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1、Medical Geography: Health Care Accessibility and ImplicationsFahui WangFred B. Kniffen Professor of Geography Louisiana State UniversityJune 17, 2010 CNU1技术知识ContentsoThe issue of accessoGIS-based accessibility measuresoOptimization towards equal accessoApplication in healthcare access nPHSA designa
2、tion and late-stage canceroConcluding comments2技术知识Access Matters!oConvenience of access to activitiesnjob, school, healthcare, park, public service, shopping oAccess defines “location”oSpatialnWhere you areoNonspatialnWho you areoSocial justice and public policy3技术知识MeasurementoHow scarce are the s
3、ervices?nSupply vs. Demand (ratio)oHow far are demands from supplies?nDistancenRoad networknTransportation means4技术知识Primitive measuresoDistance (time) from supplyoSimply potential modeloSupply-demand ratio within an areaoFCA with a radius/boxoFCA with a travel time range5技术知识From S/D Ratio to FCAoS
4、imply S/D RatiooFCA with a RadiusnImprovements oWithin-unit variationoCross-bordernLimitationsoStraight-lineoS-D beyond radius6技术知识2-step floating catchment area: 2SFCAoScale availability at each supply location oSum up accessible supplies around each demand location7技术知识2SFCA Recap1a. For each supp
5、ly 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 t
6、hese supply locations:8技术知识Generalizing “distance decay”oas a continuous function na power or exponential function na Gaussian functionoas a discrete variablendichotomous as in 2SFCA nmultiple as in E2SFCAoa hybrid approachna kernel density function na three-zone approach 9技术知识Generalizing “distance
7、 decay”10技术知识Validation oModeling actual supply-demand interactionsnIndividual travel behaviornAggregated travel pattern11技术知识Optimization oTowards equal accessibilityoFormulated as a planning problem ominimizing accessibility gaps among demand locations by adjusting the amounts of supplies at given
8、 supply locations. 12技术知识A Quadratic Programming ApproachoSubject towhere13技术知识Value of optimizationoEmphasizing the equality issue oIdentifying over- and under-capacity of supplyoGuiding planning and public policy in closing the gap14技术知识Application in Healthcare Access: HPSA designationoU.S. ranks
9、 behind in health performanceodeep disparities in access to care and health outcomesoFederal programs: MUP & HPSAs oCalls for better measure of accessibility15技术知识 Non-spatialNon-spatialSocioeconomicSocioeconomicDisadvantagesDisadvantages(Factor 1)(Factor 1)Socio-culturalSocio-culturalBarriersBarrie
10、rs(Factor 2)(Factor 2) High Healthcare High Healthcare NeedsNeeds(Factor 3)(Factor 3) Female-headed households (%) Female-headed households (%) Population in poverty (%) Population in poverty (%) Nonwhite minorities (%) Nonwhite minorities (%) Households w/o vehicles (%) Households w/o vehicles (%)
11、Home ownership (%) Home ownership (%)Households with linguistic isolation (%)Households with linguistic isolation (%) Households with 1 person per room (%) Households with 1 person per room (%) Population w/o high-school diploma (%) Population w/o high-school diploma (%)Median income ($)Median incom
12、e ($) High needs Population (%) High needs Population (%)Consolidating nonspatial variables16技术知识17技术知识18技术知识19技术知识20技术知识Integrating Spatial and Nonspatial FactorsoGeographic AreanPrimary Indicator (spatial accessibility score) 1/3500nPrimary Indicator (spatial accessibility score) 1/3000 AND second
13、ary indicator (factor 3) 1 standard deviation above mean oPopulation 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技术知识22技术知识Application in healthcare a
14、ccess (vs. late-stage cancer)Cancer mortalityLate-stage diagnosisHealthcare access23技术知识Risk breakdownsUrban vs. ruralTravel time to cancer screening facilityAccess to primary careSpatial: where we areIndividual attributesCommunity characteristics (contextual)Nonspatial: who we are24技术知识CultureKnowl
15、edge(Dis)advantageHealth insuranceAccess to primary careAvailability and accessibilityof screening servicesQuality of health careMultilevel approachSocio-economic disadvantageSocial networks and institutionsLocal resourcesPERSONPLACE25技术知识Rural-urban continuumChicagoChicago suburbsOther metro areasL
16、arge town (10-50k) Rural26技术知识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*
17、 -.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*-.08
18、7Non_Engli.012*.002-.001.003Access-37.6*20.0-27.2*-9.9Time.0020.00027技术知识Findings oEffects of individual attributesnOlder age linked to reduced risknBlacks linked to higher riskoEffects of contextual variablesnIncome & primary care access: significant in breast and lung cancernOthers: marginally or
19、not significantoEffects of urban-rural location28技术知识“urban disadvantage”?29技术知识Public policy implicationHow people in particular geographic contexts interact with local health care providers?30技术知识Concluding remarksoRise of Computational Social Sciences (CSS) and Spatially-integrated Social Sciences (SSS)oTrends in social sciencesoMichael 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技术知识
