Spatial Accessibility and Social Inclusion: The Impact of Portugal's Last Health Reform

Area of Science:

• Health Services Research
• Spatial Analysis
• Public Health Policy

Background:

• Health policies aim for equitable geographical access, but fixed facility locations can exacerbate inequalities.
• Vulnerable populations often face significant barriers to healthcare access due to service dispersal.
• Geographic Information Systems (GIS) offer potential for evaluating spatial accessibility in health planning.

Purpose of the Study:

• To evaluate the impact of health facility distribution on population accessibility using network analysis.
• To demonstrate the utility of spatial accessibility measures in health system planning and policy.
• To compare different scenarios for optimizing health facility locations in mainland Portugal.

Main Methods:

• Utilized network analysis within Geographic Information Systems (GIS) for spatial accessibility evaluation.
• Applied an enhanced two-step floating catchment area (E2SFCA) method integrating network data.
• Developed and analyzed various distribution scenarios for health facilities in mainland Portugal.

Main Results:

• Optimal health facility distribution can significantly improve population accessibility and mitigate social exclusion.
• The study identified decreased accessibility levels, particularly for disadvantaged groups, following a recent healthcare reform in Portugal.
• A 12-minute increase in travel time was observed for the most disadvantaged populations between 2001 and 2011.

Conclusions:

• Spatial accessibility measures are essential decision-making tools for effective health system planning.
• Integrating network data into accessibility measures enhances their accuracy and utility.
• Current health policies, like Portugal's emergency network reform, require careful evaluation to ensure equitable access for all demographic groups.