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MedicalGeography HealthCareAccessibilityandImplications FahuiWangFredB KniffenProfessorofGeographyLouisianaStateUniversityJune17 2010 CNU Contents TheissueofaccessGIS basedaccessibilitymeasuresOptimizationtowardsequalaccessApplicationinhealthcareaccessPHSAdesignationandlate stagecancerConcludingcomments AccessMatters Convenienceofaccesstoactivitiesjob school healthcare park publicservice shopping Accessdefines location SpatialWhereyouareNonspatialWhoyouareSocialjusticeandpublicpolicy Measurement Howscarcearetheservices Supplyvs Demand ratio Howfararedemandsfromsupplies DistanceRoadnetworkTransportationmeans Primitivemeasures Distance time fromsupplySimplypotentialmodelSupply demandratiowithinanareaFCAwitharadius boxFCAwithatraveltimerange FromS DRatiotoFCA SimplyS DRatioFCAwithaRadiusImprovementsWithin unitvariationCross borderLimitationsStraight lineS Dbeyondradius 2 stepfloatingcatchmentarea 2SFCA ScaleavailabilityateachsupplylocationSumupaccessiblesuppliesaroundeachdemandlocation 2SFCARecap 1a Foreachsupplylocationj selectalldemandlocationskwithinatraveltimerangefromj catchmentCj 1b ComputethesupplytodemandratiowithinCj 2a Foreachdemandlocationi searchallsupplylocationsjwithinthetraveltimerangefromi catchmentZi 2b Sumupthesupplytodemandratiosatthesesupplylocations Generalizing distancedecay asacontinuousfunctionapowerorexponentialfunctionaGaussianfunctionasadiscretevariabledichotomousasin2SFCAmultipleasinE2SFCAahybridapproachakerneldensityfunctionathree zoneapproach Generalizing distancedecay Validation Modelingactualsupply demandinteractionsIndividualtravelbehaviorAggregatedtravelpattern Optimization TowardsequalaccessibilityFormulatedasaplanningproblemminimizingaccessibilitygapsamongdemandlocationsbyadjustingtheamountsofsuppliesatgivensupplylocations AQuadraticProgrammingApproach Subjectto where Valueofoptimization EmphasizingtheequalityissueIdentifyingover andunder capacityofsupplyGuidingplanningandpublicpolicyinclosingthegap ApplicationinHealthcareAccess HPSAdesignation U S ranksbehindinhealthperformancedeepdisparitiesinaccesstocareandhealthoutcomesFederalprograms MUP HPSAsCallsforbettermeasureofaccessibility Non spatial SocioeconomicDisadvantages Factor1 Socio culturalBarriers Factor2 HighHealthcareNeeds Factor3 Female headedhouseholds Populationinpoverty Nonwhiteminorities Householdsw ovehicles Homeownership Householdswithlinguisticisolation Householdswith 1personperroom Populationw ohigh schooldiploma Medianincome HighneedsPopulation Consolidatingnonspatialvariables IntegratingSpatialandNonspatialFactors GeographicAreaPrimaryIndicator spatialaccessibilityscore 1 3500PrimaryIndicator spatialaccessibilityscore 1 3000ANDsecondaryindicator factor3 1standarddeviationabovemeanPopulationGroupPrimaryIndicator factor1 1standarddeviationabovemeanPrimaryIndicator factor1 standarddeviationabovemeanandsecondaryindicator factor2 1standarddeviationabovemean Applicationinhealthcareaccess vs late stagecancer Riskbreakdowns CultureKnowledge Dis advantageHealthinsurance AccesstoprimarycareAvailabilityandaccessibilityofscreeningservicesQualityofhealthcare Multilevelapproach Socio economicdisadvantageSocialnetworksandinstitutionsLocalresources PERSON PLACE Rural urbancontinuum ChicagoChicagosuburbsOthermetroareasLargetown 10 50k Rural MultilevelModelCoefficients Findings EffectsofindividualattributesOlderagelinkedtoreducedriskBlackslinkedtohigherriskEffectsofcontextualvariablesIncome primarycareaccess significantinbreastandlungcancerOthers marginallyornotsignificantEffectsofurban rurallocation urbandisadvantage Publicpolicyimplication Concludingremarks RiseofComputationalSocialSciences CSS andSpatially integ