Assessment of the spatial accessibility to health professionals at French census block level.
Assessment of the spatial accessibility to health professionals at French census block level.
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DOI：
10.1186/s12939-016-0411-z
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发表时间：
2016-08-02
影响因子：
4.8
通讯作者：
Deguen S
中科院分区：
文献类型：
--
作者：
Gao F;Kihal W;Le Meur N;Souris M;Deguen S
居民区卫生保健地理可及性评价为公共政策提供了重要信息。传统的方法-如医生人口比率（PPR）或最短旅行时间-只能提供一个可达性的一维视图。本文开发了一个改进的指标：空间可达性指数（伊萨），以衡量地理医疗保健可达性在最小的可用的城市下层，即，在城市可达性指数。本研究在法国诺德省进行。医疗保健专业人员使用法国国家健康保险网站上提供的邮政地址进行地理定位。伊萨源自增强型两步浮动集水区（E2 FCA）。我们已经为每个医疗保健提供者构建了一个集水区，考虑到住宅建筑质心，汽车旅行时间计算的谷歌地图和边缘效应。主成分分析（PCA）被用来建立一个复合伊萨来描述不同类型的卫生专业人员的全球可及性。我们应用我们的方法来研究地理保健可及性孕妇，通过选择三种类型的医疗服务提供者：全科医生，妇科医生和助产士。总共有3 587名医疗保健提供者有可能为诺德省的居民提供护理。平均每10万居民有92名全科医生、22名助产士和21名妇科医生。这三类保健提供者的综合伊萨为每10万居民39人。伊萨和医生人口比例之间的比较分析表明，伊萨代表一个更均匀的分布，而医生人口比例显示了一个'全有或全无'的方法。伊萨是一个多层面的改进措施，它结合了相对于人口规模的服务量和相对于人口所在地的服务距离，在最小可行的地理范围内提供。它可以指导政策制定者强调需要更多医疗服务提供者的关键领域，这些领域应该被指定为进一步的知识型政策制定。
The evaluation of geographical healthcare accessibility in residential areas provides crucial information to public policy. Traditional methods - such as Physician Population Ratios (PPR) or shortest travel time - offer only a one-dimensional view of accessibility. This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the smallest available infra-urban level, that is, the Îlot Regroupé pour des Indicateurs Statistiques. This study was carried out in the department of Nord, France. Healthcare professionals are geolocalized using postal addresses available on the French state health insurance website. ISA is derived from an Enhanced Two-Step Floating Catchment Area (E2FCA). We have constructed a catchment for each healthcare provider, by taking into account residential building centroids, car travel time as calculated by Google Maps and the edge effect. Principal Component Analyses (PCA) were used to build a composite ISA to describe the global accessibility of different kinds of health professionals. We applied our method to studying geographical healthcare accessibility for pregnant women, by selecting three types of healthcare provider: general practitioners, gynecologists and midwives. A total of 3587 healthcare providers are potentially able to provide care for inhabitants of the department of Nord. On average there are 92 general practitioners, 22 midwives and 21 gynecologists per 100,000 residents. The composite ISA for the three types of healthcare provider is 39 per 100,000 residents. A comparative analysis between ISA and physician-population ratios indicates that ISA represents a more even distribution whereas the physician-population ratios show an ‘all-or-nothing’ approach. ISA is a multidimensional and improved measure, which combines the volume of services relative to population size with the proximity of services relative to the population’s location, available at the smallest feasible geographical scale. It could guide policy makers towards highlighting critical areas in need of more healthcare providers, and these areas should be earmarked for further knowledge-based policy making.