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Healthcare site selection assumes an imperative part in healthcare development and management. From part of the public authority, proper medical site selection will help the distribution of clinical assets, coordinating with the arrangement of medical care with the social and economic demands, organizing the metropolitan and rural healthcare administration advancement, and facilitating social logical inconsistencies. Site suitability analysis is a variety of analysis utilized in GIS to work out the simplest place or site for one thing. The main objective of the current study was to select a site for new healthcare services with geospatial technologies to intermix spatial and non-spatial data to create a weighted result. The current study had been done into three phases, where many processes are intermixed into a single phase. In the first phase of analysis, distance, density, and proximity were mapped to seek out poor and lower accessible areas of healthcare from existing healthcare. To selecting new healthcare sites, four-factor criteria (Buffer around road and rail, land use land cover and buffer around settlement,) and some constrain criteria considered in the second phase of analysis. Finally, the shortest network path analysis has been done in the third phase to determine the shortest and best route from selected healthcare sites towards district medical college. The current study presents some suitable sites in the poor and inaccessible areas of the district. This study will be very helpful for the decision support system of healthcare management in the future.

Background: Ethical medical practice requires managing health services to promote professionalism and secure accessibility to care. Commercially financed and industrially managed services strain the physicians’ clinical autonomy and ethics because the industry’s profitability depends on commercial, clinical standardisation. Private insurance companies also reduce access to care whilst fragmenting and segmenting health systems. Against this background, given the powerful, symbolic significance of their common voice, physicians’ and patients’ organisations could effectively leverage together political parties and employers’ organisations to promote policies favouring access to professional care. Main text: To provide a foundation for negotiations between physicians’ and patients’ organisations, we propose policy principles derived from an analysis of rights-holders and duty-bearers’ stakes, i.e. patients, physicians and health professionals, and taxpayers. Their concerns are scrutinised from the standpoints of public health and right to health. Illustrated with post-WWII European policies, these principles are formulated as inputs for tentative action-research. The paper also identifies potential stumbling blocks for collective doctor/patient negotiations based on the authors’ personal experience. The patients’ concerns are care accessibility, quality, and price. Those of physicians and other professionals are problem-solving capacity, autonomy, intellectual progress, ethics, work environment, and revenue. The majority of taxpayers have an interest in taxes being progressive and public spending on health regressive. Mutual aid associations tend to under-estimate the physician’s role in delivering care. Physicians’ organisations often disregard the mission of financing care and its impact on healthcare quality. Conclusion: The proposed physicians-patients’ alliance could promote policies in tune with professional ethics, prevent European policies’ putting industrial concerns above suffering and death, bar care financing from the ambit of international trade treaties, and foster international cooperation policies consistent with the principles that inspire the design of healthcare policies at home and so reduce international migration. To be credible partners in this alliance, physicians’ associations should promote a public health culture amongst their members and a team culture in healthcare services. To promote a universal health system, patients’ organisations should strive to represent universal health interests rather than those of patients with specific diseases, ethnic groups, or social classes., SCOPUS: no.j, info:eu-repo/semantics/published

International audience; We aimed to identify the contextual factors associated with participation in the organized Cervical Cancer Screening (CCS) pilot program, which includes specific interventions to reach vulnerable women, in the Greater Paris region.Study population consisted of 231,712 women aged 25–65 years, who were not up to date to their smear test and had been invited to take part in the program from July 2014 to September 2017. Using a multilevel mixed logistic regression with random effects, we investigated the effect of grassroots interventions targeting vulnerable women, healthcare provider accessibility, social environment and municipal policy-related factors.The CCS rate was two times higher in women who had received their first invitation to the program during the study period (32·9%) compared to those who were already invited before the study period (15·3%). In both populations, there were no significant trends in participation with regards to the type of grassroots interventions, level of accessibility of healthcare services or municipal commitment to healthcare. Among women invited previously and aged above 35 increased participation was seen in neighborhoods with low proportion of single women or in less deprived neighborhoods.Our results identified groups of women who participated less in the organized CCS program and suggested that additional interventions targeting the barriers faced by vulnerable women, especially those aged 35–45 years old, are needed.

