Geographic variation in spatial accessibility of U.S. healthcare providers

Abstract

Background Growing physician maldistribution and population demographic shifts have contributed to large geographic variation in healthcare access and the emergence of advanced practice providers as contributors to the healthcare workforce. Current estimates of geographic accessibility of physicians and advanced practice providers rely on outdated “provider per capita” estimates that have shortcomings. Purpose To apply state of the art methods to estimate spatial accessibility of physician and non-physician clinician groups and to examine factors associated with higher accessibility. Methods We used a combination of provider location, medical claims, and U.S. Census data to perform a national study of health provider accessibility. The National Plan and Provider Enumeration System was used along with Medicare claims to identify providers actively caring for patients in 2014 including: primary care physicians (i.e., internal medicine and family medicine), specialists, nurse practitioners, and chiropractors. For each U.S. ZIP code tabulation area, we estimated provider accessibility using the Variable-distance Enhanced 2 step Floating Catchment Area method and performed a Getis-Ord Gi* analysis for each provider group. Generalized linear models were used to examine associations between population characteristics and provider accessibility. Results National spatial patterns of the provider groups differed considerably. Accessibility of internal medicine most resembled specialists with high accessibility in urban locales, whereas relative higher accessibility of family medicine physicians was concentrated in the upper Midwest. In our adjusted analyses independent factors associated with higher accessibility were very similar between internal medicine physicians and specialists–presence of a medical school in the county was associated with approximately 70% higher accessibility and higher accessibility was associated with urban locales. Nurse practitioners were similar to family medicine physicians with both having higher accessibility in rural locales. Conclusions The Variable-distance Enhanced 2 step Floating Catchment Area method is a viable approach to measure spatial accessibility at the national scale.

Climate migration and health system preparedness in the United States

“…Establishing and maintaining trust with communities through grassroots organizing, participation and collaboration is foundational to that goal. Additionally, assessing Hauer, 2017;Hinojosa & Meléndez, 2018;Hunter, 2005;IOM, 2020;Kim, 2020;Martin, 2018;Malo, 2019;McMichael et al, 2012;Robinson et al, 2020;Rudowitz et al, 2006;Siders, 2019;The Nansen Initiative, 2015;Universiteit Maastricht et al, 2016;Watts et al, 2015Health Systems Abramitzky et al 2013Baumgartner et al, 2020;Department for Professional Employees, 2016;Garrett and Gangopadhyaya 2020;Hersher and Benincasa 2019;Naylor et al, 2019;Nekoie-Moghadam et al, 2016; Office of the Assistant Secretary for Preparedness and Response, 2016; Paybarah et al 2020; Reeves 2020; Rice et al, 2013;Roser-Renouf et al, 2016;Rudowitz et al, 2006;Tikkanen et al, 2020 Climate Migration andHealth Systems Perch-Nielsen et al, 2008;McMichael et al, 2012;Roser-Renouf et al, 2016;Schwerdtle et al, 2018;Sendai Framework for Disaster Risk Reduction, 2015-2030Watts et al, 2015 Note: This table delineates the resources reviewed for climate migration, health systems, and the intersection of the two fields. There are some overlaps for resources that grappled with multiple elements.…”

“…There is also increasing physician geographic maldistribution, which further contributes to the unequal distribution of health resources across the country. Additionally, there is a shortage of primary care physicians (Hinojosa & Meléndez, 2018) with little financial incentive to pursue that career (Naylor et al, 2019). Physicians are more likely to move to urban centres in the mid-Atlantic and northeast.…”

Prediction of hospital visits for the general inpatient care using floating catchment area methods: a reconceptualization of spatial accessibility

“…Therefore, it is questionable if current concepts of hospital planning allow an adequate allocation of hospital resources [14]. Floating Catchment Area (FCA) methods (as a special case of a gravity model) could improve this allocation process since they integrate both the concept of the need for health care (as suggested by the realistic theory) and a sophisticated measure of spatial accessibility [17][18][19]. Delamater et al further showed that FCA methods can provide predictions of patient utilization patterns [20].…”

Spatial Accessibility to Primary Care in Dual Public-Private Health System in Malaysia: A Case Study in Rural Selangor

“…This study also only use xed catchment size of 30 minutes, regardless of type of clinic although bigger clinic should theoretically have bigger catchment size or service coverage [54,72]. Therefore the use of multiple catchment sizes depending on type of clinic or different types of rural areas also could further improve the precision of the E2SFCA measure, especially for a national-level or a larger scale study [32,73]. This study also demonstrates the practicability of data integration, bene ting from multiple databases that routinely collected by the government agencies.…”