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Background: Access to healthcare is critical for population health; however, geographic barriers persist especially in rural and deprived regions. This study aims to develop an overall composite potential spatial accessibility index to healthcare facilities and services in Sistan and Baluchestan Province in southeast Iran. Methods: This study employed the enhanced two-step floating catchment area (E2SFCA) method to create an overall composite spatial accessibility index for healthcare facilities and services in Sistan and Baluchestan Province, southeast Iran. Spatial accessibility for general practitioners, nursing, dentistry, midwifery, pharmacy, medical laboratory, nutrition, public health, radiology, psychology, environmental health, rural health workers, inpatient hospital beds, and five medical specialty services were calculated. Spatial accessibility scores were normalized from 0 to 1 (no access = 0, low = 0.01 to 0.33, moderate = 0.331 to 0.66, high = 0.661 to 1) and aggregated into overall indices of primary, secondary, and overall healthcare accessibility for each district. Inequality was assessed using the Lorenz curve and Gini coefficient analysis. Results: Low geographic accessibility was found across Sistan and Baluchestan Province, especially in rural areas. Almost 75% of the population had low/no access to overall primary care services within a 30-minute drive time. For secondary care, nearly 45% had low/no access to hospital inpatient beds within a 30-minute drive time, and around 40% had low/no access to specialists within a 60-minute drive time. Just 11.6% of the population had high overall healthcare access. The calculated Gini coefficient of 0.517 for the overall spatial accessibility index to healthcare services in Sistan and Baluchestan Province highlights a highly unequal distribution of healthcare services. Conclusions: This study demonstrates a useful replicable methodology that combines individual service accessibility metrics into an overall spatial healthcare access index. Furthermore, this study provides evidence of major shortfalls in healthcare access across Sistan and Baluchestan Province. Targeted strategies are required to increase the availability and capacity of services in underserved communities. Improving geographic access is key for progressing towards universal coverage and better population health. [ABSTRACT FROM AUTHOR]

Two-step floating catchment area (2SFCA) indices serve to measure accessibility in a geographical area. They were developed mainly to investigate the distribution of medical resources to civilians. Recently, the 2SFCA methodology was introduced to a military background where accessibility of field hospitals along a frontline is considered. This article aims to develop a new composite index with a clear interpretation that allows accessibility to be compared for two distinct situations in the following setting. In the first situation, accessibility is calculated and then the situation changes which impacts accessibility as well. The composite index that is developed in this article then interprets the change and assigns to it an interpretable numerical value. The final composite index is a weighted mean of eleven properties of accessibility indices. Furthermore, the developed index is appropriated for the use in military environment to investigate the distribution of field hospitals along a frontline. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Geographic Information Systems / Türkiye Coğrafi Bilgi Sistemleri Dergisi is the property of Mersin University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Recently, several big cities have been faced with rapid expansion of the population in China, ultimately leading to unprecedented pressure on urban healthcare facilities. Thus, new healthcare facilities are established to meet residents’ increasing demand for healthcare. Under the current circumstances, an essential task was to evaluate the improvement of these new facilities to residents’ healthcare accessibility. In this study, the rapid development city of Xi’an, China was employed as the case study, and the Gaussian-based 2SFCA method was utilized to measure the spatial distribution of high-level healthcare accessibility by private cars and public transit. The change in accessibility could be obtained by quantifying the difference in accessibility before and after establishment of the new hospitals. Furthermore, the improvement in equity in healthcare accessibility was measured using the Gini coefficient. Finally, the contribution of each new hospital to healthcare accessibility was evaluated from the perspectives of population coverage, average improvement of each bed, and improvement of the Gini coefficient. The results show that the areas with significant improvement are scalloped to the periphery of the study area, especially in the communities near the new hospitals. What’s more, a slight improvement could also be observed in the equity of healthcare accessibility after the construction of the new hospitals. These results could provide guidance for optimizing and allocating healthcare facilities. [ABSTRACT FROM AUTHOR]

Abstract The need for equitable access to primary healthcare services in the current global context has attracted widespread attention, prompting nations to continuously enhance their grassroots medical service levels. In response, China launched the "Healthy China" initiative, which prioritizes the enhancement of national health as a core goal of the healthcare system and uses this opportunity to deepen reforms aimed at strengthening primary care. However, in remote and rural areas, the optimization of medical resource allocation and the achievement of balanced service development remain critical challenges owing to limited resources. This study selected Liannan Yao Autonomous County, which is situated in the northwestern corner of Guangdong Province, as a case study due to its remote mountainous location, underdeveloped economy, and minority region characteristics. Through field research and interviews, this study thoroughly explored the needs of both supply and demand, factoring in elements such as the service capability of healthcare facilities and residents' travel thresholds to enhance the two-step floating catchment area model, thus making it more applicable to remote villages. By integrating electric bikes and cars, which are the primary means of transportation in rural areas, this study conducted a thorough analysis and comparison of the accessibility of medical services in Liannan Yao Autonomous County (Liannan County) . The results reveal significant disparities in healthcare accessibility, an uneven distribution of medical resources, and varying impacts of transportation conditions and facility service capabilities on accessibility. Notably, the study revealed that improving transportation conditions alone has limited effects in rural areas; the key lies in balancing medical service capabilities and the rationality of overall layouts. From the perspectives of equity and efficiency, this study employs the equitable coverage model and the efficiency-driven model to construct two scenarios, comparing accessibility changes in Liannan County under both conditions and proposing strategies to improve the spatial layout of local healthcare facilities. This research not only deepens the understanding of healthcare service accessibility in rural areas but also provides a scientific basis for optimizing resource allocation and enhancing primary medical services, offering valuable guidance and reference for Liannan County and other similar rural regions.