The purpose of this study was to analyze the concept of the “healthcare safety net” during the COVID-19 pandemic. Walker and Avant’s process of concept analysis was used in this systematic literature review. The attributes of the concept of a healthcare safety net during the COVID-19 pandemic were found to be: (a) capacity, (b) accessibility, (c) health equality, and (d) education. In consideration of these defining criteria, antecedents to the concept were identified as: (a) the COVID-19 pandemic, (b) health inequalities (internal factors and external factors), and (c) healthcare systems (health insurance, screening, protective equipment, medicine, and medical services). Consequences of the concept were: (a) meeting healthcare needs, (b) quality of life, and (c) a decrease in morbidity and mortality. A healthcare safety net is an important concept during the COVID-19 pandemic. In situations like COVID-19, healthcare safety nets are designed to meet safety needs, improve quality of life, and reduce patient turnover and mortality. Based on the results of this study, the development of standardized tools for measuring a healthcare safety net as well as that of policies and systems for resolving a healthcare safety net in the COVID-19 situation is recommended.

The area surrounding California’s Salton Sea, which lies within Riverside and Imperial counties, has particularly negative health outcomes. Imperial County, a primarily rural region that encompasses the lake, has pediatric asthma-related emergency healthcare visits that double the state average. This paper seeks to assess the level of emergency healthcare access in the Salton Sea region of Imperial County, drawing from spatial science methods. For this study, the "Salton Sea region" is defined as all Imperial County census tracts that include the Salton Sea within its boundaries. To measure "access," this study calculated driving travel times from census tracts to hospitals within Imperial County rather than Euclidean distance to account for geography and urban infrastructures such as road networks and traffic conditions. This study also used the Rational Agent Access Model, or RAAM, to assess access. RAAM scores account for the supply and demand for hospitals in addition to travel times. Results showed that the average travel time for Salton Sea region residents to drive to Imperial County emergency healthcare facilities ranged from 50–61 minutes, compared to 14–20 minutes for other Imperial County tracts. RAAM scores, compared to other Imperial County tracts, were about 30% higher in the Salton Sea region, meaning that healthcare supply is limited in the region. State and county policy should account for spatial inaccessibility to healthcare institutions in order to address emergency healthcare access.

Background Access to healthcare services has major implications for vulnerable populations’ health. Socio-cultural and gender characteristics shape the utilization and access of healthcare services among ethnic minorities worldwide. One such vulnerable ethnic minority is the Arab Bedouin women in Israel. As women, they are marginalized in their community, where women do not have full equity and they experience multiple barriers to healthcare services The main objective of this study is to provide a nuanced, experiential, emic description of healthcare accessibility issues among Bedouin women in Israel. Identifying the barriers, they face in accessing healthcare may help healthcare policymakers make changes based on and tailored to Bedouin women’s needs. Methods A qualitative study included in-depth semi-structured interviews with 21 Arab Bedouin village residents, consisting of 14 women and 7 men. Eligible participants were Arab Bedouins over 18 years of age and who used healthcare services at least once in the last 5 years. The interviews were carried out in Arabic-Bedouin dialect and included demographic questions, open-ended questions that asked about participants’ perceptions regarding their experiences with healthcare services, including the factors that helped and hindered them in accessing these services and questions regarding suggestions for improving the accessibility of healthcare services based on the identified needs. Data collected were analyzed using thematic analysis. Study trustworthiness was ensured using audit, reflexivity, and peer debriefing. Results Arab Bedouin women experienced varied barriers while accessing healthcare services. This study uncovered how language, cultural and gender barriers intersect with other disadvantages ingrained in social norms, values and beliefs and affect the access of a minority women subgroup to healthcare services. The participants identified subgroups of Bedouin women (e.g. elderly Bedouin women) affected differently by these barriers. Conclusion Taking into consideration the identified needs and the Arab Bedouin women’s unique characteristics, along with adopting the intersectional approach should help improve access to healthcare services among such a vulnerable subgroup and other subgroups within minorities worldwide.

Background With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes. Methods Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services. Results Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other. Conclusion While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.

