The increasing availability of Geographical Information Systems (GIS) in health organisations, together with the proliferation of spatially disaggregate data, has led to a number of studies that have been concerned with developing measures of access to health care services. The main aim of this paper is to review the use of GIS-based measures in exploring the relationship between geographic access, utilisation, quality and health outcomes. The varieties of approaches taken by researchers concerned with teasing out the relative importance of geographical factors that may influence access are examined. To date, in the absence of detailed data on health utilisation patterns, much of this research has focused on developing measures of potential accessibility. This paper then critically evaluates the situation with regard to the use of such measures in a broad range of accessibility studies. In particular, there has been less research to date that examines the relationship between such measures and health outcomes. In the final sections of the paper, I draw on the review to outline areas where a broader research agenda is needed, particularly in relation to more recent innovations in health care delivery.

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Spatial accessibility measures are an important policy tool for managing healthcare provision and reducing health inequality. The two-step floating catchment area technique, in common with many alternative methodologies, requires that demand-side population be estimated using spatial interpolation techniques. This article studies the implications of adopting differing spatial representations of population on healthcare accessibility modeling outcomes. Results indicate that a dasymetric model yields lower accessibility scores than a standard pro rata model. More important, the difference is spatially disproportionate, suggesting that the degree of disadvantage experienced in rural areas may be greater than has previously been recognized.

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Tooth retention has been one of the main aims of oral care which in turn could have contributed to the social oral health divide. To investigate this issue further, data collected for a group audit was used to study the reasons for tooth extraction for patients attending for routine treatment at four dental practices. The practices served populations in areas with different levels of deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic 5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits per day within the group of dental surgeons varied with three practitioners performing more than three extraction visits per day while one practitioner had only 0.51. These reasons did not significantly depend on levels of deprivation. However, significantly more teeth were extracted for caries in the most deprived group in comparison to the least deprived. Therefore, could there be a case for appropriate extractions in the quest for equitable care?

There have been a plethora of studies investigating access issues in relation to health services but until recently a relative lack of research on geographical factors that may be influencing utilisation patterns. This paper includes a timely review on what is known from existing studies, a description of the main methodological concerns highlighted by such studies and draws on the review to present some ideas for more research in this area. The use of Geographical Information Systems (GIS) in investigating the relative importance of geographical factors on utilisation patterns is advocated through a review of published studies and a call made for more research to examine potential relationships with for example health outcomes. Recent advances with regard to the availability of detailed geographically disaggregate data and new location-based techniques such as developments in Global Positioning Systems (GPS) hold out great promise in such regards. Finally the policy relevance of such studies is re-iterated in terms of helping to tackle perceived inequities in the system, addressing health inequalities as well as gauging the effectiveness of current and planned service configurations.

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A large body of research has examined relationships between accessibility to green space and a variety of health outcomes with many researchers finding benefits in terms of levels of physical activity and relationships with levels of obesity, mental health, and other health conditions. Such studies often use spatial analytical techniques to examine relationships between distance to such spaces and health data collated at an individual survey respondent's home address or, more commonly, derived from area-based census measures summarised at a centroid. Generally, such measures are becoming more sophisticated and have moved on from the use of straightforward Euclidean-based measures to those based on network distance. However, few studies tend to use a combination of approaches or seek to establish the implications of incorporating alternative measures of accessibility on potential relationships. Using a database of green spaces (and associated attributes) and a detailed network dataset for the city of Cardiff, Wales, we examine the sensitivity of findings to the ways in which different metrics are calculated. This is illustrated by examining the variations in association between such metrics and a census-based deprivation index widely used in health studies to measure socioeconomic conditions. Our findings demonstrate that not only will the distances to green spaces vary according to the methodologies adopted but that any study that aims to investigate relationships with attributes of the nearest green space should acknowledge that matches may vary widely according to the techniques used. We conclude by warning against the use of inappropriate methodologies in examining access to green space which may directly influence directions (and levels) of association and hence may limit their relevance in wider geographical contexts.