2.2 Geographical accessiblity vs specialization

This learning object addresses the tension between achieving a high level of geographical accessibility of health care services and delivering appropriate levels of specialist care. This tension is most acute where the difference between the basic and advanced services offered by a health care system are greatest. The presentation below introduces this concept but also identifies the limitation.

 
It is important to recognize that geographical accessibility, to which GIS can make its most powerful contribution, is only one component of the overall accessiblity of health care services. There is a general expectancy that local health services will be more accessible to a population than centralised specialist services but the reality is much more complex. Firstly, the geographical separation of patient and service may not be the primary barrier to obtaining care and secondly, geographical accessibility may need to be measured in metrics more complex than simple distance.

One of the most important elements of non-geographical access is the process of medical referral, whereby a patient presenting a medical condition to a general practitioner, usually at the local level, is referred on for more specialist care. The process of referral thus controls most patients’ access to hospital except via accident and emergency admissions. In determining geographical access to health care it is therefore the patterns of access to primary care which have the greatest influence on ability to obtain care. While referral patterns may be influenced by a GP’s awareness of the distance that patients would need to travel to hospital, this is an indirect effect and is increasingly secondary to considerations of patient choice and other market considerations in many systems. It is thus entirely possible for a patient who lives in an inner urban area close to a major teaching hospital to have poorer access to its facilities than a suburban resident because the urban area has poorer provision of primary health care. In general in the UK, larger suburban primary health centres may have multidisciplinary teams and advanced diagnostic equipment, while the less attractive central locations may be served by older, single handed GPs working from poorer premises There is however, little evidence that overall levels of care, or patient satisfaction, are poorer (Hippisley-Cox et al., 2001).
 

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