Spatial accessibility of pediatric primary healthcare: Measurement and inference

TL;DR

This paper develops a measurement and modeling framework to analyze disparities in spatial accessibility to pediatric primary care, highlighting significant inequalities in Georgia that are resistant to policy changes.

Contribution

It introduces an optimization-based measurement method combined with statistical inference to assess spatial accessibility disparities and their policy impacts.

Findings

Significant disparities in pediatric healthcare access in Georgia.

Current policies are ineffective in reducing accessibility inequalities.

Major structural changes are needed to improve access.

Abstract

Although improving financial access is in the spotlight of the current U.S. health policy agenda, this alone does not address universal and comprehensive healthcare. Affordability is one barrier to healthcare, but others such as availability and accessibility, together defined as spatial accessibility, are equally important. In this paper, we develop a measurement and modeling framework that can be used to infer the impact of policy changes on disparities in spatial accessibility within and across different population groups. The underlying model for measuring spatial accessibility is optimization-based and accounts for constraints in the healthcare delivery system. The measurement method is complemented by statistical modeling and inference on the impact of various potential contributing factors to disparities in spatial accessibility. The emphasis of this study is on children's accessibility to primary care pediatricians, piloted for the state of Georgia. We focus on disparities in accessibility between and within two populations: children insured by Medicaid and other children. We find that disparities in spatial accessibility to pediatric primary care in Georgia are significant, and resistant to many policy interventions, suggesting the need for major changes to the structure of Georgia's pediatric healthcare provider network.