Geography of Health Care Access: Measurement, Analyses and Integration

This dissertation addresses the geography of healthcare access and disparity issues in the United States using geospatial methods. Disparities in access to quality healthcare services are of great concern in the field of both public health and geography. Access is a key element within the healthcare delivery system, influenced by both spatial factors and non-spatial factors. Focusing on the spatial dimensions of access, an innovative contribution of this dissertation is the integration of spatial modeling, geo-statistics and location problems in a Geographic Information System (GIS) environment to investigate healthcare access.

Improving health access begins with developing reliable methods to measure accessibility. In health geography and social sciences literature, the term spatial accessibility is used to refer to the fusion of both availability and accessibility of health demand and supply. Thus, a major focus of this dissertation is to present an alternative set of healthcare accessibility measures – a network-based health accessibility index method (NHAIM) to measure accessibility and identify underserved areas. Another focus of this dissertation is to understand neighborhood factors that contribute to healthcare access – both potential and revealed access through statistical analysis. Studies have shown that social and physical environments affect individual’s health status, yet less has been done on whether neighborhood factor influence health access. A final focus of this dissertation is to propose a planning method - a Network-based Covering Location Problem (Net-CLP) to locate healthcare facilities so as to maximize service coverage while reducing spatial disparity between healthcare supply and demand in a sustainable manner. As mentioned above, spatial accessibility relies on the geographical interactions between healthcare facilities and population in need, therefore the facility location is essential in ensuring access.

In summary, this dissertation aims to achieve following three goals: 1) develop a reliable method to measure health care accessibility and capture underserved areas; 2) investigate neighborhood factors and health care access; 3) propose a feasible planning method to locate health care facilities and improve overall access.