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Accessibility of health services - transporting people and services


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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.

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Accessibility of health services - transporting people and services

  1. 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. 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. 11.11.2019 2
  3. 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 11.11.2019 3 Transit line
  4. 4. Car and public transport routing 11.11.2019 4 • 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. 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). 11.11.2019 5
  6. 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. 11.11.2019 6
  7. 7. Accessibility by bus and car In Greater Oulu region and Northern Ostrobothnia 11.11.2019 7
  8. 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. 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 11.11.2019 9
  10. 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 11.11.2019 10
  11. 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 11.11.2019 11
  12. 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 11.11.2019 12 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● R = 1 8 R = 1 8 + 2 8 = 3 8 R = 1 4 = 2 8 ● Population point Service point
  13. 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 11.11.2019 13 weightweight distance distance threshold 1 0 threshold 1 0
  14. 14. 11.11.2019 14
  15. 15. 11.11.2019 1511.11.2019 15 Tiina Huotari PhD student University of Oulu Geography research unit Tiina Lankila Post-doctoral researcher University of Oulu Geography research unit