Temporal influences on accessibility to healthcare, using the example of pediatricians in Bavaria, Germany

Accessibility to healthcare is shaped by spatial and temporal dynamics. This paper develops a framework that explicitly considers temporal variability across micro- (daily routines), meso- (seasonal fluctuations), and macro-scales (demographic and structural changes). Using pediatric outpatient care in Southern Germany as a case, we examine how these temporal factors interact with regional disparities in service provision. A mixed-methods research design combined telephone surveys of pediatric practices, GIS modeling, and a household survey. Results reveal marked meso-scale fluctuations: average practice utilization increased from 98 % in summer to 115 % in winter, with up to one third of practices being temporarily unable to admit new patients. Correspondingly, travel times increased during winter, particularly in peripheral areas where the loss of a single provider substantially reduced accessibility. On the macro-scale, the number of pediatricians has grown only modestly despite a rising population at risk. At the same time the proportion of providers aged 55 and older increased significantly in less urbanized areas, signaling future long-term shortages. From the family perspective, around 20 % of the respondents reported being unable to consult their preferred pediatrician, most often due to admission stops. Younger cohorts' parents are more affected. We thus conclude that accessibility is highly sensitive to temporal variability. Static planning approaches thus risk underestimating barriers to care. Integrating time scales into healthcare planning is essential to ensure equitable and sustainable access to outpatient services. Addressing these temporal dynamics in policy and planning helps reduce regional inequalities and strengthen resilience in healthcare provision.