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Medical Geography:Health Care Accessibility and ImplicationsFahui WangFred B.Kniffen Professor of Geography Louisiana State UniversityJune 17,2010 CNU1技術(shù)知識(shí)Contentso The issue of accesso GIS-based accessibility measureso Optimization towards equal accesso Application in healthcare access n PHSA designation and late-stage cancero Concluding comments2技術(shù)知識(shí)Access Matters!o Convenience of access to activitiesn job,school,healthcare,park,public service,shopping o Access defines“l(fā)ocation”o Spatialn Where you areo Nonspatialn Who you areo Social justice and public policy3技術(shù)知識(shí)Measuremento How scarce are the services?n Supply vs.Demand(ratio)o How far are demands from supplies?n Distancen Road networkn Transportation means4技術(shù)知識(shí)Primitive measureso Distance(time)from supplyo Simply potential modelo Supply-demand ratio within an areao FCA with a radius/boxo FCA with a travel time rangejijjidSA5技術(shù)知識(shí)From S/D Ratio to FCAo Simply S/D Ratioo FCA with a RadiusnImprovements o Within-unit variationo Cross-bordernLimitationso Straight-lineo S-D beyond radius6技術(shù)知識(shí)2-step floating catchment area:2SFCAo Scale availability at each supply location o Sum up accessible supplies around each demand location7技術(shù)知識(shí)2SFCA Recap1a.For each supply location j,select all demand locations k within a travel time range from j(catchment Cj).1b.Compute the supply to demand ratio within Cj:2a.For each demand location i,search all supply locations j within the travel time range from i(catchment Zi).2b.Sum up the supply to demand ratios at these supply locations:jCkkjjPSR/ijiZjCkkjZjjiPSRA)/(8技術(shù)知識(shí)Generalizing“distance decay”o as a continuous function n a power or exponential function n a Gaussian functiono as a discrete variablen dichotomous as in 2SFCA n multiple as in E2SFCAo a hybrid approachn a kernel density function n a three-zone approach 9技術(shù)知識(shí)Generalizing“distance decay”10技術(shù)知識(shí)Validation o Modeling actual supply-demand interactionsn Individual travel behaviorn Aggregated travel pattern11技術(shù)知識(shí)Optimization o Towards equal accessibilityo Formulated as a planning problem o minimizing accessibility gaps among demand locations by adjusting the amounts of supplies at given supply locations.12技術(shù)知識(shí)A Quadratic Programming ApproachoSubject to minjjijjaVdS112)(minS1 S2.Sn SmkkjkjdDV1where13技術(shù)知識(shí)Value of optimizationo Emphasizing the equality issue o Identifying over-and under-capacity of supplyo Guiding planning and public policy in closing the gap14技術(shù)知識(shí)Application in Healthcare Access:HPSA designationo U.S.ranks behind in health performanceo deep disparities in access to care and health outcomeso Federal programs:MUP&HPSAs o Calls for better measure of accessibility15技術(shù)知識(shí) Consolidating nonspatial variables16技術(shù)知識(shí)025507512.5MilesSpatial Accessibility by 2-step FCA MethodLegendAccessibility Score 0.003876-0.0048860.003218-0.0038750.002464-0.0032170.001727-0.0024630.000986-0.0017260.000000-0.000985County Boundary05102.5MilesSpatial Accessibility by 2-step FCA MethodLegendAccessibility Score 0.003876-0.0048860.003218-0.0038750.002464-0.0032170.001727-0.0024630.000986-0.0017260.000000-0.000985County Boundary17技術(shù)知識(shí)025507512.5MilesSocioeconomic Disadvantage Scores(Factor 1)LegendFACTOR1-2.011300-0.462800-0.462799-0.1000000.100001-0.9333000.933301-1.8886001.888601-3.1617003.161701-5.872100County Boundary05102.5MilesSocioeconomic Disadvantage Scores(Factor 1)LegendFACTOR1-2.011300-0.462800-0.462799-0.1000000.100001-0.9333000.933301-1.8886001.888601-3.1617003.161701-5.872100County Boundary18技術(shù)知識(shí)025507512.5MilesSocio-cultural Barrier Scores(Factor 