Quantitative data on geographical accessibility to healthcare remain generally limited in sub-Saharan Africa. This study sought to generate quantitative evidence regarding health care access in the Ashanti region of Ghana. Dasymetric mapping technique and GIS tools were used to estimate the total population living within the World Health Organization (WHO)'s recommended 5 km distance to the nearest health facility. An estimated 81.4% of the population had access to general primary health care, 61.4% to secondary-level health care and, only 14.3% to tertiary health care. Despite the high levels of accessibility to general primary health care, accessibility remains poor in some selected districts, especially rural districts in the region. About 30% of the population are more likely to have to travel long distances to access healthcare, particularly specialist services which are available only at secondary and tertiary centres. There is the need for intensified efforts to address inequities in geographic accessibility to healthcare so as to minimise inequalities in health outcomes as well as achieve the desired improvements in population health.

The objective of this review is to document contemporary barriers to accessing healthcare faced by Indigenous people of Canada and approaches taken to mitigate these concerns. A narrative review of the literature was conducted. Barriers to healthcare access and mitigating strategies were aligned into three categories: proximal, intermediate, and distal barriers. Proximal barriers include geography, education attainment, and negative bias among healthcare professionals resulting in a lack of or inadequate immediate care in Indigenous communities. Intermediate barriers comprise of employment and income inequities and health education systems that are not accessible to Indigenous people. Distal barriers include colonialism, racism and social exclusion, resulting in limited involvement of Indigenous people in policy making and planning to address community healthcare needs. Several mitigation strategies initiated across Canada to address the inequitable health concerns include allocation of financial support for infrastructure development in Indigenous communities, increases in Indigenous education and employment, development of culturally sensitive education and medical systems and involvement of Indigenous communities and elders in the policy-making system. Indigenous people in Canada face systemic/policy barriers to equitable healthcare access. Addressing these barriers by strengthening services and building capacity within communities while integrating input from Indigenous communities is essential to improve accessibility.

Background: The lesbian, gay, bisexual and transgender (LGBT) populations have unique health risks including an increased risk of mental health problems, high usage of recreational drugs and alcohol, and high rates of infection with human immunodeficiency virus (HIV). Healthcare workers’ heteronormative attitudes compromise the quality of care to the LGBT population. Aim: The objective of this study was to provide an overview of documented evidence on South Africa interventions aimed at improving healthcare access for LGBT individuals using a systematic scoping review. Setting: This is a secondary literature review. Methods: An electronic search was conducted using the following databases: EBSCOhost, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Abstract and full article data were screened using inclusion and exclusion criteria by two researchers. Data extracted from the eligible studies were analysed using thematic analysis. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool, version 2011. Results: Seventeen articles of the initial 151 hits were selected for review and an additional five files were identified through bibliographical search. Most studies had small sample sizes and focused on sexual health, targeting gay men and men who have sex with men in urban areas. Lesbians and bisexual women were not prioritised. Discussion: It emerged from the review that LGBT issues were not covered in the healthcare worker curriculum. Further it was noted that there is a paucity of data on the South African LGBT population, as sexual orientation does not form part of the routine data set. The findings of this review indicate gaps in the literature, practice guidelines and policies in LGBT healthcare in South Africa.

Accessibility is a major method for evaluating the distribution of service facilities and identifying areas in shortage of service. Traditional accessibility methods, however, are largely model-based and do not consider the actual utilization of services, which may lead to results that are different from those obtained when people&rsquo, s actual behaviors are taken into account. Based on taxi GPS trajectory data, this paper proposed a novel integrated catchment area (ICA) that integrates actual human travel behavior to evaluate the accessibility to healthcare facilities in Shenzhen, China, using the enhanced two-step floating catchment area (E2SFCA) method. This method is called the E2SFCA-ICA method. First, access probability is proposed to depict the probability of visiting a healthcare facility. Then, integrated access probability (IAP), which integrates model-based access probability (MAP) and data-based access probability (DAP), is presented. Under the constraint of IAP, ICA is generated and divided into distinct subzones. Finally, the ICA and subzones are incorporated into the E2SFCA method to evaluate the accessibility of the top-tier hospitals in Shenzhen, China. The results show that the ICA not only reduces the differences between model-based catchment areas and data-based catchment areas, but also distinguishes the core catchment area, stable catchment area, uncertain catchment area and remote catchment area of healthcare facilities. The study also found that the accessibility of Shenzhen&rsquo, s top-tier hospitals obtained with traditional catchment areas tends to be overestimated and more unequally distributed in space when compared to the accessibility obtained with integrated catchment areas.

