Measuring Accessibility to Primary Health Care Across the Urban-rural Continuum in the Province of Alberta

Abstract

The proper estimation of accessibility is necessary to understand the issue of the urban-rural divide in access health care. The main concern with the previously developed accessibility measures is that the urban-rural continuum is treated as a dichotomous variable, while many degrees of rurality exist. While many studies attempted to include a distance decay function to address local travel patterns, it is usually arbitrary and may not exactly reflect the reality. This project is an attempt to improve the current methodology and make it more suitable for provincial settings that include various degrees of rurality. The past records of health care utilization are analyzed and distance decay coefficients are extracted for each type of urban and rural area. These coefficients are used to enhance a commonly used two-step floating catchment area (2SFCA) method to estimate accessibility scores. In addition, health needs and mobility measures are added to the model. The result of this enhanced methodology is compared to other methods where distance decay is used. The proposed method consistently shows better and more accurate results. The alternative methods often underestimate accessibility, especially in remote areas. The distance decay function derived from actual utilization data also allows use of this approach for large areas such as a Canadian province.

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