The need for equitable access to primary healthcare services in the current global context has attracted widespread attention, prompting nations to continuously enhance their grassroots medical service levels. In response, China launched the "Healthy China" initiative, which prioritizes the enhancement of national health as a core goal of the healthcare system and uses this opportunity to deepen reforms aimed at strengthening primary care. However, in remote and rural areas, the optimization of medical resource allocation and the achievement of balanced service development remain critical challenges owing to limited resources. This study selected Liannan Yao Autonomous County, which is situated in the northwestern corner of Guangdong Province, as a case study due to its remote mountainous location, underdeveloped economy, and minority region characteristics. Through field research and interviews, this study thoroughly explored the needs of both supply and demand, factoring in elements such as the service capability of healthcare facilities and residents' travel thresholds to enhance the two-step floating catchment area model, thus making it more applicable to remote villages. By integrating electric bikes and cars, which are the primary means of transportation in rural areas, this study conducted a thorough analysis and comparison of the accessibility of medical services in Liannan Yao Autonomous County (Liannan County). The results reveal significant disparities in healthcare accessibility, an uneven distribution of medical resources, and varying impacts of transportation conditions and facility service capabilities on accessibility. Notably, the study revealed that improving transportation conditions alone has limited effects in rural areas; the key lies in balancing medical service capabilities and the rationality of overall layouts. From the perspectives of equity and efficiency, this study employs the equitable coverage model and the efficiency-driven model to construct two scenarios, comparing accessibility changes in Liannan County under both conditions and proposing strategies to improve the spatial layout of local healthcare facilities. This research not only deepens the understanding of healthcare service accessibility in rural areas but also provides a scientific basis for optimizing resource allocation and enhancing primary medical services, offering valuable guidance and reference for Liannan County and other similar rural regions. [ABSTRACT FROM AUTHOR]

The multi-modal two-step floating catchment area (MM-2SFCA) method is an extension of the two-step floating catchment area (2SFCA) method that incorporates the impact of different transportation modes, thereby facilitating more accurate calculations of the spatial accessibility of public facilities in urban areas. However, the MM-2SFCA method does not account for the impact of distance within the search radius on supply–demand capacities, and it assumes an idealized supply–demand relationship. This paper introduces the gravity model into the MM-2SFCA method, proposing a multi-modal gravity-based 2SFCA (MM-G2SFCA) method to better account for distance decay and supply–demand relationships. Furthermore, a standardized gravity model is proposed based on the traditional gravity model. This model imposes constraints on upper and lower limits for distance decay weights without compromising the fundamental curve characteristics of the gravity model, thereby avoiding extreme weight scenarios. The accessibility of public hospitals in Shenzhen is evaluated through the integration of basic geographic information data, resident travel data, and official statistical data. The findings demonstrate that the standardized gravity model effectively addresses the issue of excessively high local distance weights in the traditional gravity model, making it more suitable as a distance decay function. The MM-G2SFCA method improves the consideration of distance and supply–demand relationships, thereby facilitating a more rational distribution of accessibility on a global scale. This study discovers differences in the spatial allocation of public hospital resources across the Shenzhen's districts. Accessibility within the metropolitan core is significantly higher than that outside the core. Additionally, there is a notable difference in the level of accessibility among the districts. Accessibility is found to be better in district centers and along the main traffic arteries. [ABSTRACT FROM AUTHOR]

With the rapid expansion of cities, the demand for park green spaces within urban living circles is increasing. Enhancing park accessibility and distributional equity has become an important avenue for improving urban residents’ quality of life. However, existing studies mainly rely on static population data, neglecting the impact of residents’ dynamic location changes on park accessibility, and lack a systematic analysis across different living circles. To fill this research gap, this paper takes the urban core area of Shenzhen as a case study. By combining static and dynamic population data and employing the improved dynamic two-step floating catchment area (D2SFCA) and the traditional two-step floating catchment area (2SFCA) methods, we systematically evaluate the walkability and equity of parks within different living circles (5-, 15-, and 30 min). The results show significant differences between static and dynamic population distributions, with overall park accessibility being lower for the dynamic population than for the static population. Within the 5 min living circle, the Gini coefficient for the static population is 0.952 but reaches as high as 0.971 for the dynamic population, indicating extreme inequity in park distribution within short walking distances. In the 15- and 30 min living circles, the Gini coefficients for the static population are 0.813 and 0.731, respectively, while those for the dynamic population are 0.882 and 0.785, indicating that the degree of inequitable park resource distribution decreases with increased walking time. Overall, the study reveals that park accessibility for the static population is significantly higher than that for the dynamic population across different living circles, especially within short-time living circles where the difference is most pronounced.

With the acceleration of urbanization and the impact of climate change, the frequent occurrence of urban waterlogging not only leads to road closures and traffic congestion but also severely affects the timeliness of urban emergency rescue. To accurately assess and enhance the response capability of urban emergency rescue under storm-induced waterlogging scenarios, a hydrodynamic model of urban waterlogging was developed to simulate waterlogging conditions under various design rainfall scenarios. By identifying road waterlogging risks and blocked roads, as well as combining the Two-Step Floating Catchment Area (2SFCA) method, the accessibility of emergency rescue services for points of interest (POIs) with different vulnerabilities was evaluated. The Liwan District of Guangzhou City was selected as a case study for accessibility impact assessment and improvement simulation. The results indicate that with the increase in the return period of rainfall, both the area and depth of waterlogged regions increased and the number of roads affected by waterlogging rose, leading to an increase in the length of blocked roads from 11 km to 49 km, an increase of over 300%. Additionally, the number of POIs inaccessible to emergency rescue increased, while the number of accessible POIs decreased, resulting in a significant downward trend in overall accessibility. By deploying mobile pumping vehicles, the depth and area of waterlogging under different rainfall return periods were reduced by over 10%, the number of blocked roads decreased by more than 10%, and the number of accessible POIs increased by more than 12%. The findings highlight that storm-induced waterlogging not only hinders traffic flow but also reduces the response capability of emergency rescue services. Through the strategic deployment of mobile pumping vehicles, the accessibility of urban emergency rescue services under waterlogging conditions can be effectively improved, mitigating the impact of waterlogging on urban functions and public safety. [ABSTRACT FROM AUTHOR]

In China, the equal accessibility of social infrastructure, especially public housing and healthcare, has become a prominent concern in solving the problems of rapid but uneven growth-oriented urbanization in the post-reform era. However, few studies have focused on the accessibility of various healthcare resources to different types of public housing using different transport modes. Utilizing Internet map services, this study first calculated the travel time from talent, economically affordable, and public rental housing to hospitals using three transport modes—walking, public transport, and driving—in Shenzhen, China. Subsequently, the optimized two-step floating catchment area method (2SFCA) was employed to comprehensively evaluate the accessibility of healthcare resources to public housing and explore differences in healthcare accessibility among different populations. The results reveal that: (1) Public housing is located far away from healthcare resources, with 15% of public housing unable to access AAA hospitals within 30 minutes by car, and only 10% able to access ordinary hospitals within 15 minutes. (2) Accessibility of healthcare resources to public housing exhibits spatial heterogeneity, gradually declining from special to non-special economic zones. (3) Talent housing experiences the best accessibility, followed by affordable and public rental housing. (4) Public transportation and walking exhibit greater spatial variation in accessibility than driving. Theoretically, the current public housing accessibility in Shenzhen reflects the common problems of public housing accessibility throughout the country. In the process of promoting the equal accessibility of basic public services, focus on its accessibility should be emphasized. This study proposes an optimized 2SFCA by introducing a Gaussian distance decay function, establishing a multilevel search radius, considering supply and demand-side competition effects, and using real-time traffic big data. Our methodological framework simultaneously considers differences among various types of public housing, hospitals with different service capacities, and diverse travel modes. This provides a new research perspective for a comprehensive and thorough understanding of the equal accessibility of basic public services.

