درک تغییر زمانی در دسترسی فضایی به مراقبت های بهداشتی: یک چارچوب تحلیلی برای اثرات عوامل محلی

Population demand, health service supply, and the linkages between them (e.g., transport infrastructure) are important factors that determine spatial accessibility to healthcare at a place. These three factors vary differently over time and location, leading to temporal changes and spatial disparities in access to healthcare. Few analytic methods have been developed to measure local impacts of these factors on healthcare accessibility over time, which are essential to alleviating health disparities and evaluating intervention programs. We propose a spatially explicit analytic framework to measure local factor impacts over time by adopting a chain substitution method from economics. The analysis is illustrated by a case study of spatial accessibility to physicians in Florida, USA, from 1990 to 2010. For each census block group, the results show the impact of local population change, physician relocation, and road-network expansion on the loss and gain of healthcare accessibility over time. The leading impact factor are identified for each census block group through comparison, and spatial clusters of factor impacts are discovered. To the literature of healthcare accessibility, this article presents a promising start of factor impact analysis and offers new perspectives in exploring spatial processes underlying people's access to healthcare.