Health Services and Outcomes Research, National Healthcare Group, Singapore.
Int J Health Plann Manage. 2012 Jul-Sep;27(3):e173-85. doi: 10.1002/hpm.1063. Epub 2010 Jul 29.
Primary care services in Singapore are provided by 18 Government-funded polyclinics and about 1200 private General Practitioners (GPs). This study aims to examine the spatial accessibility to polyclinics and identify service gaps, and suggest optimal sites using Geographic Information System (GIS) to aid in future planning. A national database containing 3.6 million polyclinic visits in 2006 were geo-analysed using ArcView GIS. Patients' travel impedance to the nearest polyclinic was computed using DriveTime to identify areas with the lowest spatial accessibility and highest volume of under-served population. Jurong West and Sembawang were ranked as top areas with poor spatial accessibility to polyclinic services. ArcGIS was used to identify optimal sites with the minimum accumulated distance impedance to this under-served population. If new facilities were set up at these identified sites, volume of visits by Jurong West and Sembawang patients who could access the nearest polyclinics within 4 km Euclidean distance from their residence would total at 123 000 and 93 000, respectively. Future efforts in polyclinic planning should take this into consideration to maximize patients' benefits and minimize patients' travelling costs in order to achieve social equity on healthcare access.
新加坡的基层医疗服务由 18 家政府资助的综合诊疗所和大约 1200 名私人全科医生提供。本研究旨在考察综合诊疗所的空间可达性,识别服务差距,并利用地理信息系统(GIS)确定最佳地点,以协助未来规划。2006 年,使用 ArcView GIS 对包含 360 万次诊疗所就诊的全国性数据库进行了地理分析。使用 DriveTime 计算了患者前往最近的诊疗所的出行阻抗,以确定空间可达性最低和服务不足人群数量最高的地区。裕廊西和三巴旺被评为综合诊疗所服务空间可达性最差的地区。ArcGIS 用于确定与服务不足人群的累积距离阻抗最小的最佳地点。如果在这些确定的地点建立新的设施,那么可以在 4 公里欧几里得距离内到达最近的诊疗所的裕廊西和三巴旺患者的就诊量将分别达到 123000 和 93000。未来的综合诊疗所规划应考虑到这一点,以最大限度地提高患者的收益,同时降低患者的出行成本,从而实现医疗保健可及性方面的社会公平。