Evaluating temporal variations in access to multi-tier hospitals using personal vehicles and public transit: Implications for healthcare equity.

• Incorporated spatial-temporal factors to quantify healthcare accessibility. • Investigated temporal variations in both horizontal and vertical equity. • Case study: Shanghai's PT and PV accessibility to multi-tier hospitals. • Proposed multi-faceted strategies to improve healthcare accessibility and equity. Understanding healthcare accessibility, or the ability to access healthcare services, has significant implications for both individual well-being and community equity. However, existing studies seldom account for temporally varying factors such as traffic conditions and hospital schedules, resulting in miscalculation of accessibility. This study addresses this gap by introducing a framework that evaluates accessibility to multi-tier hospitals, factoring in both spatial and temporal aspects, using public transit (PT) and personal vehicles (PVs), and assesses its impact on horizontal and vertical equity. Implemented in Shanghai, China, we employ the Gaussian two-step floating catchment area method for accessibility quantification and utilize map APIs for dynamic travel time data. Our analysis reveals: (i) notable temporal fluctuations in healthcare accessibility, especially for PT, and their significant impact on both horizontal and vertical equity due to varying travel times and hospital schedules; (ii) larger disparities in higher-tier hospital accessibility compared to lower-tier ones; (iii) greater horizontal equity using PV-based accessibility and higher vertical equity using PT-based accessibility. These findings highlight the need to offer customized transit to healthcare facilities, expand telehealth services, incorporate equity in healthcare resource allocation, incentivize healthcare professionals to work in underserved areas, and develop outreach programs to improve accessibility and equity. [ABSTRACT FROM AUTHOR]