Background Shenzhen has rapidly grown into a megacity in the recent decades. It is a challenging task for the Shenzhen government to provide sufficient healthcare services. The spatial configuration of healthcare services can influence the convenience for the consumers to obtain healthcare services. Spatial accessibility has been widely adopted as a scientific measurement for evaluating the rationality of the spatial configuration of healthcare services. Methods The multi-modal two-step floating catchment area (2SFCA) method is an important advance in the field of healthcare accessibility modelling, which enables the simultaneous assessment of spatial accessibility via multiple transport modes. This study further develops the multi-modal 2SFCA method by introducing online map APIs to improve the estimation of travel time by public transit or by car respectively. Results As the results show, the distribution of healthcare accessibility by multi-modal 2SFCA shows significant spatial disparity. Moreover, by dividing the multi-modal accessibility into car-mode and transit-mode accessibility, this study discovers that the transit-mode subgroup is disadvantaged in the competition for healthcare services with the car-mode subgroup. The disparity in transit-mode accessibility is the main reason of the uneven pattern of healthcare accessibility in Shenzhen. Conclusions The findings suggest improving the public transit conditions for accessing healthcare services to reduce the disparity of healthcare accessibility. More healthcare services should be allocated in the eastern and western Shenzhen, especially sub-districts in Dapeng District and western Bao’an District. As these findings cannot be drawn by the traditional single-modal 2SFCA method, the advantage of the multi-modal 2SFCA method is significant to both healthcare studies and healthcare system planning.

Aim: To improve specialist accessibility and involvement in treatment management planning for rural and remote mental health consumers. Background: Central Queenslandrural and remote mental health services exhibits similar challenges faced by contemporary healthcare as a whole. These include process and flow problems due to lack of standardisation, fragmentation and poor coordination between process steps. Moreover, there are inherent constraints; such as a tyrant of geographical distances between regional and rural centres, limited resources and workforce retention and recruitment issues. Furthermore, due to the absence of resident consultant psychiatrists, the reliance on regional consultant psychiatrists who provide outreach services to rural areas resulted in their reduced involvement in the formulation of treatment plans for consumers. There was, also, an increased, mental health referral activity between primary and secondary healthcare services due to the increasing demand of mental health needs emanating from the downturn in the mining sector; some of which were unnecessary. Therefore, the impetus of the project was to apply Lean philosophy to improve mental health accessibility for consumers, clinicians’ involvement and information flow between the rural and remote primary and secondary mental health care services. In addition lean was applied to improve the internal secondary mental health services involvement of specialists in formulating treatment management plans for the consumers Methods: A chart audit tool, based on Gearing et al 2006 Chart audit review framework, was developed. It had 11 items which included the allocation of a consultant psychiatrist as an internal contact for the consumers on their electronic charts. It was used to review consumer records pre and post-Lean to ensure that all consumers with open episodes or admitted into case management had a recorded allocated consultant psychiatrist on their electronic chart, CIMHA (Consumer Integrated Mental Health Application). Lean interventionincluded Kaizen (rapid improvement) three-day workshops which were conducted with operational staff to develop standard work instructions, flow charts, service entry criteria and available services directory. Visual management and huddles were used to monitor clinicians’ compliance and adherence rate to the recording of specialists’ involvement in the treatment management planning on CIMHA. Clear communication plan was developed to ensure dissemination of information and application of standard processes. Key results: Clear secondary care service entry criteria assisted in accomplishing stepped care model;Clear referral flow charts to the secondary care mental health services ;A list of services available ensured that consumers were appropriately referred;Reduction in unnecessary referrals to the secondary care mental health services; Reduced waiting list to see a specialist in the secondary public health services;Increased involvement of specialist in treatment management planning for the consumers who were open to the services Conclusion: The findings are indicative that Lean philosophy can be applied in rural and remote mental health services to improve the specialists’ accessibility and involvement in consumer treatment management planning, subsequently improving consumer safety, and improved outcomes for the rural mental health consumers.

