Spatial access to health care in Costa Rica and its equity: a GIS-based study
Spatial access to health care in Costa Rica and its equity: a GIS-based study
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DOI：
10.1016/s0277-9536(03)00322-8
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发表时间：
2004-04-01
影响因子：
5.4
通讯作者：
Rosero-Bixby, L
中科院分区：
文献类型：
--
作者：
Rosero-Bixby, L
本研究组装了一个地理信息系统（GIS），将2000年人口普查（需求）与卫生设施（供应）清单联系起来。报告评估了哥斯达黎加人公平获得保健服务的情况，以及正在进行的卫生部门改革对保健服务的影响。它使用传统的基于到最近设施的距离的可达性测量方法，并提出了一个更全面的可达性指数，该指数是由所有设施的大小、邻近程度以及人口和设施的特征加权得出的。该指标的权重因子是通过对全国家庭样本中诊所选择的计量经济学分析确定的。一半哥斯达黎加人居住的地方距离门诊部不到1公里，距离医院不到5公里。公平而言，根据以下三个指标，12-14%的人口得不到充分的服务：在4公里内有门诊部，在25公里内有医院，每人每年少于0.2小时。数据显示，1994年至2000年间，门诊治疗的可及性（和公平性）有了实质性改善。这些改进与1995年以来实施的卫生部门改革有关。在1995- 1996年开始改革的先锋地区，获得门诊医疗服务（密度指标）不公平的人口比例从30%下降到22%。相比之下，在2001年尚未进行改革的地区，服务不足的比例从7%略微增加到9%。基于到最近设施的距离的一个更简单的指数也得出了类似的结果。在此期间，获得医院护理的机会保持稳定。改革首先以最弱势群体为目标，并采取了新的社区医疗办事处和综合保健基本小组等措施，与这些群体合作，从而取得了这一成果。为本研究开发的地理信息系统平台使人们能够精确定位获得卫生保健机会不足的社区，在这些社区，改善获得卫生保健机会的干预措施将产生最大的影响。(C) 2003 Elsevier Ltd.版权所有。
This study assembles a geographic information system (GIS) to relate the 2000 census population (demand) with an inventory of health facilities (supply). It assesses the equity in access to health care by Costa Ricans and the impact on it by the ongoing reform of the health sector. It uses traditional measurements of access based on the distance to the closest facility and proposes a more comprehensive index of accessibility that results from the aggregation of all facilities weighted by their size, proximity, and characteristics of both the population and the facility. The weighting factors of this index were determined with an econometric analysis of clinic choice in a national household sample. Half Costa Ricans reside less than 1 km away from an outpatient care outlet and 5 km away from a hospital. In equity terms, 12-14% of population are underserved according to three indicators: having an outpatient outlet within 4km, a hospital within 25 km, and less than 0.2 MD yearly hours per person. The data show substantial improvements in access (and equity) to outpatient care between 1994 and 2000. These improvements are linked to the health sector reform implemented since 1995. The share of the population whose access to outpatient health care (density indicator) was inequitable declined from 30% to 22% in pioneering areas where reform began in 1995-96. By contrast, in areas where reform has not occurred by 2001, the proportion underserved has slightly increased from 7% to 9%. Similar results come from a simpler index based on the distance to the nearest facility. Access to hospital care has held steady in this period. The reform achieved this result by targeting the least privileged population first, and by including such measures as new community medical offices and Basic Teams for Integrated Health Care (EBAIS) to work with these populations. The GIS platform developed for this study allows pinpointing communities with inadequate access to health care, where interventions to improve access would have the greatest impact. (C) 2003 Elsevier Ltd. All rights reserved.