Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements

Mcgrail

Description

The two step floating catchment area (2SFCA) method has emerged in the last decade as a key measure of spatial accessibility, particularly in its application to primary health care access. Many recent ‘improvements’ to the original 2SFCA method have been developed, which generally either account for distance-decay within a catchment or enable the usage of variable catchment sizes. This paper evaluates the effectiveness of various proposed methods within these two improvement groups. Moreover, its assessment focuses on how well these improvements operate within and between rural and metropolitan populations over large geographical regions. Results Demonstrating these improvements to the whole state of Victoria, Australia, this paper presents the first comparison between continuous and zonal (step) decay functions and specifically their effect within both rural and metropolitan populations. Especially in metropolitan populations, the application of either type of distance-decay function is shown to be problematic by itself. Its inclusion necessitates the addition of a variable catchment size function which can enable the 2SFCA method to dynamically define more appropriate catchments which align with actual health service supply and utilisation. Conclusion This study assesses recent ‘improvements’ to the 2SFCA when applied over large geographic regions of both large and small populations. Its findings demonstrate the necessary combination of both a distance-decay function and variable catchment size function in order for the 2SFCA to appropriately measure healthcare access across all geographical regions.

Sujets

• Primary health care
• Rural health
• Health geography

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 18
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

McGrailInternational Journal of Health Geographics2012,11:50 http://www.ijhealthgeographics.com/content/11/1/50

R E S E A R C H

INTERNATIONAL JOURNAL OF HEALTH GEOGRAPHICS

Open Access

Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements 1,2* Matthew R McGrail

Abstract Background:The two step floating catchment area (2SFCA) method has emerged in the last decade as a key measure of spatial accessibility, particularly in its application to primary health care access. Many recent ‘improvements’to the original 2SFCA method have been developed, which generally either account for distancedecay within a catchment or enable the usage of variable catchment sizes. This paper evaluates the effectiveness of various proposed methods within these two improvement groups. Moreover, its assessment focuses on how well these improvements operate within and between rural and metropolitan populations over large geographical regions. Results:Demonstrating these improvements to the whole state of Victoria, Australia, this paper presents the first comparison between continuous and zonal (step) decay functions and specifically their effect within both rural and metropolitan populations. Especially in metropolitan populations, the application of either type of distancedecay function is shown to be problematic by itself. Its inclusion necessitates the addition of a variable catchment size function which can enable the 2SFCA method to dynamically define more appropriate catchments which align with actual health service supply and utilisation. Conclusion:This study assesses recent‘improvements’to the 2SFCA when applied over large geographic regions of both large and small populations. Its findings demonstrate the necessary combination of both a distancedecay function and variable catchment size function in order for the 2SFCA to appropriately measure healthcare access across all geographical regions. Keywords:Spatial accessibility, Primary health care, Rural health, Access to health care, Service catchments, Medical geography

Introduction Access to health care is widely accepted internationally as a key goal in meeting the health needs of individuals [14]. However, assessing the extent to which adequate access to health care services is achieved is difficult be cause there is no single agreed definition of access [58]. Healthcare access is such a complex concept that Norris and Aiken [9] went as far as to state that“It is as if everyone is writing about‘it’[access] but no one is saying what‘it’is”.

Correspondence: [e-mail] 1 Gippsland Medical School, Monash University, Northways Road, Churchill, VIC 3842, Australia 2 Centre of Research Excellence in Rural and Remote Primary Health Care, Gippsland, Australia

A fundamental problem of defining access is its status as both a noun and a verb [10], thus healthcare access can refer both to the potential for use as well as the act of using healthcare. Furthermore, access is multidimen sional with specific access barriers covering a range of spatial and aspatial dimensions [1113], making it diffi cult to operationalise. Health service planners have tended to adopt Penchansky and Thomas’[13] five main dimensions of access–specifically availability, accessibil ity, affordability, accommodation and acceptability. As a result, healthcare access indicators vary immensely, and may be capturing but not limited to the availability of care, the ability to get to and pay for available care, or the act of seeking and utilising available care. One com mon approach to evaluating access to health care is

© 2012 McGrail; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.