Abstract Background Quantifying spatial access to care—the interplay of accessibility and availability—is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research. Methods A two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step. Results We identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes. Conclusions Gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods—both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.

The ongoing novel coronavirus (COVID-19) pandemic has highlighted the need for individuals to have easy access to healthcare facilities for treatment as well as vaccinations. The surge in COVID-19 hospitalizations during 2020 also underscored the fact that accessibility to nearby hospitals for testing, treatment and vaccination sites is crucial for patients with fever or respiratory symptoms. Although necessary, quantifying healthcare access is challenging as it depends on a complex interaction between underlying socioeconomic and physical factors. In this case study, we deployed a Multi Criteria Decision Analysis (MCDA) approach to uncover the barriers and their effect on healthcare access. Using a least cost path (LCP) analysis we quantified the costs associated with healthcare access from each census block group in the Los Angeles metropolitan area (LA Metro) to the nearest hospital. Social vulnerability reported by the Centers for Disease Control and Prevention (CDC), the daily number of COVID-19 cases from the Los Angeles open data portal and built environment characteristics (slope of the street, car ownership, population density distribution, walkability, traffic collision density, and speed limit) were used to quantify overall accessibility index for the entire study area. Our results showed that the census block groups with a social vulnerability index above 0.75 (high vulnerability) had low accessibility owing to the higher cost of access to nearby hospitals. These areas were also coincident with the hotspots for COVID-19 cases and deaths which highlighted the inequitable exposure of socially disadvantaged populations to COVID-19 infections and how the pandemic impacts were exacerbated by the synergistic effect of socioeconomic status and built environment characteristics of the locations where the disadvantaged populations resided. The framework proposed herein could be adapted to geo-target testing/vaccination sites and improve accessibility to healthcare facilities in general and more specifically among the socially vulnerable populations residing in urban areas to reduce their overall health risks during future pandemic outbreaks.

The multi-modal two-step floating catchment area (MM-2SFCA) method is an extension of the two-step floating catchment area (2SFCA) method that incorporates the impact of different transportation modes, thereby facilitating more accurate calculations of the spatial accessibility of public facilities in urban areas. However, the MM-2SFCA method does not account for the impact of distance within the search radius on supply–demand capacities, and it assumes an idealized supply–demand relationship. This paper introduces the gravity model into the MM-2SFCA method, proposing a multi-modal gravity-based 2SFCA (MM-G2SFCA) method to better account for distance decay and supply–demand relationships. Furthermore, a standardized gravity model is proposed based on the traditional gravity model. This model imposes constraints on upper and lower limits for distance decay weights without compromising the fundamental curve characteristics of the gravity model, thereby avoiding extreme weight scenarios. The accessibility of public hospitals in Shenzhen is evaluated through the integration of basic geographic information data, resident travel data, and official statistical data. The findings demonstrate that the standardized gravity model effectively addresses the issue of excessively high local distance weights in the traditional gravity model, making it more suitable as a distance decay function. The MM-G2SFCA method improves the consideration of distance and supply–demand relationships, thereby facilitating a more rational distribution of accessibility on a global scale. This study discovers differences in the spatial allocation of public hospital resources across the Shenzhen’s districts. Accessibility within the metropolitan core is significantly higher than that outside the core. Additionally, there is a notable difference in the level of accessibility among the districts. Accessibility is found to be better in district centers and along the main traffic arteries.

Copyright of Tropical Geography is the property of Tropical Geography Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Quantifying spatial access to care—the interplay of accessibility and availability—is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research. Methods: A two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step. Results: We identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes. Conclusions: Gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods—both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements. [ABSTRACT FROM AUTHOR]

The accessibility of commercial centers (CCs) is a topic of great concern to consumers and planners. However, current research is mostly limited to the accessibility of a single traffic mode or rough road network, which makes it difficult to reflect on the real travel situation of residents. Based on the two-step floating catchment area (2SFCA) method framework, we propose an extended method for analyzing the accessibility of CCs in different transportation modes, making it suitable for commercial geography research. The Baidu Map API is used to provide more accurate, convenient, and realistic data for reliable estimates to pinpoint underserved populations. The results can be summarized as follows: First, the multimode R2SFCA method proposed fills the knowledge gap to the accessibility of a single traffic mode or or rough road network. Second, there exist significant differences in the spatial distribution of access to CCs for consumers in different transportation modes. The range of public transit along metro or bus routes shows a finger-like spatial distribution, while car traffic extends along external urban traffic routes and is time-sensitive because of traffic conditions. Third, changes in the average accessibility scores for all travel modes showed similar patterns with increasing threshold time. These accessibility measures help identify underserved areas and enable the development of policy recommendations for the optimal allocation of commercial facilities and resources. [ABSTRACT FROM AUTHOR]

The issue of reducing spatial disparities is one of the most pressing concerns for policymakers and planners, which consider a crucial focus in planning and public service, especially accessibility to healthcare. Accessibility and proximity are the principal keys to providing good public service. Therefore, a healthcare system that meets the requirements of availability and affordability will be useless if spatial accessibility is not provided equally to all demands (population). Many technics and methods exist to quantify accessibility, including the two-step floating catchment area (2SFCA) method, its widely used to measure healthcare accessibility based on the travel distance threshold. This research paper aims to use the 2SFCA method to measure the spatial healthcare accessibility in Batna City because the 2SFCA method offers to measure accessibility on both spatial and functional levels. The spatial level will consider the threshold distances between the health demand (population) and the health provider location (healthcare facilities); moreover, functional accessibility is measured based on facility to population ratio that will give a better overview of Batna's healthcare provider. As a result, the optimal threshold distance that offers balanced results between the spatial accessibility score and other WHO ratios will be a distance between 1000- and 1500-meters travel distance. In addition, the central census districts have a higher access score than the rest of the city's districts; most census districts that do not have accessibility (12% of the population) to healthcare facilities are concentrated in the southwest of Batna city.

