Access to Neurosurgery for Patients in Germany-Strategic Considerations Based on Geographic Information Mapping

Background/Objectives: To estimate, against the background of the upcoming German healthcare reform, current access to neurosurgery for patients in Germany, and to derive improvement strategies from geographic information mapping. Methods: We defined access to neurosurgery on a geographical basis as the sum of all points from which one can reach a neurosurgical department within 40 min by car (A2N40). We identified 182 departments of neurosurgery, and we retrieved population numbers and geodetic information from open sources. We processed data and conducted statistical analyses in R. Results: Population density and A2N40 per square kilometer were significantly positively correlated (Spearman's rho = 0.82, p = 0.0001). Population density is significantly lower (Wilcoxon rank sum test, p = 0.009) and A2N40 per square kilometer is significantly worse (Wilcoxon rank sum test, p = 0.005) in the new federal states (without Berlin) as compared to the rest of the country. Geographic information mapping yielded 3 distinct improvement strategies. Conclusions: In Germany, population density and A2N40 per square kilometer are significantly positively correlated, with significantly less A2N40 per square kilometer in the new federal states. Geographic mapping may inform tailored regional improvement policies.