Potential Hospital Care Accessibility Scores: Association with Healthcare Utilization and Non-Hospital Care Service Accessibility

Abstract

Background: Optimal healthcare access improves people's health status and decreases health inequalities. Many studies demonstrated spatial access importance in health outcomes. Recent studies assessed spatial healthcare access using the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to build a hospital facility access indicator at a fine geographic scale and to determine whether there is a complementarity between non-hospital and hospital care accessibility by investigating the length of hospital stays (LOS). Methods: This study focused on the ≥75-year-old population of the Nord administrative region of France. Hospital spatial accessibility was computed with the E2SFCA method, and then the LOS score was calculated from the French national hospital activity and patient discharge database. Linear regression models were used to analyze the relationship between LOS and spatial accessibility to hospital-based care and to the three types of non-hospital care services (general practitioners, physiotherapists, and home-visiting nurses). Results: Overall, there were 19.0 beds in Medical, Surgical and Obstetrics (MCO) facilities and 5.58 beds in Postoperative and Rehabilitation Care facilities (SSR) per 10,000 inhabitants, but with important geographic variations. Accessibility to hospital services was higher for people in large urban areas, despite the dense population and the higher demand. In 2014, the mean LOS scores were 0.26 for MCO and 0.85 for SSR, with a non-homogeneous geographical repartition. Linear regression analysis revealed a strong negative and significant association between hospital and non-hospital care accessibility.Conclusions: This is the first study to measure spatial accessibility to hospital-based cares in France using the E2SFCA method, and the first to investigate the relationship between spatial accessibility to hospital-based care facilities and three types of non-hospital care services and healthcare utilization (LOS). Our findings should help to take decisions about deploying additional beds and to identify the best locations for non-hospital care services. Moreover, they should also help to improve access, and to ensure the best coordination and sustainability of inpatient and outpatient services, in order to better cover the population’s healthcare needs. Other international studies using multiple consensual indicators of healthcare outcomes and accessibility and sophisticated modeling methods should be developed.

Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization

“…Based on the enhanced two-step floating catchment area (E2SFCA) method, ISA takes into account the number of beds in Medical, Surgical and Obstetrics facilities (Médecine, Chirurgie, Obstétrique: MCO) and Postoperative and Rehabilitation Care facilities (Soins de Suite et de Réadaptation: SSR) facilities, the car travel time, and the population distribution. ISA construction steps have been previously described [83,86]. It is a special form of physician-to-population ratio, expressed as the number (N) of beds per 10,000 inhabitants.…”