At present, the hierarchical medical system is widely promoted in China, and the reasonable allocation of medical resources and equal medical services have become important research topics in the field of urban planning. However, it is rare to see studies on the allocation of medical resources from the perspective of spatial accessibility based on the hierarchy of medical facilities and more refined spatial units of population. This research refines the population data from general to residential buildings in urban villages based on census data of buildings. By examining Shenzhen through a 2SFCA (2-step floating catchment area), this research evaluates the accessibility of community and regional medical facilities and the spatial matching at various referral rates by implementing GIS network analysis. The main findings are as follows. ① The overall development of medical facilities in Shenzhen is currently lagged back among the first-tier cities in China, and there is a discrepancy between administrative districts in terms of the accessibility of medical facilities. ② Under the current conditions in Shenzhen, the best spatial matching can be achieved only at the referral rate of 70% - 80%, indicating weak primary medical resources in Shenzhen. In the future layout and construction of medical facilities, it is necessary to classify and grade the communities and increase the construction of medical facilities in communities with lagging medical standards. In addition, the treatment capacity of community medical services should be improved and the treatment of minor diseases in senior hospitals should be evacuated, so that the referral rate can be controlled at an appropriate level to achieve a balanced allocation and efficient use of medical resources. [ABSTRACT FROM AUTHOR]

The spatial accessibility of urban parks is an important indicator of the livability level of cities. In this paper, we propose a comprehensive multimodal two-step floating catchment area (CM2SFCA) method which integrates supply capacity, the selection probability of individuals, and variable catchment sizes into the traditional multimodel 2SFCA method. This method is used to measure park accessibility in Wuhan, China. The results show that the spatial distribution of park accessibility under the proposed method is variant. High accessibility areas are clustered near the Third Ring Road with strong supply capacity parks, and low accessibility areas are distributed in the western and southern regions. Compared with the single-model accessibility (bicycling, driving, and public transit) method, we found that the multimodal spatial accessibility, combining the characteristics of three single transportations, can provide a more realistic evaluation. We also explore the spatial relationship between park accessibility and population density by bivariate local Moran's I statistic and find that the Low Ai-High Pi area is located in the center of the study area, and the Low Ai-Low Pi area is located at the edge of the study area, with a relatively discrete distribution of parks and weak supply capacity. These findings may provide some insights for urban planners to formulate effective policies and strategies to ease the spatial inequity of urban parks. [ABSTRACT FROM AUTHOR]

Healthcare spatial accessibility requires a better understanding and evaluation, especially during pandemic outbreaks like the recent COVID-19 pandemic. The main goal of this study is to measure and assess community-level spatial accessibility in Amman city to various COVID-19 related healthcare resources that could provide any urgent medical care for suspected or confirmed COVID-19 cases. To address this aim, the Enhanced 2-step floating catchment area (E2SFCA) method combined with several geospatial techniques were performed. The main E2SFCA results show the differences in the capacities and spatial accessibility of health facilities within Amman city, as well as how the variations are captured at different regions. The resulted spatial accessibility scores were presented in interactive Geo-spatial maps, analyzed, and compared for several health resources in public, private, and educational hospitals. The current research findings stated that although there are enough healthcare facilities to service almost the entire city, inappropriate health facility distribution, rather than a lack of resources, has resulted in coverage gaps in some areas. The center zones had been fully serviced, or perhaps over-served, by a large number of facilities. The other zones, on the contrary, were partially served or were even underserved by a certain number of resources.

Rapid urbanization in China has led to an exponential increase in the stocks of metals used in cities. Exploring their amount and growth patterns is an important way to forecast future metal demand and identify the potential for urban mining. Here, we use a combination of bottom-up and GIS tools to estimate the amount of in-use stocks and scrap metal of steel, copper, and aluminum in 366 regions of mainland China from 2010 to 2020. We then downscaled the 2020 metal scrap volume based on a multi-source dataset of socioeconomic factors. Finally, the accessibility of the urban mining pilot base (UMPB) was calculated using the two-step floating catchment area method (2SFCA), and the spatial layout assessment analysis of the UMPB was conducted under the supply–demand balance perspective. The results showed that the total in-use stocks of steel, copper, and aluminum increased from an initial 3186 million tons to 5216 million tons, with a corresponding trend of continued growth in the amount of metal scrap. The high value of scrap metal in 2020 is concentrated in the Beijing–Tianjin–Hebei urban agglomeration, the Yangtze River Delta region, and the Chengdu–Chongqing metropolitan area. The accessibility results show that the road network distance-based accessibility covered a smaller area than the Euclidean distance-based accessibility, but when the UMPB service radius was set to 300 km, the road network distance-based accessibility could also cover most of the eastern part of China. The spatial evaluation results of UMPB show that for service radii of 200 km and 300 km, low-supply and high-demand areas account for 6.32 percent and 5.89 percent, respectively. [ABSTRACT FROM AUTHOR]

With the increasingly prominent phenomenon of social stratification in urban development, it is of practical significance to study the accessibility of elderly care facilities for different social groups. The study improves the mathematical model of the two-step floating catchment area method (2SFCA) as regards three aspects: the accurate demand of elderly residents, the comprehensive supply capacity of elderly care facilities, and the precision of travel costs. Taking Tianjin as an example, the study measures the accessibility of elderly care facilities from the perspective of social stratification. The results show that: (1) The improved model is more practical in evaluating the accessibility of elderly care facilities. (2) The spatial distribution of social groups in Tianjin presents a concentric structure and the social stratification in the periphery area is more obvious. (3) The accessibility scores of elderly care facilities are higher in the city center, lower in the periphery area, higher in the south, and lower in the north. (4) High- and middle-income groups have better accessibility, while the elite and low-income groups have worse accessibility. [ABSTRACT FROM AUTHOR]

