiete zufriedenstellend zu modellieren. Ein selbst entwickelter Ansatz, der verschiedene Methoden kombiniert, liefert bezüglich der Bevölkerung nur zweitbeste Ergebnisse nach Thiessen Polygonen, während für keine der Methoden die Grenzen mit den Grenzen übereinstimmen, die für die tatsächliche Nutzung ermittelt wurden.Until now catchment areas of health centers are considered as the administrative boundaries of the sector where the health center is situated. The main objective of this study is to determine the actual catchment areas of health centers in Huye District (Southern Province, Rwanda) and to test approaches used in other studies in a geographical information system for an improved estimation of catchment areas. Furthermore reasons for disparities in health center utilization are to be revealed. Questionnaires filled with patients at health centers as well as data retrieved from registration books aim to give information about spatial disparities in health center utilization and serve as evaluation basis for further analysis. The study shows that none of the tested methods is able to predict catchment areas or the population to be served in a satisfying accuracy. An own approach that combines different methods gives only second best results after Thiessen polygons regarding the served population while for none of the methods the boundaries match well the catchment areas as they are defined by the data