Spatial Accessibility
2023-12-14
Healthcare Access Measurement Review: Gravity models for potential spatial healthcare access measurement: a systematic methodological review
Gravity models for measuring potential spatial healthcare access are dominated by the two-step floating catchment area (2SFCA) family of methods, with methodological developments showing increasing complexity while research practice largely favors simpler models.
Abstract:
Background: Quantifying spatial access to care—the interplay of accessibility and availability—is vital for healthcare planning and understanding implications of services (mal-)distribution. A plethora of methods aims to measure potential spatial access to healthcare services. The current study conducts a systematic review to identify and assess gravity model-type methods for spatial healthcare access measurement and to summarize the use of these measures in empirical research.
Methods: A two-step approach was used to identify (1) methodological studies that presented a novel gravity model for measuring spatial access to healthcare and (2) empirical studies that applied one of these methods in a healthcare context. The review was conducted according to the PRISMA guidelines. EMBASE, CINAHL, Web of Science, and Scopus were searched in the first step. Forward citation search was used in the second step.
Results: We identified 43 studies presenting a methodological development and 346 empirical application cases of those methods in 309 studies. Two major conceptual developments emerged: The Two-Step Floating Catchment Area (2SFCA) method and the Kernel Density (KD) method. Virtually all other methodological developments evolved from the 2SFCA method, forming the 2SFCA method family. Novel methodologies within the 2SFCA family introduced developments regarding distance decay within the catchment area, variable catchment area sizes, outcome unit, provider competition, local and global distance decay, subgroup-specific access, multiple transportation modes, and time-dependent access. Methodological developments aimed to either approximate reality, fit a specific context, or correct methodology. Empirical studies almost exclusively applied methods from the 2SFCA family while other gravity model types were applied rarely. Distance decay within catchment areas was frequently implemented in application studies, however, the initial 2SFCA method remains common in empirical research. Most empirical studies used the spatial access measure for descriptive purposes. Increasingly, gravity model measures also served as potential explanatory factor for health outcomes.
Conclusions: Gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods—both for methodological developments and applications in empirical research. While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.
Summary:
- The study aims to identify and assess gravity model-type methods for spatial healthcare access measurement and summarize the use of these measures in empirical research.
- The study was conducted in two stages:
- In the first stage, methodological studies presenting novel developments of potential spatial healthcare access measurement were identified, categorized by methodological properties, and assessed by purpose, complexity, and data requirements.
- In the second stage, empirical studies applying one of these methods in the healthcare context were summarized and characterized, illustrating the degree to which the methodological developments are applied in research practice.
- A total of 43 studies that proposed a methodological development in the field of gravity models for measuring spatial access to healthcare were identified.
- Two major conceptual developments emerged: the two-step floating catchment area (2SFCA) method and the Kernel Density method.
- Virtually all methodological developments since 2004 were based on the 2SFCA method.
- The study also identified a plethora of methodological developments within the 2SFCA family, which were classified into novelty categories based on intuition, the first study introducing the development, following adaptations, purpose, methodological complexity, and data requirements.
- The study also found that gravity models for measuring potential spatial healthcare access are almost exclusively dominated by the family of 2SFCA methods—both for methodological developments and applications in empirical research.
- While methodological developments incorporate increasing methodological complexity, research practice largely applies gravity models with straightforward intuition and moderate data and computational requirements.
Study questions and answers:
| Question | Answer |
|---|---|
| What is the purpose of the study? | To identify and assess gravity model-type methods for spatial healthcare access measurement and summarize the use of these measures in empirical research. |
| How many studies were identified that proposed a methodological development in the field of gravity models for measuring spatial access to healthcare? | 43 |
| What are the two major conceptual developments that emerged? | The two-step floating catchment area (2SFCA) method and the Kernel Density method. |
| What is the most common methodological development since 2004? | The 2SFCA method. |
| How many methodological developments were identified within the 2SFCA family? | A plethora |
| How were the methodological developments classified? | By intuition, the first study introducing the development, following adaptations, purpose, methodological complexity, and data requirements. |
| What is the dominant family of methods for measuring potential spatial healthcare access? | The 2SFCA family of methods. |
| What is the trend in methodological complexity? | Increasing. |
| What is the trend in research practice? | Applying gravity models with straightforward intuition and moderate data and computational requirements. |