Healthcare spatial accessibility requires a better understanding and evaluation, especially during pandemic outbreaks like the recent COVID-19 pandemic. The main goal of this study is to measure and assess community-level spatial accessibility in Amman city to various COVID-19 related healthcare resources that could provide any urgent medical care for suspected or confirmed COVID-19 cases. To address this aim, the Enhanced 2-step floating catchment area (E2SFCA) method combined with several geospatial techniques were performed. The main E2SFCA results show the differences in the capacities and spatial accessibility of health facilities within Amman city, as well as how the variations are captured at different regions. The resulted spatial accessibility scores were presented in interactive Geo-spatial maps, analyzed, and compared for several health resources in public, private, and educational hospitals. The current research findings stated that although there are enough healthcare facilities to service almost the entire city, inappropriate health facility distribution, rather than a lack of resources, has resulted in coverage gaps in some areas. The center zones had been fully serviced, or perhaps over-served, by a large number of facilities. The other zones, on the contrary, were partially served or were even underserved by a certain number of resources. [ABSTRACT FROM AUTHOR]

Inequalities in accessibility to grocery stores can lead to disparate health outcomes among the population. Although existing studies have examined grocery accessibility inequality across income and racial/ethnic groups, little research has been dedicated to revealing the intra‐racial disparities of grocery accessibility and comparing inter‐racial and intra‐racial inequalities in grocery accessibility. This study adopts a modified two‐step floating catchment area (2SFCA) method, which accounts for the supply/demand inflation effect, and an alternative distribution inequality metric called the Palma ratio to measure the inequalities in grocery access between the richest 10% and poorest 40% of the census tracts within the same racial/ethnic group in Chicago (USA). The results indicate that in Chicago, inter‐racial inequality in grocery accessibility is more serious than intra‐racial inequality, especially because the Hispanic‐majority census tracts generally suffer from low grocery accessibility regardless of their income levels. [ABSTRACT FROM AUTHOR]

In spatial accessibility studies based on market areas, such as floating catchment area (FCA) family methods, it is crucial to identify the point to which weights are assigned, both on the demand and supply side. Bearing in mind that it is not always possible to work on disaggregated data, the aim of this paper was to investigate which method of determining a point, minimises bias in the estimation of walking accessibility. The research used the G2SFCA method, introduced by Dai, which has been employed several times to model walking accessibility. Results clearly show that point location methods for area units, based on disaggregating data to buildings, perform better at the scale of statistical districts or cadastral precincts, compared to those based on the centrally weighted mean. They also show that positional measures such as the Euclidean centrally weighted median can improve the results of analyses in units that are heterogeneous in terms of settlement network pattern. [ABSTRACT FROM AUTHOR]

We intend to tackle two under-addressed issues in access to healthcare services during the COVID-19 pandemic: first, the spatiotemporal dynamic of access during the pandemic of acute communicable disease; second, the demographic and socioeconomic access disparities. We used the two-step floating catchment area (2SFCA) method to measure the spatial access to public hospitals during the second COVID-19 wave (September 28th-February 28th, 2021) in Nottinghamshire, UK. To investigate the temporal variation in access along with the development of the pandemic, we divided our study period into 11 sections and applied the 2SFCA to each of them. The results indicate that western Nottinghamshire is better than the eastern part from a spatial perspective and the north-western urban area represents the highest spatial access; temporally, the accessibility of the public hospitals generally decreased when the number of cases increased. Particular low accessibility was observed at the beginning of the pandemic when the outbreak hit the university region and its vicinities during the back-to-school season. Our disparity analysis found that i) the access of the senior population to public hospitals deviated from that of the general population, ii) the access was positively associated with socioeconomic status, and iii) all disparities were related to the urban-rural discrepancy. These findings can help to plan temporary clinics or hospitals during epidemic emergencies. More generally, they provide scientific support to pandemic-related healthcare resource allocation and policy- making, particularly for people in vulnerable areas.

Spatial equality of parks is a significant issue in environmental justice studies. In cities with high-density development and limited land resources, this study uses a supply-demand adjusted two-step floating catchment area model (2SFCA), paying attention to residents' subjective preferences and psychological accessibility. It assesses equality of access to urban parks from two dimensions: spatial equality and quantitative equality at a fine scale of 100 × 100 m grid resolution. The spatial equality of urban parks in Chengdu is measured under different transportation modes (walking, cycling, and driving) based on multi-source geospatial big data and machine learning approaches. The results show: (1) There were significant differences in the spatial distribution of park accessibility under different modes of transportation. The spatial distribution under walking was significantly influenced by the park itself, while the distribution of rivers significantly influenced the spatial distribution under cycling and driving; (2) Accessibility to urban parks was almost universally equal in terms of driving, relatively equal in terms of cycling, and seriously unequal in terms of walking; (3) Spatial local autocorrelation analysis shows that park accessibility tended to be significantly clustered, with little spatial variation; and (4) The supply and demand of urban parks were relatively equal. The results can help urban planners to formulate effective strategies to alleviate spatial inequality more reasonably and precisely. The applied research methods can further improve the system of scientific evaluation from a new perspective.

Urban parks, as important carrier of outdoor physical activity, can effectively reduce the incidence of chronic diseases and promote public health. The accessibility of parks directly affects residents' levels of physical activity. However, current accessibility assessments do not consider physical activity needs into account and are unable to adapt to the current developmental needs of a healthy China. We propose a framework for evaluating park accessibility oriented towards a physical activity service perspective. First, we introduced a park attractiveness index based on physical activity preferences. The index encompasses not only objective park features but also subjective environmental perception features, which are evaluated using deep-learning techniques. Furthermore, the size of the park catchment area was correlated with the park attractiveness index, and the likelihood of park selection based on people's physical activity preferences was computed. Fuzhou City's Gulou District was selected for this case study. The results show the following: (1) Our proposed evaluation model can identify more underserved neighborhoods in scenarios geared toward physical activity requirements than traditional approaches. (2) The distribution of parks in the Gulou District was not sufficiently balanced, with the accessibility value at the 90th percentile only slightly higher than the average value of 6.35. There was obvious spatial differentiation, with a pattern of high values in the central area and low values in the surrounding areas. (3) Approximately 12.70 % of the population is located within service-blind zones and the overall level of accessibility is poor. This study offers novel ideas and approaches for optimizing the spatial layout of urban parks within a health-oriented framework. This aids planners and policymakers in enhancing the spatial layout of parks and ensuring equitable access to urban parks that foster physical activity. ● A park attractiveness index based on physical activity preferences is proposed and added to the accessibility model. ● Perceived quality was assessed using deep learning techniques. ● The improved model better assesses park accessibility under physical activity preferences. ● It provides new ideas and methods to study the rationality of the spatial layout of urban parks under health orientation. [ABSTRACT FROM AUTHOR]

