Int J Health Geogr - Measuring geographic access to health care: raster and network-based methods.

Tópicos

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Resumo

CKGROUND: Inequalities in geographic access to health care result from the configuration of facilities, population distribution, and the transportation infrastructure. In recent accessibility studies, the traditional distance measure (Euclidean) has been replaced with more plausible measures such as travel distance or time. Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted.METHODS: We examine the assumptions present in population-based travel time models. Conceptual and practical differences between raster and network data models are reviewed, along with methodological implications for service area estimates. Our case study investigates Limited Access Areas defined by Michigan's Certificate of Need (CON) Program. Geographic accessibility is calculated by identifying the number of people residing more than 30 minutes from an acute care hospital. Both network and raster-based methods are implemented and their results are compared. We also examine sensitivity to changes in travel speed settings and population assignment.RESULTS: In both methods, the areas identified as having limited accessibility were similar in their location, configuration, and shape. However, the number of people identified as having limited accessibility varied substantially between methods. Over all permutations, the raster-based method identified more area and people with limited accessibility. The raster-based method was more sensitive to travel speed settings, while the network-based method was more sensitive to the specific population assignment method employed in Michigan.CONCLUSIONS: Differences between the underlying data models help to explain the variation in results between raster and network-based methods. Considering that the choice of data model/method may substantially alter the outcomes of a geographic accessibility analysis, we advise researchers to use caution in model selection. For policy, we recommend that Michigan adopt the network-based method or reevaluate the travel speed assignment rule in the raster-based method. Additionally, we recommend that the state revisit the population assignment method.

Resumo Limpo

ckground inequ geograph access health care result configur facil popul distribut transport infrastructur recent access studi tradit distanc measur euclidean replac plausibl measur travel distanc time network rasterbas method often util estim travel time geograph inform system therefor explor differ under data model associ method impact geograph access estim warrantedmethod examin assumpt present populationbas travel time model conceptu practic differ raster network data model review along methodolog implic servic area estim case studi investig limit access area defin michigan certif need con program geograph access calcul identifi number peopl resid minut acut care hospit network rasterbas method implement result compar also examin sensit chang travel speed set popul assignmentresult method area identifi limit access similar locat configur shape howev number peopl identifi limit access vari substanti method permut rasterbas method identifi area peopl limit access rasterbas method sensit travel speed set networkbas method sensit specif popul assign method employ michiganconclus differ under data model help explain variat result raster networkbas method consid choic data modelmethod may substanti alter outcom geograph access analysi advis research use caution model select polici recommend michigan adopt networkbas method reevalu travel speed assign rule rasterbas method addit recommend state revisit popul assign method

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