IMPRO:n järjestämässä Paikkatieto sote-uudistuksen tukena -seminaarissa 8.10.2019 Helsingin yliopistolla Oulun yliopiston Tiina Lankila ja Tiina Huotari esittelivät tuloksiaan terveydenhuollon saavutettavuus -tutkimuksistaan. Esityksessä keskityttiin erityisesti palveluiden mobiliteettiin sekä asiakkaiden liikkumiseen.

1. 11.11.2019 1
Accessibility of health services -
transporting people and services
Tiina Huotari & Tiina Lankila
Geography Research Unit
University of Oulu
11.11.2019 1

2. Transporting people – The background
(Ossi Kotavaara, Aleksi Nivala, Tiina Huotari, Tiina Lankila & Harri Antikainen)
• Adequate and equal access to services is one key factor for good-quality services.
• Local primary health services, how can they be accessed by car and by public
transport.
• Multimodal accessibility of services.
• Study area covers whole Finland, though public transport areas do not extend
everywhere.
- Car accessibility, whole Finland.
- Local and regional public transport accessibility, covers over 85 % of the population.
• Depending on the health service type different part of population can be studied, e.g.
the whole population, the elderly, families with childen.
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3. Data of public transport: open GTFS data
• Data about local and regional public transport in Finland
(commercial long distance transport not included).
• Final network datasets consists of data of 29 most
populous city regions, publicly supported regional transit
and regional bus companies who had made their GTFS
data public.
- Helsinki, Tampere, Oulu, Turku, Jyväskylä, Lahti and Kuopio
- Hämeenlinna, Joensuu, Jyväskylä, Kajaani, Kotka, Kouvola,
Kuopio, Lahti, Lappeenranta, Mikkeli, Oulu, Rovaniemi and
Vaasa
- Three regional government agencies (Centres for Economic
Development, Transport and the Environment of Central
Finland, Northern Ostrobothnia and Northern Savonia)
- Southwest Finland and Southern Ostrobothnia
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Transit line

4. Car and public transport routing
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• Digiroad
- Regional and local main streets, collector
and feeder streets and private roads
allowed for public use.
- Travel speed estimates were formulated on
the basis of the speed limit data.
• General Transit Feed Specification (GTFS) of
public transports
- Scheduled public transport connections
- Travel chains
- 4 km/h applied for walking
• Turn penalties / urban delay rates

5. Population and health services
• Population in 250x250m YKR (Monitoring system of
spatial structure and urban form) statistical grids.
• Travel chains consists of walking from home to the bus
stop, traveling with bus and walking from the bus stop to
the health care facility.
→ 1 kilometer cutoff was set for walking distance from home.
→ Maximum distance of 3 kilometers from service was used
when assessing whether walking or using the public transport
connection results in quicker access.
• Location of municipal health centres that offer doctoral
treatment (530), municipal dentists (740), municipal
maternity and child health clinics (772), pharmacies (808).
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6. Car and public transport accessibility of services
• Potential public transport users are routed from home
locations to closest service locations via the fastest
available transit connections within a defined time period.
• Car users are routed via Digiroad road network.
• Combination of tools in ArcGIS Network Analyst and
Python are used.
• Analysis is done with whole population, but different
population subgroups will also be studied.
- Elderly, households with children, households with/without
car.
→ Car and public transport accessibility of services among
different population groups, and in different areas.
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7. Accessibility by bus and car
In Greater Oulu region and Northern Ostrobothnia
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8. 11.11.2019 8
Ageing and equity of care:
Balance of supply and demand of home care
services of elderly people in peripheral areas
Tiina Huotari, Harri Antikainen, Tiina Lankila
11.11.2019 8

9. Background of the study
• In Kainuu region population structure differs from Finnish average
- The share of population of 65 years and older is higher and the amount of working age and
children is lower than average
• Kainuu region is sparsely populated (3.6 persons / km²) even when compared to
Finnish average (18.2 persons / km²)
- Sets a challenge to organize any health care services efficiently
• Pilot area of the project
• Because of willingness to stay at home and the high cost of institutional care, it is
reasonable to provide an efficient home care system to ensure safe living for the elderly
• Higher level planning
- Currently route optimization of home care services is done separately in each municipality
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10. Accessibility of primary health care in Kainuu
• There are differences in health
centers accessibility between age
groups
• Population of ≥ 75 years old lives
closer to centers in Kainuu region
• Population of ≥ 75 years old also
uses home care services more
often than population of 65–74
years old
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11. Data
• Locations of home care
service units
- Number of personnel in
each service facility
providing home care
services
• Grid data of the elderly
- Population of ≥ 75 years
old
- 18.37 percent of the ≥ 75
years old use home care
services on a regular basis
• Street and road network
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12. ●
Two-step floating catchment area (2SFCA)
• Commonly used to assess the balance of supply and
demand of health care services
• In the first step, provider-to-population ratios are
calculated for the supply locations as the ratio of the
number of service providers (e.g. physicians) to their
surrounding population within a threshold travel time or
distance
• In the second step, the provider-to-population ratios
are summed up around each demand location (e.g.
residential location) within the same threshold
time/distance as in the first step
- The perspective of service users
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● ●
●
● ● ● ●
● ● ●
● ●
●
●
●
●
●
●
R =
1
8
R =
1
8
+
2
8
=
3
8
R =
1
4
=
2
8
● Population point
Service point

13. Catchments used in 2SFCA
• ”Traditional” 2SFCA: binary 0/1 catchment
• ”Enhanced” 2SFCA (E2SFCA): uses
distance decay within catchments
- The willingness or capability of accessing
the service gradually diminishes as
distance increases
- In our study, distance decay might
represent the increasing difficulty of
delivering service to clients living far away
from the ”depot” location
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weightweight
distance
distance
threshold
1
0
threshold
1
0

14. 11.11.2019 14

15. 11.11.2019 1511.11.2019 15
Tiina Huotari
tiina.huotari@oulu.fi
PhD student
University of Oulu
Geography research unit
Tiina Lankila
tiina.lankila@oulu.fi
Post-doctoral researcher
University of Oulu
Geography research unit