As a public service facility that provides relief, resettlement, and evacuation services to disaster-affected people, emergency shelters play a vital role in helping people cope with disaster events. The measurement of spatial accessibility of existing emergency shelters is a key task in improving emergency shelter services and minimizing property losses and deaths. In this study, considering the differences in emergency shelters' service capacities and population distribution, we developed a two-step floating catchment area (2SFCA) method with a variable service radius and evacuation radius to describe emergency shelter accessibility in Lanzhou's core area and compared with the traditional 2SFCA method. Furthermore, we used bivariate local Moran's I to identify the spatial relationships between emergency shelter accessibility and population density. The results show that the traditional 2SFCA method underestimates accessibility in densely populated areas with dispersed emergency shelters. Shelter accessibility in Lanzhou's core area is unevenly distributed, with the lowest levels of accessibility in densely populated areas. There is an obvious spatial mismatch between the accessibility of emergency shelters and the population density, and the central and western part of Chengguan has a serious shortage of emergency shelters. This study provides important information for the planning and construction of emergency shelters. [ABSTRACT FROM AUTHOR]

The spatial distribution and accessibility of urban public service facilities affect socioeconomic factors in the lives of residents, especially housing prices. Given that most previous studies focus on the accessibility of a certain, single type of facility and its impact on housing prices, this research uses improved two-step floating catchment area (2SFCA) methods by considering the differences in the service capacity of different types of public service facilities in real life to evaluate their accessibility to residential communities in Jinan city based on 3117 facilities covering 11 different kinds of facilitates. Then, we assess the spatial distribution of the impact of the accessibility of different public service facilities on housing prices in Jinan city through a local indicator of a spatial association (LISA) cluster diagram generated based on the bivariate local Moran's index. Our objectives are to assess the accessibility of multiple public service facilities using an improved 2SFCA method and to explore the spatial correlations between the accessibility of public service facilities and housing prices. The results show that the housing prices in Jinan are clustered and that the areas with high housing prices are mainly concentrated in the Lixia District and the center of the downtown area. The accessibility of medical, shopping, educational and bus stop facilities in the Lixia District is better than that in other districts. The accessibility of shopping, medical and tourist attraction facilities has the most significant impact on housing prices, and the number of communities in which the accessibility of these public service facilities and housing prices form a positive correlation cluster accounts for 50.5%, 47.9% and 45.8% of all communities, respectively. On the other hand, educational accessibility and bus stop accessibility have nothing to do with housing prices, and the number of communities in which the accessibility of these public service facilities forms a not-significant cluster with housing prices accounting for 51.1% and 56.5% of the total, respectively. In this study, the combined 2SFCA method is used to improve the method for evaluating the accessibility of a variety of public service facilities, and its applicability is verified by practical application. By analyzing the spatial correlation between accessibility and housing prices, we expand our understanding of accessibility and show that it plays a central role in housing prices, which will help to improve the spatial pattern of urban public places in the future, provide support for decision makers and provide a reference for the government and real estate developers. [ABSTRACT FROM AUTHOR]

Worldwide bike-sharing systems are growing in popularity as an alternative, environmentally friendly mode of transportation. As cities seek to further develop bike-sharing programmes, it is important to consider how systems should expand to simultaneously address existing inequalities in accessibility, and best serve demand. In this paper, we determine ideal locations for future bike-sharing stations in Glasgow, Scotland, by integrating demand modelling with accessibility considerations. We began by analysing the spatio-temporal trends of bike-sharing usage, and assessed the spatial equity of access to stations in Glasgow. To identify important determinants of bike-sharing demand, we ran an ordinary least squares regression model using bike sharing trip data from Nextbike Glasgow. We then quantifiably measured the level of spatial accessibility to stations by applying the two-step floating catchment area (2SFCA) methodology and ran a GIS weighted overlay analysis using the significant determinants of station demand. Lastly, we combined the demand and accessibility results to determine where new stations should be located using a maximum covering location problem (MCLP) that maximized the population served. Our results show that distance from transit stations, distance from downtown, employment rates, and nearby cycling lanes are significant factors affecting station-level demand. Furthermore, levels of spatial access were found to be highest primarily in the centre and eastern neighbourhood of Glasgow. These findings aided in determining areas to prioritize for future station locations, and our methodology can easily be applied to other bike-share programmes with adjustments according to varying aims for system expansion. [ABSTRACT FROM AUTHOR]

There has been limited information on spatial accessibility to healthcare in Multi-island Micro States (MIMS). This is partly due to the application of methodologies that do not sufficiently consider the dynamic or unique characteristics of MIMS. The objective of the paper is to evaluate the performance of different Geographic Information Systems (GIS) methodologies for quantifying spatial accessibility to public healthcare in Multi-island States (MIMS). Spatial accessibility was measured using three GIS-based methodologies: Temporally Available Two-Step Floating Catchment Area (TA2SFCA) and traditional models [Two-Step Floating Catchment Area (2SFCA) and the Gravity Model]. Unlike the Gravity Model and the 2SFCA which only used population and health facilities locations along with travel times to quantify spatial accessibility, the TA2SFCA also included information on the hours of operations and health schedules in its assessment. These additional variables were used to develop the time windows to assess differences in capacity among available service sites. TA2SFCA results showed that spatial accessibility was linked to a 'traveling doctor' dynamic with access to healthcare services reflecting changes in the supply of services. As such, the Gravity Model and 2SFCA which did not account for this peculiarity were inadequate for measuring spatial accessibility in MIMS. The TA2SFCA addressed both the temporal and spatial aspects of health which were most reflective of the health system of these islands. Given the spatial-temporal dynamics, improving accessibility to healthcare requires periodic assessments and reassessments of health service delivery since this is affected by operating times and changes in capacity. Furthermore, there is the need for more research to develop methodologies that are more reflective or sensitive to MIMS dynamics. [ABSTRACT FROM AUTHOR]

Abstract Background Poor spatial accessibility to hospital services is associated with higher morbidity and mortality rates among people living with disability. Improved methods to evaluate spatial accessibility are needed. This study measured the potential spatial accessibility of people living with disability by applying four configurations of the two-step floating catchment area (2SFCA) method to recommend the best model for use in health services research. Methods 2SFCA and an enhanced version (E2SFCA) were used to measure hospital accessibility for people living with disability. We also developed and embedded a non-spatial severity index into the two 2SFCA models. We used 16,186 records of people living with disability experience to evaluate the methodological performance across 68 neighbourhoods of the city of Ahvaz, located in south-western Iran. The models’ performance were measured through correlation of the four accessibility scores with the distance to closest hospital for each neighbourhood centroid. Results Among the four models used to measure spatial accessibility, the E2SFCA integrated with the severity index displayed the best performance. Most people with disabilities lived in neighbourhoods located in the South-western and central areas of the city. Interestingly, south-western neighbourhoods had poor hospital accessibility score and were identified as unmet need areas for access to health services. Conclusions Inclusion of the severity factor in the E2SFCA improved access measurements. Identifying areas with poor levels of hospital accessibility can help policymakers design tailored interventions and improve accessibility to hospital-based care in urban settings for people living with disability.

