Revealed versus potential spatial accessibility of healthcare and changing patterns during the COVID-19 pandemic

Kristina Gligorić · Chaitanya Kamath · Daniel J. Weiss · Shailesh Bavadekar · Yun Liu · Tomer Shekel +2 more

28 citations0/0 files storedCommunications Medicine

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Urban Transport and Accessibility Public Health and Social Inequalities Human Mobility and Location-Based Analysis

Abstract

BACKGROUND: Timely access to healthcare is essential but measuring access is challenging. Prior research focused on analyzing potential travel times to healthcare under optimal mobility scenarios that do not incorporate direct observations of human mobility, potentially underestimating the barriers to receiving care for many populations. METHODS: We introduce an approach for measuring accessibility by utilizing travel times to healthcare facilities from aggregated and anonymized smartphone Location History data. We measure these revealed travel times to healthcare facilities in over 100 countries and juxtapose our findings with potential (optimal) travel times estimated using Google Maps directions. We then quantify changes in revealed accessibility associated with the COVID-19 pandemic. RESULTS: We find that revealed travel time differs substantially from potential travel time; in all but 4 countries this difference exceeds 30 minutes, and in 49 countries it exceeds 60 minutes. Substantial variation in revealed healthcare accessibility is observed and correlates with life expectancy (⍴=-0.70) and infant mortality (⍴=0.59), with this association remaining significant after adjusting for potential accessibility and wealth. The COVID-19 pandemic altered the patterns of healthcare access, especially for populations dependent on public transportation. CONCLUSIONS: Our metrics based on empirical data indicate that revealed travel times exceed potential travel times in many regions. During COVID-19, inequitable accessibility was exacerbated. In conjunction with other relevant data, these findings provide a resource to help public health policymakers identify underserved populations and promote health equity by formulating policies and directing resources towards areas and populations most in need.

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References

2006Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups 2013Traveling Towards Disease: Transportation Barriers to Health Care Access 2009An enhanced two-step floating catchment area (E2SFCA) method for measuring spatial accessibility to primary care physicians 2018A global map of travel time to cities to assess inequalities in accessibility in 2015 2015Accessibility, equity and health care: review and research directions for transport geographers 2016Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review 2021Lifestyle and mental health disruptions during COVID-19 1997Inequality, Income Growth, and Mobility: The Basic Facts

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2024Measuring geographic access to emergency obstetric care: a comparison of travel time estimates modelled using Google Maps Directions API and AccessMod in three Nigerian conurbations

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