Background: Primary care is widely seen as the most important form of healthcare provision to maintain population health. Its effectiveness, however, depends on the adequate spatial distribution of primary care facilities. In recent years, access to primary healthcare services has received a great deal of attention in the field of health geography, with most of this research focused on general practitioners. Although pediatricians in residential practices form an indispensable part of the Swiss primary healthcare system, little is known about the spatial accessibility to pediatric practices, and with mounting anecdotal reports about inadequate supply, it is an important issue to address.
Methods: Floating Catchment Area (FCA) methods are frequently used to assess spatial accessibility to healthcare services. The main advantage of FCA methods is their independence from arbitrary administrative spatial entities, while simultaneously accounting for competition between the demand for a given supply’s capacity (availability) and travel distances between populations and supplies (reachability). FCA methods are highly interdisciplinary and incorporate statistical, econometric, and geographical ideas. Since their inception in the early 2000s, a number of substantial advancements have been achieved, with the Modified Huff-Based Variable Three-Step FCA (MHV3SFCA) method currently being among the most sophisticated. By further improving the MHV3SFCA, this thesis compares it to the current application approach and integrates continuous distances from the National Passenger Transportation Model (NPVM). This makes it possible to determine optimal variable catchment sizes and to enhance the travel times—usually assumed to be by car—as it takes public transport into account as well.
Results: Spatial accessibility to and supply density of pediatric practices in Switzerland are characterized by significant disparities. Large urbanized areas generally have higher spatial accessibility, also seen in certain remote locations. In contrast however, the relatively densely populated Swiss Plateau is inadequately supplied in many areas. Overall, there is a tendency for francophone and Italian-speaking areas to have better spatial accessibility and supply density than German-speaking areas, with the canton of Bern remaining a notable exception. However, only about 35% of the population reaches the recommended supply density of approximately 1 full-time equivalent (FTE) pediatrician per 1,000 inhabitants (median: 0.65 FTE’s across Switzerland). The inclusion of public transport increases accessibility to pediatricians, particularly for intermediate (suburban) areas. The MHV3SFCA method achieves a correlation of 0.86 (p<0.001) when compared to its previous application approach. A limitation poses the completeness of the data especially regarding the delineation of the primary care pediatric workforce.
Conclusions: For the first time, an assessment of spatial accessibility to pediatric primary care for our youngest is being conducted in Switzerland. We have found significant spatial disparities in access and supply density throughout the country. This information may assist policymakers in making informed decisions regarding healthcare provision. The approach developed presents a costsaving and easily transferable alternative with unique advantages over the previous application approach of the MHV3SFCA method
