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1、MedicalGeography HealthCareAccessibilityandImplications FahuiWangFredB KniffenProfessorofGeographyLouisianaStateUniversityJune17 2010 CNU Contents TheissueofaccessGIS basedaccessibilitymeasuresOptimizationtowardsequalaccessApplicationinhealthcareaccessPHSAdesignationandlate stagecancerConcludingcomm
2、ents AccessMatters Convenienceofaccesstoactivitiesjob school healthcare park publicservice shopping Accessdefines location SpatialWhereyouareNonspatialWhoyouareSocialjusticeandpublicpolicy Measurement Howscarcearetheservices Supplyvs Demand ratio Howfararedemandsfromsupplies DistanceRoadnetworkTrans
3、portationmeans Primitivemeasures Distance time fromsupplySimplypotentialmodelSupply demandratiowithinanareaFCAwitharadius boxFCAwithatraveltimerange FromS DRatiotoFCA SimplyS DRatioFCAwithaRadiusImprovementsWithin unitvariationCross borderLimitationsStraight lineS Dbeyondradius 2 stepfloatingcatchme
4、ntarea 2SFCA ScaleavailabilityateachsupplylocationSumupaccessiblesuppliesaroundeachdemandlocation 2SFCARecap 1a Foreachsupplylocationj selectalldemandlocationskwithinatraveltimerangefromj catchmentCj 1b ComputethesupplytodemandratiowithinCj 2a Foreachdemandlocationi searchallsupplylocationsjwithinth
5、etraveltimerangefromi catchmentZi 2b Sumupthesupplytodemandratiosatthesesupplylocations Generalizing distancedecay asacontinuousfunctionapowerorexponentialfunctionaGaussianfunctionasadiscretevariabledichotomousasin2SFCAmultipleasinE2SFCAahybridapproachakerneldensityfunctionathree zoneapproach Genera
6、lizing distancedecay Validation Modelingactualsupply demandinteractionsIndividualtravelbehaviorAggregatedtravelpattern Optimization TowardsequalaccessibilityFormulatedasaplanningproblemminimizingaccessibilitygapsamongdemandlocationsbyadjustingtheamountsofsuppliesatgivensupplylocations AQuadraticProg
7、rammingApproach Subjectto where Valueofoptimization EmphasizingtheequalityissueIdentifyingover andunder capacityofsupplyGuidingplanningandpublicpolicyinclosingthegap ApplicationinHealthcareAccess HPSAdesignation U S ranksbehindinhealthperformancedeepdisparitiesinaccesstocareandhealthoutcomesFederalp
8、rograms MUP HPSAsCallsforbettermeasureofaccessibility Non spatial SocioeconomicDisadvantages Factor1 Socio culturalBarriers Factor2 HighHealthcareNeeds Factor3 Female headedhouseholds Populationinpoverty Nonwhiteminorities Householdsw ovehicles Homeownership Householdswithlinguisticisolation Househo
9、ldswith 1personperroom Populationw ohigh schooldiploma Medianincome HighneedsPopulation Consolidatingnonspatialvariables IntegratingSpatialandNonspatialFactors GeographicAreaPrimaryIndicator spatialaccessibilityscore 1 3500PrimaryIndicator spatialaccessibilityscore 1 3000ANDsecondaryindicator factor
10、3 1standarddeviationabovemeanPopulationGroupPrimaryIndicator factor1 1standarddeviationabovemeanPrimaryIndicator factor1 standarddeviationabovemeanandsecondaryindicator factor2 1standarddeviationabovemean Applicationinhealthcareaccess vs late stagecancer Riskbreakdowns CultureKnowledge Dis advantage
11、Healthinsurance AccesstoprimarycareAvailabilityandaccessibilityofscreeningservicesQualityofhealthcare Multilevelapproach Socio economicdisadvantageSocialnetworksandinstitutionsLocalresources PERSON PLACE Rural urbancontinuum ChicagoChicagosuburbsOthermetroareasLargetown 10 50k Rural MultilevelModelC
12、oefficients Findings EffectsofindividualattributesOlderagelinkedtoreducedriskBlackslinkedtohigherriskEffectsofcontextualvariablesIncome primarycareaccess significantinbreastandlungcancerOthers marginallyornotsignificantEffectsofurban rurallocation urbandisadvantage Publicpolicyimplication Concludingremarks RiseofComputationalSocialSciences CSS andSpatially integratedSocialSciences SSS TrendsinsocialsciencesMichaelBatty todogoodsocialsciencethatispolicyrelevant quantitativemethodsareessentialandsuchmethods andthetheorybehindtheirpractice mustbespatial
