The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice

Abstract

Background Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature. Methods A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures. Results Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%). Conclusion This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.

A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia

“…Distance to services is a significant barrier to accessing healthcare. Wood et al [ 91 ] in a systematic review, identified that there is a lack of research which measures spatial access specific to mental health services in Australia, and highlighted a need for consensus on what is reasonable access to healthcare services. Further, reports have noted that while distance alone is a significant barrier to accessing healthcare, accommodation may sometimes need to be sought depending on the time of the appointment, adding to the cost of attending the appointment [ 92 ] and further perpetuating the resource issues experienced by those living in rural areas of Australia.…”

Advancing Urban Healthcare Equity Analysis: Integrating Public Participation GIS with Fuzzy Best–Worst Decision-Making

“…Health inequalities are an important challenge at the global level and require substantial investment in different regions. In order to identify geographic areas in terms of the health status of citizens, knowledge is needed in the decision-making and implementation of health policies in order to address the situation of inequalities, spatial measures, and coherent spatial classifications [1]. Accessibility to health centres and hospitals (HCHs), as defined by the World Health Organization (WHO), refers to the provision of health services that are easily and reasonably available to all segments of both urban and rural populations, with a particular focus on marginalised and underserved groups.…”

Regional access to a centralized extracorporeal membrane oxygenation (ECMO) service in Victoria, Australia

“…Equity of community access to centralised low-volume highly specialised healthcare services is desirable but complex to achieve and can be measured in a variety of ways. 1 Investigation of geographical and socioeconomic factors on access to healthcare services and resultant outcomes within Australia have demonstrated mixed results, often disproportionately affecting rural residents. [2] , [3] , [4] , [5] , [6] Extracorporeal membrane oxygenation (ECMO) is a form of advanced mechanical organ support for refractory cardio-respiratory failure.…”

“…There are several well-described statistical methods to evaluate geographic access to, and utilisation of health services. 1 , 16 , 17 Choropleth maps are a common method of visually displaying data trends across a geographic region. 18 Spatial autoregression models permit analysis of geographical factors when healthcare access is subject to spatial lag, where an outcome variable in a location is influenced by both it and its neighbours’ independent and dependent variables.…”