Urban vitality is a spatial phenomenon and a public service. Previous studies often did not measure the fairness of the accessibility of urban vitality. This research analyzed the spatial distribution of urban vitality in Wuhan as a case study area using big data from multiple sources. The study used the two-step floating catchment area method (2SFCA) to measure the accessibility level of each residential district to the vibrant zones (VZs). Furthermore, the inequality in the level of accessibility of residential areas with different housing prices was assessed on the basis of the Gini coefficient. The main conclusions are as follows: (1) the Gini coefficient of reaching the accessibility level of high-grade VZs is 0.426, and the corresponding sub-high-grade Gini coefficient is 0.274. This shows that the inequality in accessibility of different residential areas is more obvious as the level of vitality is higher and (2) residential areas with high housing prices have greater accessibility than those areas with low housing prices. It was also noticed that the level of accessibility and fairness in vitality is generally higher in central urban areas than in suburban areas. The Gini coefficient of high-grade vitality is generally higher than that of sub-high-grade. The results of this study provide a reference for researching the accessibility level of urban vitality, which considers the needs of population, and can also provide guidelines in urban planning regarding the allocation of services and resources.

This study examines the narrative(s) that surround the development of the Two-Step Floating Catchment Area (2SFCA) family of GIS-based accessibility statistics. It identifies what has been omitted from the pre-GIS era in its discourse and presents a parallel but alternative narrative behind these statistics. The results suggest that the 'crowdedness' metric from the i2SFCA can more broadly be viewed as a form of market potential, and the 2SFCA and i2SFCA are normalized, singly supply-constrained and singly demand-constrained spatial interaction models, respectively. It postulates that the R j values calculated in the 2SFCA are not real supply-to-population ratios, but the inverse of the market potential metric associated with the i2SFCA is, and this inverse value can be used to develop an adjusted supply accessibility metric. This enables the 2SFCA family of supply accessibility metrics also to account for congestion at service sites. Results using the adjusted and congested supply accessibility metrics suggest that less densely populated areas may not be at a disadvantage with respect to the supply of services once congestion is taken into account. The adjusted and congested supply accessibility metrics also have a complementary cost accessibility metric that when used in tandem measure the size and efficiency of supply availability. [ABSTRACT FROM AUTHOR]

Abstract Background Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies. Methods Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement. Results The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making. Conclusions The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

BackgroundHealthcare resources are always more limited compared with demand, but better matching supply with demand can improve overall resource efficiency. In countries like China where patients are free to choose healthcare facilities, over-utilization and under-utilization of healthcare resources co-exist because of unreasonable healthcare seeking behavior. However, scholarship regarding the spatial distribution of utilization for healthcare resources, resulting from unreasonable spatial tendencies in healthcare seeking, is rare.MethodsIn this article, we propose a new External Patient Healthcare Index (EPHI) to simulate the spatial distribution of utilization for healthcare resources, based on the Two-Step Floating Catchment Area (2SFCA) method, which is widely used to assess potential spatial accessibility. Instead of using individual-level healthcare utilization data which is difficult to obtain, the EPHI uses institution-level aggregated data, including numbers of inpatient/outpatient visits. By comparing the estimated utilization (based on local healthcare institution services provision) with the expected utilization (based on local population morbidity), guest patients (e.g., patients flowing in for treatment) and bypass patients (patients flowing out) can be identified. To test the applicability of this index, a case study was carried out on China's Hainan Island. The spatial tendencies of patients for inpatient and outpatient services were simulated, then incorporated with spatial access to healthcare resources to evaluate overall resource allocation efficiency, thus guiding future resource allocations and investment for policy makers and healthcare providers.ResultsThe EPHI revealed that bypass activities widely exist on Hainan Island in both inpatient and outpatient care, with patients tending to travel from less developed regions with fewer healthcare resources to more highly developed regions with more healthcare resources to receive healthcare. Comparison with spatial accessibility demonstrated how bypass activities on Hainan produced an under-utilization of doctors in less developed regions and over-utilization of doctors in more developed coastal regions.ConclusionsThis case study on Hainan Island demonstrates that this new index can very clearly identify both the sources and sinks of patient spatial tendencies. Combining these results with spatial accessibility of healthcare resources, how efficiently the available supply matches the utilization can be revealed, indicating wide-ranging applicability for local governments and policymakers.

China's rapid economic development has led to inequality in terms of property, education, and health. Equal access to basic public facilities has become a key concern of inclusive development policies. However, previous studies have paid little attention to the effects of different travel modes on the accessibility of basic public facilities. The present research fills this gap. Taking Xiamen city as a case study, it explores the degrees of horizontal and vertical equity by examining the accessibility of various basic public facilities, paying attention to different travel modes and travel times. The results for Xiamen city show that disadvantaged groups experience a greater level of inequity. By taking these aspects into account, one is better equipped to identify areas in the city where access to basic public facilities is in need of substantial improvement. [ABSTRACT FROM AUTHOR]

As an important part of ecological externalities, the spatial spillover effect has attracted the attention of researchers in the field of environmental economics. However, the traditional view that the spillover mechanism of ecological externalities generally decreases in line with increases in distance remains to be thoroughly proven. Effective ecological management requires an understanding of the relationship between the natural environment and human communities. In this study, the concept of geographical accessibility and a two-step mobile search model are introduced in order to connect ecosystems and humans by a spatial distance. This model can fully demonstrate the external spatial spillover effect of ecology. Based on research from the Beihai Wetland Reserve, Guangxi, China, this study found that the change in the ecological externality spillover mechanism is not only affected by spatial distance but is also affected by the pro-environmental attributes of individual residents around the region. Under the same conditions, residents with a high degree of interaction with ecological protection zones can display a stronger spatial spillover effect. The conclusion of this study provides a more accurate understanding of the changes in the spillover effect of ecological externalities, which in turn can help managers to formulate more adequate ecological protection policies that are based on the specific conditions of different residents. This is crucial for the successful management of protected ecological areas that are highly linked to human communities.

