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

Geographic Description and Analysis of Factors Affecting the Demand for, and Supply of General Practice Services in New Zealand

General Practitioner (GP) shortages are an international problem. NZ is simultaneously experiencing an increase in GP demand due to a rising chronic health burden and a decrease in GP supply due to problems with recruitment, retention and retirement. This study used a mixed methods research methodology, mixing qualitative Action Research principles with quantitative analysis. These methods were applied to data collected on the location of 1064 general practices, 186 teaching practices and 495 medical students’ origin in order to determine the feasibility of utilising GIS technology in primary care research. This geographic data was combined with demographic data from the 2013 census in a GIS database to analyse for factors related to need and supply of general practice services. The network analysis has produced the most current and up-to-date picture of general practice accessibility in New Zealand. The data resulting from these analysis comprises of general practices or ‘points of supply’, linked to thirty-minute service area polygons containing 2013 census demographic information including the NZDep Score. This method has shown that physical accessibility to general practices varies considerably throughout New Zealand but that inaccessibility in the South Island of NZ is related more to rurality than socio-economic disadvantage. Urbanisation of both population and health services is having a marked effect upon accessibility for rural regions. However the presence of clinics in rural areas is reducing the shortage of medical services and increasing the access of these populations to health professionals. The analysis of the teaching practice data showed that practices that are located within moderately to high deprivation areas were more likely to have trained students in 2014. This may have beneficial effects on GP shortages in high need areas as positive training exposure is linked to a higher likelihood of selecting General Practice as a speciality. The geographical origin of students is also associated with future career choices. This study found that the medical students were more likely to originate from the least deprived regions of NZ so exposure to high need communities is particularly important. GIS has much to offer primary care research, however its’ most effective use relies on an understanding of the software, its application to the NZ context and potential access to a specialist for assistance with data analysis

Planning for the future: Addressing the spatial accessibility of aged residential care facilities in New Zealand

Evidence in New Zealand suggests that spatial access to aged residential care facilities (ARCFs) has been declining. Poor spatial access to facilities has been shown internationally to lead to reduced frequency of visitation by family and friends, and in turn poorer mental health and wellbeing of people in care. However, the New Zealand population is ageing and older people are increasing as a proportion of the total population. Subsequently, total demand for ARCFs is set to increase dramatically and a substantial number of facilities will likely need to be built by 2026. The intent of this thesis is to explore how geographic information science (GIS) methods can be used to identify potential locations for these ARCFs in New Zealand so that travel time for friends and family is minimised. Providers were surveyed on the relative importance of a series of spatial attributes when deciding where to place new facilities. Maps for each spatial attribute were generated from their preferences and overlaid using weighted linear combination and areas exceeding a suitability threshold were identified as potential locations. To choose optimal locations, maximal covering location-allocation models were used based on projected populations and demand for 2026. The spatial accessibility of these locations was then compared to the spatial accessibility of facilities in 2011. The results suggest that GIS methods have the potential to improve the spatial access to ARCFs to friends and family of people in care