Health Care Access

10 Key excerpts on "Health Care Access"

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  eBook - ePub

  Geographic Health Data

  Fundamental Techniques for Analysis

  • Francis Boscoe, Francis P Boscoe(Authors)
  • 2013(Publication Date)
  • CAB International

    (Publisher)

  9 Geographic Access to Health Services

  Kevin A. Henry* and Kaila McDonald

  University of Utah, Salt Lake City, Utah, USA

  9.1 Introduction

  Timely access to health care is an important priority among citizens and governments worldwide and is a highly debated political issue owing to the potential social justice and human rights implications of fair access (WHO, 2010). Greater health in a population is most often linked to lower mortality, lower morbidity and fewer disability adjusted life years (DALYs). Policy and research efforts to improve access to health care and eliminate health disparities have mostly focused on access in terms of costs, affordability and health insurance. While these are essential components of access to health care, there are additional components that can influence it too, including the availability of health services in a community (supply), the number of people needing a service (demand) and the travel distance or time between different populations and health service locations. These components are often described in terms of the geographic access to or spatial accessibility of health services.

  In this chapter, we review the basic concepts related to geographic accessibility to health services, and describe the most common measures for estimating geographic accessibility. We also explain how various measures of geographic accessibility can be applied in a real world setting and provide several worked examples of how to calculate these measures. While you are reading the chapter, we encourage you to begin thinking about health care in your community and the factors that play into your own decisions in utilizing health care services.

  9.2 Geographic Access to Health Services

  Health services include services dealing with the diagnosis and treatment of disease as well as the maintenance and rehabilitation of health. They include services such as cancer screening (e.g. mammography), childhood vaccination, home care services, mental health services, cardiac rehabilitation programmes, hospitalization, dental care, physician care, occupational therapy and child medical services. The term access

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  Access to Health Care

  • Martin Gulliford, Myfanwy Morgan(Authors)
  • 2013(Publication Date)
  • Routledge

    (Publisher)

  Chapter 2 Geographical Access to Health Care Robin Haynes Introduction Providing equal access to health care wherever people live is not possible in most parts of the world. It is easy to demonstrate that access to health care depends on location in low-income countries, where health services are scarce, and in more developed countries where settlement is spread thinly over vast areas, as in interior parts of North America or Australia. In economically developed and densely populated regions of the Western world, however, distances to high-quality services are comparatively short and the influence of geography on access is not so obvious. This chapter examines the evidence mostly in the context of the United Kingdom, a country which has aimed to achieve geographically-uniform standards of health care for over 50 years. ‘Accessibility’ is the term geographers and planners use to describe the ease or difficulty of reaching services in another place. It has two main components. One is the location of services relative to the population: accessibility is high when people live close to services. The second is personal mobility, the means of reaching the destination. Services are more accessible to people who have cars than to people who do not, and where they can be reached by public transport compared to where they cannot. In an equitable world, accessibility should reflect need. People with the greatest need for a service should be able to reach it more easily than people with lesser needs. The factors that determine geographical accessibility to health services and the consequences of variations in accessibility are summarised in Figure 2.1, which maps the structure of this chapter. In the United Kingdom, the location of health services has been determined by two opposing forces acting on the historical pattern of service availability

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  A Companion to Health and Medical Geography

  • Tim Brown, Sara McLafferty, Graham Moon(Authors)
  • 2009(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  In the devel- Chapter 28 LOCATION-ALLOCATION PLANNING 541 oping world, improved access to primary health care is required for the successful attainment of at least three of the United Nation’s Millennium Development Goals (reduce child mortality; improve maternal health; and combat HIV/AIDS, malaria, and other diseases) (UNDP 2005). Physical access to health services is determined by the geographical location of patient locations in relation to available facilities, by physical and topographical barriers and by patient mobility including the modes of transport that are available to reach these destinations. Measures of geographical accessibility concentrate on the physical separation that impedes contact (Haynes 2003). Impedance (the “fric- tion of distance”) can be represented by Euclidean distance, distance along a road network, travel time, or travel cost. Accessibility to health care differs markedly by setting and population. In developed countries patients typically have much greater choice and mobility and distance constitutes less of a barrier in accessing care. By contrast, in many developing-country settings patients will attend the nearest facil- ity, irrespective of discrepancies in standard of delivery of care, because patients are less mobile and unable to afford the additional expense of traveling to facilities that are further away. This makes the choice of location of facilities (such that they are physically accessible to the vast majority of the population) in these settings vital. Meaningfully measuring geographical access remains difficult in such settings where patients commonly use walking as their primary mode of transport and public transport is unregulated and its temporal and spatial coverage sporadic.