Equal accessibility to healthcare services is essential to the achievement of health equality. Recent studies have made important progresses in leveraging GIS-based location–allocation models to optimize the equality of healthcare accessibility, but have overlooked the hierarchical nature of facilities. This study developed a hierarchical maximal accessibility equality model for optimizing hierarchical healthcare facilities. The model aims to maximize the equality of healthcare facilities, which is quantified as the variance of the accessibility to facilities at each level. It also accounts for different catchment area sizes of, and distance friction effects for hierarchical facilities. To make the optimization more realistic, it can also simultaneously consider both existing and new facilities that can be located anywhere. The model was operationalized in a case study of Shenzhen, China. Empirical results indicate that the optimal healthcare facility allocation based on the model provided more equal accessibility than the status quo. Compared to the current distribution, the accessibility equality of tertiary and secondary healthcare facilities in optimal solutions can be improved by 40% and 38%, respectively. Both newly added facilities and adjustments of existing facilities are needed to achieve equal healthcare accessibility. Furthermore, the optimization results are quite different for facilities at different levels, which highlights the feasibility and value of the proposed hierarchical maximal accessibility equality model. This study provides transferable methods for the equality-oriented optimization and planning of hierarchical facilities. [ABSTRACT FROM AUTHOR]

Background: Poor spatial accessibility to hospital services is associated with higher morbidity and mortality rates among people living with disability. Improved methods to evaluate spatial accessibility are needed. This study measured the potential spatial accessibility of people living with disability by applying four configurations of the two-step floating catchment area (2SFCA) method to recommend the best model for use in health services research.Methods: 2SFCA and an enhanced version (E2SFCA) were used to measure hospital accessibility for people living with disability. We also developed and embedded a non-spatial severity index into the two 2SFCA models. We used 16,186 records of people living with disability experience to evaluate the methodological performance across 68 neighbourhoods of the city of Ahvaz, located in south-western Iran. The models' performance were measured through correlation of the four accessibility scores with the distance to closest hospital for each neighbourhood centroid.Results: Among the four models used to measure spatial accessibility, the E2SFCA integrated with the severity index displayed the best performance. Most people with disabilities lived in neighbourhoods located in the South-western and central areas of the city. Interestingly, south-western neighbourhoods had poor hospital accessibility score and were identified as unmet need areas for access to health services.Conclusions: Inclusion of the severity factor in the E2SFCA improved access measurements. Identifying areas with poor levels of hospital accessibility can help policymakers design tailored interventions and improve accessibility to hospital-based care in urban settings for people living with disability. [ABSTRACT FROM AUTHOR]

In recent decades, access to primary health care has become a crucial issue for health policy planners and researchers. One of the fundamental problems is inequitable access to health care due to imbalanced resource distributions between health care providers and population location. Accordingly, this study aims to examine the spatial access to Community Health Centers (CHC) in the Asmat district, one of the most isolated regions in Papua, Indonesia. We conducted the study using a two-step floating catchment area (2SFCA) method to quantify accessibility value to primary health care of each village in the district of Asmat. By taking five distance thresholds ranging from 5 to 25 km with an increment of 5 km, the results indicate that distance has a varying impact on each village. For example, within a 5-km distance threshold, 74% of villages have a zero score or have no access to CHCs, 22% have a score < 100, while only 4% of villages have a score > 100 or meet the minimum score recommended by World Health Organization (WHO). Two major related factors of these geographic disparities are the unequal distribution of CHCs and the high population dispersion. As an attempt to provide equal access to health care services, these results suggest that spatial access should be conscientiously considered by health planners and policy makers. [ABSTRACT FROM AUTHOR]

Abstract Two-step floating catchment area (2SFCA) methods that account for multiple transportation modes provide more realistic accessibility representation than single-mode methods. However, the use of the impedance coefficient in an impedance function (e.g., Gaussian function) introduces uncertainty to 2SFCA results. This paper proposes an enhancement to the multi-modal 2SFCA methods through incorporating the concept of a spatial access ratio (SPAR) for spatial access measurement. SPAR is the ratio of a given place’s access score to the mean of all access scores in the study area. An empirical study on spatial access to primary care physicians (PCPs) in the city of Albuquerque, NM, USA was conducted to evaluate the effectiveness of SPAR in addressing uncertainty introduced by the choice of the impedance coefficient in the classic Gaussian impedance function. We used ESRI StreetMap Premium and General Transit Specification Feed (GTFS) data to calculate the travel time to PCPs by car and bus. We first generated two spatial access scores—using different catchment sizes for car and bus, respectively—for each demanding population location: an accessibility score for car drivers and an accessibility score for bus riders. We then computed three corresponding spatial access ratios of the above scores for each population location. Sensitivity analysis results suggest that the spatial access scores vary significantly when using different impedance coefficients (p

Abstract Background Shenzhen has rapidly grown into a megacity in the recent decades. It is a challenging task for the Shenzhen government to provide sufficient healthcare services. The spatial configuration of healthcare services can influence the convenience for the consumers to obtain healthcare services. Spatial accessibility has been widely adopted as a scientific measurement for evaluating the rationality of the spatial configuration of healthcare services. Methods The multi-modal two-step floating catchment area (2SFCA) method is an important advance in the field of healthcare accessibility modelling, which enables the simultaneous assessment of spatial accessibility via multiple transport modes. This study further develops the multi-modal 2SFCA method by introducing online map APIs to improve the estimation of travel time by public transit or by car respectively. Results As the results show, the distribution of healthcare accessibility by multi-modal 2SFCA shows significant spatial disparity. Moreover, by dividing the multi-modal accessibility into car-mode and transit-mode accessibility, this study discovers that the transit-mode subgroup is disadvantaged in the competition for healthcare services with the car-mode subgroup. The disparity in transit-mode accessibility is the main reason of the uneven pattern of healthcare accessibility in Shenzhen. Conclusions The findings suggest improving the public transit conditions for accessing healthcare services to reduce the disparity of healthcare accessibility. More healthcare services should be allocated in the eastern and western Shenzhen, especially sub-districts in Dapeng District and western Bao’an District. As these findings cannot be drawn by the traditional single-modal 2SFCA method, the advantage of the multi-modal 2SFCA method is significant to both healthcare studies and healthcare system planning.