Geographical disparities in access to hospital care in Ontario, Canada: a spatial coverage modelling approach
Open Access
- 28 January 2021
- Vol. 11 (1), e041474
- https://doi.org/10.1136/bmjopen-2020-041474
Abstract
Objectives Previous studies on geographical disparities in healthcare access have been limited by not accounting for the healthcare provider’s capacity, a key determinant of supply and demand relationships. Design This study proposed a spatial coverage modelling approach to evaluate disparities in hospital care access using Canadian Institute for Health Information data in 2007. Setting This study focusses on accessibility of inpatient and emergency cares at both levels of individual hospital and the administrative regions of Local Health Integration Network (LHIN) levels. Measures We integrated a set of traffic and geographical data to precisely estimate travel time as a measure of the level of accessibility to the nearest hospital by three scenarios: walking, driving and a combination of the both. We estimated population coverage rates, using hospital capacities and population in the catchments, as a measure of the level of the healthcare availability. Hospital capacities were calculated based on numbers of medical staff and beds, occupation rates and annual working hours of healthcare providers. Results We observed significant disparities in hospital capacity, travel time and population coverage rate across the LHINs. This study included 25 teaching and 148 community hospitals. The teaching hospitals had stronger capacities with 489 209 inpatient and 130 773 emergency patients served in the year, while the population served in community hospitals were 2.64 times higher. Compared with north Ontario, more locations in the south could reach to hospitals within 30 min irrespective of the travel mode. Additionally, Northern Ontario has higher population coverage rates, for example, with 42.6~46.9% for inpatient and 15.7~44% for emergency cares, compared with 2.4~34.7% and 0.35~14.6% in Southern Ontario, within a 30 min catchment by driving. Conclusion Creating a comprehensive, flexible and integrated healthcare system should be considered as an effective approach to improve equity in access to care.Keywords
Funding Information
- Canadian Institute of Health Research Research (CIHR) through an Operating Grant: Data Analysis Using Existing Databases and Cohorts – Healthy Cities Intervention Research Grant (DA4-170261)
This publication has 15 references indexed in Scilit:
- Geographical accessibility to healthcare and malnutrition in RwandaSocial Science & Medicine (1982), 2015
- Interpreting the results of a modified gravity model: examining access to primary health care physicians in five Canadian provinces and territoriesBMC Health Services Research, 2012
- Geographical accessibility and spatial coverage modeling of the primary health care network in the Western Province of RwandaInternational Journal of Health Geographics, 2012
- Measuring potential spatial access to primary health care physicians using a modified gravity modelThe Canadian Geographer / Le Géographe canadien, 2010
- Primary health care: making Alma-Ata a realityThe Lancet, 2008
- Geographic access to cancer care in the U.S.Cancer, 2008
- AccessMod 3.0: computing geographic coverage and accessibility to health care services using anisotropic movement of patientsInternational Journal of Health Geographics, 2008
- Closing rural hospitals in Saskatchewan: on the road to wellness?Social Science & Medicine (1982), 1999
- Developing a plan for primary health care facilities in Soweto, South Africa. Part II: Applying locational criteriaHealth Policy and Planning, 1996
- The Concept of AccessMedical Care, 1981