Potential accessibility, travel time, and consumer choice:: geographical variations in general medical practice registrations in Eastern England
Potential accessibility, travel time, and consumer choice:: geographical variations in general medical practice registrations in Eastern England
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DOI：
10.1068/a35165
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发表时间：
2003-10-01
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影响因子：
--
通讯作者：
Sünnenberg, G
中科院分区：
文献类型：
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作者：
Haynes, R;Lovett, A;Sünnenberg, G
在地理可达性研究中，选择的可得性是一个被忽视的方面，通常集中在到最近服务的距离上。普通医疗机构的患者登记记录提供了检查基本服务选择的地理分布的机会。这项针对剑桥郡、诺福克和萨福克200万居民的人口研究使用了从患者登记簿提取的邮政编码，并在地理信息系统中估计了从居民点到普通外科手术的汽车旅行时间。只有56%的人是在离家最近的诊所注册的。如果人们居住在农村地区而不是城市地区，并且手术在步行距离内，他们更有可能使用最近的诊所。以95%的居民使用的诊所数量衡量，选择在较大的城市地区最高，在小城镇和接受当地手术的农村地区最低。10%的人口受到垄断行为的服务。总体而言，登记人数的分布反映了一种定期和可预见的选择，取代了增加的旅行时间。每多一分钟的旅行时间，人们注册实践的可能性就会降低29%：一个近乎完美的距离-衰减关系，用于校准研究区域内潜在的可达性模型。潜在可达性的结果值被发现近似于距离最近的手术的旅行时间和居民实际选择的范围的组合。潜在的可及性模型反映了消费者的行为，这一证明在健康领域之外也有应用。
The availability of choice is a neglected aspect in studies of geographical accessibility, which typically concentrate on distance to the nearest service. Records of patient registrations with general medical practices offer the opportunity to examine the geographical distribution of choice for an essential service. This population study of two million residents of Cambridgeshire, Norfolk, and Suffolk used postcodes extracted from patient registers and estimated car travel times from residential locations to general practice surgeries in a geographic information system. Only 56% of the population were registered with the practice nearest their home. People were more likely to use the nearest practice if they lived in rural rather than urban areas and where a surgery was within walking distance. Choice, as measured by the number of practices used by 95% of residents, was highest in the larger urban areas and lowest in small towns and rural areas with a local surgery. Ten percent of the population were served by monopoly practices. Overall, the distribution of registrations reflected a regular and predictable substitution of choice for increased travel time. People were 29% less likely to register with a practice for every additional minute of travel time: an almost perfect distance-decay relationship that was used to calibrate a potential model of accessibility over the study area. The resulting values of potential accessibility were found to approximate the combination of travel time to the nearest surgery and the actual range of choice exercised by residents. This demonstration that the potential accessibility model reflects consumer behaviour has applications beyond the health field.