Spatial Healthcare Access: Measurement, Health-Related Outcomes, and Healthcare Utilization

Healthcare delivery and access to health services are vital determinants of population health. Thus, a core goal of healthcare systems is to ensure access, i.e., that those in need of care are able to use health services. Access to care should be equal for the whole population, irrespective of demographic factors, socioeconomic status, and region of residence. Spatial components of healthcare access - availability (resources) and accessibility (distribution) - are particularly prone to inequalities as resources cannot be uniformly distributed within the system. The first dissertation aim is to investigate potential spatial access (healthcare resources available within reach) and its relationship with health-related outcomes. In the first paper, a comprehensive overview of methods to measure potential spatial access is presented. We conducted a systematic methodological review of gravity models, showing a predominance of two-step floating catchment area approaches both in methodological developments and empirical applications. In the second paper, the role of potential spatial access for receiving a depression diagnosis after experiencing symptoms is investigated in the German context. We found that spatial access to general practitioners and psychotherapists was not associated with the chance of getting diagnosed. In the third paper, the role of potential spatial access for subjective wellbeing around the onset of a chronic condition is investigated in the German context. We found that spatial access to general practitioners and hospitals was not associated with subjective wellbeing and did not moderate the wellbeing reduction at disease onset. These results suggest that variations in access do not translate into differences in diagnostic outcomes and wellbeing. The second dissertation aim is to investigate revealed spatial access (entry into the health system) by highlighting availability- and accessibility-related disparities in healthcare utilization. The fourth paper focuses on availability of procedures, namely waiting times for elective surgery in Austria. Our results showed that waiting times differed by health insurance status with those having supplementary health insurance waiting less, even after controlling for medical need. The fifth paper puts a focus on medication accessibility and antibiotic drug dispensing in Austria. We showed that on-site dispensing in rural general practice to improve medication accessibility was causally related to higher antibiotic drug dispensing. With these five papers, my thesis contributes to a better understanding of potential and revealed spatial access to healthcare.

Level thesis:degree_level

thesis.doctoral

Grantor dc:publisher

Universität Bielefeld

Year

2025

Author dc:creator

• Stacherl, Barbara

Repository record source_url

https://pub.uni-bielefeld.de/record/3006870

OAI identifier oai:identifier

oai:pub.uni-bielefeld.de:3006870