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  Health Care in America

  Separate and Unequal

  • Kant Patel, Mark E Rushefsky(Authors)
  • 2015(Publication Date)
  • Routledge

    (Publisher)

  ———— 8 ———— Geography and Health Care It is a maxim of business that success is based on “location, location, location.” If you just have your business in a place where you can get customers, then your business is more likely to prosper. Place, or geography, is the subject of this chapter. We have examined disparities from a number of different angles: race, ethnicity, gender, age, and income. And all of these factors come into play in this chapter as well. But place adds another dimension. Does access to health care, the health of residents, and the quality of care differ based on where one happens to live? The answer, in short, is yes. There are, documented in the health care literature, variations in practices by geographic boundaries (see, for example, Baicker, Chandra, and Skinner 2005; Baicker et al. 2004; Wennberg 2004). This affects all the different groups discussed in previous chapters. The interaction of place with these other factors complicates understanding health care disparities. The chapter proceeds as follows. In this introduction we will set forth the boundaries of geographic health care inequalities by exploring different geographical areas. We then look at health disparities of outcome, access, and quality of care based on geography. That is followed by a discussion of reasons for the disparities and attempts to reduce geographically based disparities. In this chapter we shall also explore the various other factors that create disparities. A Health Care Geography The National Health Care Disparities Report (Agency for Healthcare Research and Quality 2006, 182) distinguishes four geographical areas. The largest metropolitan areas are those with a million or more residents. Smaller metropolitan areas are those with less than a million residents. “Metropolitan urban areas” have 10,000 to 50,000 residents

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  Geographies of Care

  Space, Place and the Voluntary Sector

  • Christine Milligan(Author)
  • 2017(Publication Date)
  • Taylor & Francis

    (Publisher)

  2    Geographical Perspectives on Health Introduction

  As care has moved from institutional to community-based sites of delivery, concern has focused not only on the relocation of the locus of care, but also on the new sets of actors and agencies involved with its planning and provision. Attention is drawn to the ways in which decisions are made and how the social processes of care reform operate in particular places. The relationship between healthcare and the means through which social, cultural, political and economic influences alter the experience of health and illness across space and within places has been of particular interest to medical geographers in recent years.

  The study upon which this book is based builds on work that has emerged from several strands of contemporary geographical thinking. Such work maintains that for a clearer understanding of how and why specific patterns of health and healthcare emerge in particular places at particular times, there is a need to extend the focus of medical geography to incorporate a wider view of health and healthcare. These broadly embody the recognition of a need to move away from bio-medical approaches to the geographical analysis of health issues, to incorporate social models of health and healthcare. Such approaches also highlight the potential benefit of integrating multi-disciplinary perspectives to geographical analyses, and the need to understand how wider contextual factors impact on experiences of health and healthcare. To understand why these issues are of importance here, this chapter gives a brief history of the development of medical geographical thinking, identifying some of the main elements that have informed the study. In doing so, I discuss some of the main ‘traditional’ theoretical and epistemological positions through which aspects of health and illness have been examined within medical geography, and how development in thought across the discipline as a whole has become manifest in terms of “contemporary’ perspectives in geographies of health and healthcare.

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  Spatial Health Inequalities

  Adapting GIS Tools and Data Analysis

  • Esra Ozdenerol(Author)
  • 2016(Publication Date)
  • CRC Press

    (Publisher)

  6

  GIS’s Applications in Health-Care Access

  The amount and type of health-care services populations receive depend greatly on where they live, the capacity of the health-care system in their area, and the methods practiced by local providers. Different populations need particular services, and they need to be located within reasonable distances of the services they need. Knowing the demographics of an area, where health problems are prevalent, the demand for any particular service, and standards of care may help health-care organizations to decide how to allocate finite health-care resources and where to build new facilities and design population-based interventions.

  Measuring the spatial accessibility (i.e., based on travel times between residents and physicians or areas within a certain travel time of each other), aggregating various sociodemographic variables to administrative boundaries, calculating geographic centroids and population-weighted centroids, geocoding physician locations, simple overlays, clustering of utilization are fundamental geographic information systems (GIS) functions applied in health-care resource planning. Computing accessibility measures in GIS using network distances and more precise aggregation methods is no longer a daunting task. The time required for the computation of numerous network distances or aggregating voluminous data to high-level census boundaries is no longer a limitation. Most practicing physicians and policy makers have access to Google Maps, in-house GIS, and/or online GIS tools (e.g., ArcGIS.com

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  GIS in Public Health Practice

  • Massimo Craglia, Ravi Maheswaran(Authors)
  • 2016(Publication Date)
  • CRC Press

    (Publisher)

  187 0-415-30655-8/04/$0.00+$1.50 © 2004 by CRC Press LLC 12 Using GIS to Assess Accessibility to Primary Healthcare Services Andrew Lovett, Gilla Sünnenberg, and Robin Haynes CONTENTS 12.1 Introduction ................................................................................................. 187 12.2 Data Sources ............................................................................................... 188 12.3 Methods ....................................................................................................... 193 12.4 Presentation of Results ............................................................................... 196 12.5 Conclusions ................................................................................................. 202 Acknowledgments ................................................................................................ 202 References ............................................................................................................ 203 12.1 INTRODUCTION The principle of equal access to health services for those in equal need is one of the guiding tenets of the National Health Service (NHS) in the United Kingdom. Nevertheless, health services are inevitably located in particular places and are therefore more accessible to nearby residents than those living farther away. Varia-tions in proximity are, obviously, only one element of accessibility to health services (Ricketts and Savitz, 1994), but the physical difficulties of overcoming distance tend to be particularly important in rural regions. Poor physical accessibility reduces the use of services and may lead to poorer health outcomes (Carr-Hill et al., 1997; Deaville, 2001; Jones and Bentham, 1997; Joseph and Phillips, 1984). Low utiliza-tion of primary healthcare services is of particular concern because of the gatekeeper role of general practitioners (GPs) in terms of referral to hospitals.

