# Access to Neurosurgery for Patients in Germany—Strategic Considerations Based on Geographic Information Mapping

## TL;DR

This study uses geographic data to assess access to neurosurgery in Germany and suggests strategies to improve it, especially in less densely populated regions.

## Contribution

The novel contribution is the use of geographic information mapping to derive region-specific strategies for improving neurosurgery access in Germany.

## Key findings

- Population density and access to neurosurgery within 40 minutes are strongly correlated in Germany.
- New federal states (excluding Berlin) have significantly worse access to neurosurgery compared to other regions.
- Geographic mapping identified three distinct strategies to improve regional access to neurosurgery.

## Abstract

Background/Objectives: To estimate, against the background of the upcoming German healthcare reform, current access to neurosurgery for patients in Germany, and to derive improvement strategies from geographic information mapping. Methods: We defined access to neurosurgery on a geographical basis as the sum of all points from which one can reach a neurosurgical department within 40 min by car (A2N40). We identified 182 departments of neurosurgery, and we retrieved population numbers and geodetic information from open sources. We processed data and conducted statistical analyses in R. Results: Population density and A2N40 per square kilometer were significantly positively correlated (Spearman’s rho = 0.82, p = 0.0001). Population density is significantly lower (Wilcoxon rank sum test, p = 0.009) and A2N40 per square kilometer is significantly worse (Wilcoxon rank sum test, p = 0.005) in the new federal states (without Berlin) as compared to the rest of the country. Geographic information mapping yielded 3 distinct improvement strategies. Conclusions: In Germany, population density and A2N40 per square kilometer are significantly positively correlated, with significantly less A2N40 per square kilometer in the new federal states. Geographic mapping may inform tailored regional improvement policies.