Research Center for Humanities and Social Sciences, Academia Sinica, Taipei 115, Taiwan.
Department of Education and Research, Taipei City Hospital, Taipei 106, Taiwan.
Health Place. 2017 Sep;47:126-138. doi: 10.1016/j.healthplace.2017.08.006. Epub 2017 Sep 4.
Assessing access to healthcare for an entire healthcare system involves accounting for demand, supply, and geographic variation. In order to capture the interaction between healthcare services and populations, various measures of healthcare access have been utilized, including the popular two-step floating catchment area (2SFCA) method. However, despite the many advantages of 2SFCA, the problems, such as inappropriate assumption of healthcare demand and failure to capture cascading effects across the system have not been satisfactorily addressed. In this paper, a statistical model for evaluating flows of individuals was added to the 2SFCA method (hereafter we refer to it as F2SFCA) in order to overcome limitations associated with its current restriction. The proposed F2SFCA model can incorporate both spatial and nonspatial dimensions and thus synthesizes them into one framework. Moreover, the proposed F2SFCA model can be easily adapted to measure access for different types of individuals, over different service provider types, or with capacity constraints in a healthcare system. We implemented the proposed model in a case study assessing access to healthcare for the elderly in Taipei City, Taiwan, and compared the weaknesses and strengths to the 2SFCA method and its variations.
评估整个医疗体系的医疗保健可及性需要考虑需求、供给和地理差异。为了捕捉医疗服务和人口之间的相互作用,已经使用了各种医疗保健可及性衡量指标,包括流行的两步浮动目标区域(2SFCA)方法。然而,尽管 2SFCA 有许多优点,但一些问题,如医疗需求的不恰当假设以及未能捕捉整个系统的级联效应等,仍未得到令人满意的解决。在本文中,我们在 2SFCA 方法中添加了一个用于评估个体流动的统计模型(以下简称 F2SFCA),以克服其当前限制所带来的局限性。所提出的 F2SFCA 模型可以同时包含空间和非空间维度,并将它们综合到一个框架中。此外,所提出的 F2SFCA 模型可以轻松适用于测量不同类型个体、不同服务提供者类型或在医疗体系中具有容量限制的情况下的可及性。我们在一个案例研究中实施了所提出的模型,以评估台湾台北市老年人的医疗保健可及性,并将其与 2SFCA 方法及其变体的优缺点进行了比较。