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  Spatial Health Inequalities

  Adapting GIS Tools and Data Analysis

  • Esra Ozdenerol(Author)
  • 2016(Publication Date)
  • CRC Press

    (Publisher)

  139 6 GIS’s Applications in Health-Care Access The amount and type of health-care services populations receive depend greatly on where they live, the capacity of the health-care system in their area, and the methods practiced by local providers. Different populations need particular services, and they need to be located within reasonable distances of the services they need. Knowing the demographics of an area, where health problems are prevalent, the demand for any particular service, and standards of care may help health-care organizations to decide how to allocate finite health-care resources and where to build new facilities and design population-based interventions. Measuring the spatial accessibility (i.e., based on travel times between residents and physicians or areas within a certain travel time of each other), aggregating various sociodemographic variables to administrative bound- aries, calculating geographic centroids and population-weighted centroids, geocoding physician locations, simple overlays, clustering of utilization are fundamental geographic information systems (GIS) functions applied in health-care resource planning. Computing accessibility measures in GIS using network distances and more precise aggregation methods is no longer a daunting task. The time required for the computation of numerous network distances or aggregating voluminous data to high-level census boundaries is no longer a limitation. Most practicing physicians and policy makers have access to Google Maps, in-house GIS, and/or online GIS tools (e.g., ArcGIS. com map viewer published by ESRI, ArcGIS users, or other data providers) and interactive maps with the capability to understand the neighborhoods of their patients and available resources nearby that help treatment and inter- vention efforts (Berke 2010).

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  Geographies of Health, Disease and Well-being

  Recent Advances in Theory and Method

  • Mei-Po Kwan(Author)
  • 2016(Publication Date)
  • Taylor & Francis

    (Publisher)

  The study observed distinctive geographic patterns and racial differences in the utilization of cancer screening services (e.g., Hispanics in six states are significantly more likely to utilize mammography than whites). Shi et al. (Chapter 26) assess demand for cancer screening facilities using a two-step floating catchment area method that takes into account both travel time and facility capacity. The results show distinctive geographic patterns of demand for cancer screening facilities: spatially continuous but relatively low in eastern regions but sporadic and tends to be high in the west. Using patient registration data, Lewis and Longley (Chapter 27) examine access to primary health care in the London borough of Southwark. The study observed that different ethnic groups have different behavioral patterns in accessing general practitioner-run health centers. Four chapters explore pertinent issue of health and well-being in various contexts through feminist, therapeutic landscape, and nature-society perspectives. They emphasize the importance of local-level social and cultural dynamics that shape health behaviors and outcomes. Based on two case studies, Thien and Del Casino (Chapter 28) demonstrate how various sociospatial practices of masculinity affect men’s health and their affective relationships with support systems for health. The article concludes that “men’s health is not only about the management of their responsibilities as political citizens but as biological citizens with all the attendant emotional geographies.” Pope’s chapter (Chapter 29) addresses the recent history of HIV and HIV policy in Cuba and Belize through a therapeutic imaginaries framework. Through these two case studies, it shows that countries in the same region can develop different care policies that lead to different biomedical and sociocultural outcomes

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  Primary Medical Care in Chile

  Accessibility under Military Rule

  • Joseph L. Scarpaci(Author)
  • 2010(Publication Date)
  • University of Pittsburgh Press

    (Publisher)

  V Spatial Organization and Medical Care Accessibility Health care delivery systems are as diverse as the political, social, and economic milieux within which they operate (Roemer 1985; Kohn and White 1976). They can vary widely in their funding sources, their internal organizational structures, methods of payments, and physician-patient relationships (Joseph and Phillips 1984: 11-17). Harloe, for instance, has ar- gued that comparing the range of diversity in various aspects of delivery systems in capitalist and socialist societies yields potentially as much information about urban development as about the provision of human services. These studies /I ensure that national and international characteristics of urban devel- opment are not confused, but also ... enable a conscious rec- ognition to be made by researchers of the limitations that the very conditions which surround their activity impose on the context of their work, conditions which are likely to be high- lighted and contrasted by circumstances elsewhere" (1981: 185). Social, urban, and medical geographers have become increas- ingly interested in the influence of national medical care pol- icy on the location of salutary facilities. Mohan and Woods (1985) reviewed the spatial allocation of medical resources in England under the conservative government of Prime Minister Margaret Thatcher by considering many factors that influence the spatial organization of health services such as historical patterns of service delivery, urban morphology, class struggle, and patterns of residential segregation. Clearly, the spatial dis- tribution of public clinics or private physician surgeries cannot 92 Spatial Organization § 93 be examined as a virtual abstraction. No social public service can exist as an independent and static artifact, because it de- rives from dynamic social and political forces.

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