Disparities in Geographical Access to Hospitals in Portugal

Abstract

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.

Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

“…Regional and spatial inequalities in access to healthcare services are a key issue in Portugal [2]. Nationally, large disparities between municipalities exist in distance from hospitals, with isolated communities, those with a higher share of the older population and those located closer to the border with Spain facing greater disadvantages [35].…”

“…The evolution rate between different periods was ordered in three categories to allow better understanding: (1). decreased-municipalities where the evolution between periods was below 5%; (2). remained-municipalities where the evolution between two periods was between −5% and 5%; and (3).…”

“…By promoting universal and general access and public insurance, the Portuguese National Health Service (NHS) aims to ensure equity, efficiency, and quality of health care in all services [1]. However, the current system is not achieving these objectives, particularly with respect to financial and geographic equity of access [2,3]. Progress is hampered by excessive concentration of public and private resources in urban areas, resource allocation based on outdated indicators and predominance of the curative model [4].…”

Disparities in Healthcare Services and Spatial Assessments of Mobile Health Clinics in the Border Regions of Thailand

“…Area-based measures describe the ratio of population need to available services for areas such as countries, towns, or states. Several spatial analytic techniques have been proposed for describing and examining the relationship between different layers of population need combined with predefined geographical areas such as countries, zip codes, or municipality levels and for exploring how healthcare delivery can be improved [37,38]. Provider-to-population ratios are the most popular approach and have long been used to describe geographical disparities in access to healthcare across the United States due to the straightforward computation for bordered areas combined with the indicators of health service capacity, such as the number of hospitals or physicians [39,40].…”

Assessing Health Resources Equipped with Hemodynamic Rooms in the Portuguese-Spanish Borderland: Cross-Border Cooperation Strategies as a Possible Solution

“…Equality of access to these services must be achieved between different population groups regardless of social, economic, demographic, or geographical differences that in many cases lead to inequalities in the provision of these services [2][3][4]. Mainly it must be achieved in those services that are vital, such as the health service [5,6].…”