Unit 8 Inequalities in service provision & usage
This is the fifth unit in the module ‘GIS for Health Care Management’. This unit considers issues of inequality in health care provision and utilization. It will frequently be the objective of health care planning to achieve some degree of equality of service but this usually involves analysis of an existing system of provision which has in-built inequalities.
- The need/use/service provision dilemma
- Multiple geographical scales
- Endurance of inequalities through time
- Social and spatial explanations
‘The need/use/service provision dilemma’ examines the complex issue of separating out measurement of need, use and service provision. Although we might expect those in greatest need to use health services most, there are generally distinct patterns whereby greatest use is made by those with the easiest access to services – both geographical and social. The provision of health care services thus increases use: provision in areas of relatively low need does not mean that services are unutilized but that they are utilized by those whose need for them is less, while other, more needy groups, suffer relative disadvantage.
‘Multiple geographical scales’ demonstrates how health care inequalities are observable at many different scales, ranging from the international to the very local. These scales are important because they relate to the different scales at which health care planning functions can operate and thus the scales over which health care GIS may be applied.
‘Endurance of inequalities through time’ looks at evidence for the deeply-engrained nature of health care inequalities and considers why it takes extensive resources over extended time periods to bring about real changes in the distribution of health care. Population health status is determined by many factors external to the health care delivery system and an appreciation of these broader societal factors is necessary in order to design effective health care services.
The final learning object ‘Social and spatial explanations’ seeks to examine what part geography plays in these patterns of inequality. Numerous studies have endeavoured to examine health inequalities in terms of demographic characteristics, social conditions and medical need and still find enduring geographical patterns when all these factors have been taken into account. The importance of spatial insights in understanding health care inequalities serves to illustrate the important role of appropriate GIS use in health care planning.
Expect to spend about 1 week working through these materials. The learning objects in this introductory unit can be taken in any order, but it is strongly recommended that you complete this unit before proceeding with the remainder of the module ‘GIS for Health Care Management’.