2)LegendFACTOR2-1.597400-0.454300-0.454299-0.014900-0.014899-0.7280000.728001-1.7687001.768701-3.2223003.222301-6.145200County Boundary05102.5MilesSocio-cultural Barrier Scores(Factor 2)LegendFACTOR2-1.597400-0.454300-0.454299-0.014900-0.014899-0.7280000.728001-1.7687001.768701-3.2223003.222301-6.145200County Boundary19技術(shù)知識(shí)025507512.5MilesHigh Health Care Need Scores(Factor 3)LegendFACTOR3-7.376800-1.760400-1.760399-0.702300-0.702299-0.0231000.023101-0.7152000.715201-1.6974001.697401-5.786100County Boundary05102.5MilesHigh Health Care Need Scores(Factor 3)LegendFACTOR3-7.376800-1.760400-1.760399-0.702300-0.702299-0.0231000.023101-0.7152000.715201-1.6974001.697401-5.786100County Boundary20技術(shù)知識(shí)Integrating Spatial and Nonspatial Factorso Geographic AreanPrimary Indicator(spatial accessibility score)1/3500nPrimary Indicator(spatial accessibility score)1/3000 AND secondary indicator(factor 3)1 standard deviation above mean o Population GroupnPrimary Indicator(factor 1)1 standard deviation above meannPrimary Indicator(factor 1)standard deviation above mean and secondary indicator(factor 2)1 standard deviation above mean21技術(shù)知識(shí)025507512.5MilesIntegrated DesignationLegendPoor Spatial AccessMargianl Spatial Access and High NeedsPoor Socioeconomic StatusMarginal Socioeconomic Statusand Socio-Cultural BarrierCounty Boundary(Spatial access criteria:score 1/3500 or 1/3000 if ther is high needs)025507512.5MilesExisting Health Professional Shortage Area(HPSA)LegendCounty BoundaryService Area(whole county)Population Group(partial county)Population Group(by Township)Service Area(by Township)Population Group(by Census Tract)Service Area(by Census Tract)22技術(shù)知識(shí)Application in healthcare access(vs.late-stage cancer)Cancer mortalityLate-stage diagnosisHealthcare access23技術(shù)知識(shí)Risk breakdownsUrban vs.ruralTravel time to cancer screening facilityAccess to primary careSpatial:where we areIndividual attributesCommunity characteristics(contextual)Nonspatial:who we are24技術(shù)知識(shí)CultureKnowledge(Dis)advantageHealth insuranceAccess to primary careAvailability and accessibilityof screening servicesQuality of health careMultilevel approachSocio-economic disadvantageSocial networks and institutionsLocal resourcesPERSONPLACE25技術(shù)知識(shí)Rural-urban continuumChicagoChicago suburbsOther metro areasLarge town(10-50k)Rural26技術(shù)知識(shí)Multilevel Model CoefficientsBreastColorectalLungProstateChic_sub-.181*-.065*-.001-.092*-.087*-.029-.007-.012-.017-.189*-.105*-.062Other_metro-.278*-.146*-.110*-.131*-.122*-.056-.172*-.183*-.252*-.128*-.039-.012Large town-.336*-.162*-.167*-.272*-.250*-.198*-.331*-.338*-.431*-.191*-.065-.063Rural-.207*-.032-.063-.169*-.156*-.085-.204*-.212*-.323*-.164*-.035-.038Age50.547*.541*.216*.216*.195*.188*.129.128Age70-.279*-.279*-.082*-.083*-.234*-.233*-.174*-.177*Black.373*.370*.083*.077*-.068*-.085*.289*.279*Income-.134*-.047-.110*-.087Non_Engli.012*.002-.001.003Access-37.6*20.0-27.2*-9.9Time.0020.00027技術(shù)知識(shí)Findings o Effects of individual attributesn Older age linked to reduced riskn Blacks linked to higher risko Effects of contextual variablesn Income&primary care access:significant in breast and lung cancern Others:marginally or not significanto Effects of urban-rural location28技術(shù)知識(shí)“urban disadvantage”?29技術(shù)知識(shí)Public policy implicationHow people in particular geographic contexts interact with local health care providers?30技術(shù)知識(shí)Concluding remarkso Rise of Computational Social Sciences(CSS)and Spatially-integrated Social Sciences(SSS)o Trends in social scienceso Michael Batty:“to do good social science that is policy relevant,quantitative methods are essential and such methods,and the theory behind their practice,must be spatial.”31技術(shù)知識(shí)