Deprivation, Healthcare Accessibility and Satisfaction: Geographical Context and Scale Implications

Abstract

Indices explaining health phenomena are important tools for identifying and investigating health inequalities and to support policy making. Some of these indices are expressed at area-level, and the investigation of the areal influences of these indices on individual health outcomes have scale and geographical contextual implications that need to be assessed. In this study we calculated two area-level indices: one deprivation index and one index of healthcare accessibility. Using multilevel modelling, we calculated the area-level influences of these indices on an individual-level index of healthcare satisfaction considering three kinds of areas or contexts: a context of deprivation, a context of healthcare accessibility and a context combining the two characteristics of healthcare accessibility and deprivation. We evaluated two kinds of geographical problems using the statistical results of these area-level influences: the modifiable areal unit problem (MAUP) and the uncertain geographic context problem (UGCoP). Regarding the MAUP we evaluated the scale effects at two scales: census blocks and census tracts. Regarding the UGCoP we evaluated the differences in areal influences between the three kinds of contexts for both scales. The case study area was the city of Quito, Ecuador. The results of the performed analyses showed no severe MAUP and UGCoP, and revealed important evidence of the area-level influence of deprivation and healthcare accessibility on healthcare satisfaction.

Influence of Urban Multi-Criteria Deprivation and Spatial Accessibility to Healthcare on Self-Reported Health

“…The multi-criteria deprivation index for the city of Quito draws on the judgments of 13 experts of the fields of geography, health, and urban studies. The consistency of the experts' judgments has been verified by a consistency ratio lower than 0.10 [25,32]. The detailed methodology used to construct the deprivation index is explained in the study published by Cabrera-Barona, Blaschke and Gaona [25].…”

“…The consistency of the experts' judgments has been verified by a consistency ratio lower than 0.10 [25,32]. The detailed methodology used to construct the deprivation index is explained in the study published by Cabrera-Barona, Blaschke and Gaona [25]. The ten indicators used to construct the deprivation index and their corresponding AHP-based weights are shown in Table 1.…”

“…Located in the Andes, Quito is the capital city of Ecuador and is home to more than 1.5 million inhabitants. The indices of multi-criteria deprivation and healthcare accessibility adapted to the city of Quito were used in the present study [25]. These indices draw on data from the 2010 population and housing census and the locations of primary healthcare services.…”

“…The multi-criteria deprivation index for the city of Quito was used in this study [25]. The index was calculated in each census block in the study area.…”

“…The measure of spatial accessibility to healthcare proposed by Cabrera-Barona, Blaschke, and Gaona [25] was applied in this study. This measure was developed to identify inequalities of healthcare accessibility in accessing primary healthcare services at different scales, and has been related to the multi-criteria deprivation index for the city of Quito to evaluate healthcare satisfaction.…”