Background South Korea has experienced problems regarding poor management of symptoms of asthma patients and remarkable increases in sleep disorders. However, few studies have investigated these issues. We examined the relationship between sleep disorders and mortality in asthma patients to suggest effective alternatives from a novel perspective. Methods We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2004–2013, which included medical claims filed for 186,491 patients who were newly diagnosed with asthma during the study period. We performed survival analyses using a Cox proportional hazards model with time-dependent covariates to examine the relationship between sleep disorders and mortality in asthma patients. Results There were 5179 (2.78%) patients who died during the study period. Sleep disorders in patients previously diagnosed with asthma were associated with a higher risk of mortality (hazard ratio [HR]: 1.451, 95% confidence interval [CI]: 1.253–1.681). In addition, significant interaction was found between sleep disorders and Charlson comorbidity index. Conclusions Our findings suggest that an increased prevalence of sleep disorders in asthma patients increases the risk of mortality. Considering the worsening status of asthma management and the rapid growth of sleep disorders in South Korea, clinicians and health policymakers should work to develop interventions to address these issues.

Healthcare accessibility has become an issue of social equity. An accurate estimation of existing healthcare accessibility is vital to plan and allocate health resources. Healthcare capacity, population demand, and geographic impedance are three essential factors to measure spatial accessibility. Additionally, geographic impedance is usually represented with a function of travel time. In this paper, the three-step floating catchment area (3SFCA) method is improved from the perspectives of the temporal dimension and population demand. Specifically, the travel time from the population location to the service site is precisely calculated by introducing real-time traffic conditions instead of utilizing empirical speed in previous studies. Additionally, with the utilization of real-time traffic, a dynamic result of healthcare accessibility is derived during different time periods. In addition, since the medical needs of the elderly are higher than that of the young, a demand weight index of demand is introduced to adjust the population demand. A case study of healthcare accessibility in Wuhan shows that the proposed method is effective to measure healthcare accessibility during different time periods. The spatial accessibility disparities of communities and crowdedness of hospitals are identified as an important reference for the balance between the supply and demand of medical resources.

Geographers and public health researchers recognize that healthcare accessibility is a multi-dimensional concept contingent upon the interplay of a variety of spatial and non-spatial factors, including geographic distance, cost, availability, and quality of services. Understanding such complex healthcare accessibility issues often calls for broader conceptualizations and methodological apparatus. This will enable the researcher to move beyond treating individuals as subjects to be quantified, mapped and analyzed. Instead, the researcher moves toward viewing individuals as active knowledge producers with complex experiences that can inform and enhance our understandings of healthcare accessibility. In this paper, we use qualitative inquiry to understand the complex and unequal landscapes of healthcare accessibility in the Near Eastside of Columbus, Ohio (USA). We talk with and learn from lower-income residents in the study area to understand their experiences and to challenge the local, dominant discourse which suggests the neighborhood has adequate healthcare accessibility simply because it contains multiple free and low-cost clinics. We move beyond maps and official statistics to focus instead on the everyday lived experiences of individuals as they attempt to access healthcare accessibility in their neighborhood and the larger urban area. Such a shift highlights the important role for qualitative inquiry in critical health geography research. Our work develops multiple narratives and represents the experiential knowledge of multiple individuals to reveal important differences between the observed geographies of health and the reality that lower-income residents actually experience in their everyday lives while searching for quality, affordable, and accessible healthcare.

Indices explaining health phenomena are important tools for identifying and investigating health inequalities and to support policy making. Some of these indices are expressed at area-level, and the investigation of the areal influences of these indices on individual health outcomes have scale and geographical contextual implications that need to be assessed. In this study we calculated two area-level indices: one deprivation index and one index of healthcare accessibility. Using multilevel modelling, we calculated the area-level influences of these indices on an individual-level index of healthcare satisfaction considering three kinds of areas or contexts: a context of deprivation, a context of healthcare accessibility and a context combining the two characteristics of healthcare accessibility and deprivation. We evaluated two kinds of geographical problems using the statistical results of these area-level influences: the modifiable areal unit problem (MAUP) and the uncertain geographic context problem (UGCoP). Regarding the MAUP we evaluated the scale effects at two scales: census blocks and census tracts. Regarding the UGCoP we evaluated the differences in areal influences between the three kinds of contexts for both scales. The case study area was the city of Quito, Ecuador. The results of the performed analyses showed no severe MAUP and UGCoP, and revealed important evidence of the area-level influence of deprivation and healthcare accessibility on healthcare satisfaction. Springer