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Population need and geographical access to general practitioners in rural New Zealand
1Department of Geography, University of Waikato, Hamilton, New Zealand. larsb@waikato.ac.nz
Aims:
To use a geographical information system (GIS) approach to demonstrate the extent to which different areas in New Zealand vary in their geographical access to GPs, and to analyse the extent to which spatial access varies in relation to different population groups.
Methods:
Three methods; population/GP ratios, least cost path analysis (LCPA), and an allocation method (which considered the capacity constraint of GPs) were used to demonstrate differences in geographic accessibility to GPs. Travel time, and distance to the closest GP, was calculated for every census enumeration district in New Zealand (n=38336)--thus enabling population-based accessibility statistics to be calculated and aggregated to the territorial local authority level. These calculations include the average travel time if everybody visited a GP once and the population more than 30 minutes from a GP. The composition of this population is analysed according to three criteria of need: the level of deprivation (NZDep2001), ethnicity (%Maori), and age (% <5 years, and %65 years and over).
Results:
There are significant regional variations in geographical accessibility in New Zealand, and these differences are dependent upon the method to calculate accessibility. Ratio measures give a different picture of GP access than the other two indicators, reflecting the fact that TAs with similar ratios often have wide variations in travel times as well as the size and proportion of the population living more than 30 minutes from the closest GP. TAs with larger numbers and a higher proportion of their populations living in such areas tend to be more deprived and have a higher proportion of Maori, especially in the North Island. There appears to be no significant trend by age.
Conclusion:
Given the health and service consequences of poor access, the results suggest that more attention needs to be paid to extending the spatial information base in primary care, in order to achieve more effective planning of services for disadvantaged populations.
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