Bauer Jan, Klingelhöfer Doris, Maier Werner, Schwettmann Lars, Groneberg David A
Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University Frankfurt, Theodor Stern Kai 7, 60590, Frankfurt/Main, Germany.
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, 85764, Neuherberg, Germany.
Sci Rep. 2020 Nov 5;10(1):19157. doi: 10.1038/s41598-020-76212-0.
Improving spatial accessibility to hospitals is a major task for health care systems which can be facilitated using recent methodological improvements of spatial accessibility measures. We used the integrated floating catchment area (iFCA) method to analyze spatial accessibility of general inpatient care (internal medicine, surgery and neurology) on national level in Germany determining an accessibility index (AI) by integrating distances, hospital beds and morbidity data. The analysis of 358 million distances between hospitals and population locations revealed clusters of lower accessibility indices in areas in north east Germany. There was a correlation of urbanity and accessibility up to r = 0.31 (p < 0.001). Furthermore, 10% of the population lived in areas with significant clusters of low spatial accessibility for internal medicine and surgery (neurology: 20%). The analysis revealed the highest accessibility for heart failure (AI = 7.33) and the lowest accessibility for stroke (AI = 0.69). The method applied proofed to reveal important aspects of spatial accessibility i.e. geographic variations that need to be addressed. However, for the majority of the German population, accessibility of general inpatient care was either high or at least not significantly low, which suggests rather adequate allocation of hospital resources for most parts of Germany.
改善医院的空间可达性是医疗保健系统的一项主要任务，利用空间可达性测量方法的最新改进可以推动这一任务的完成。我们使用综合浮动集水区（iFCA）方法，在国家层面分析德国普通住院护理（内科、外科和神经科）的空间可达性，通过整合距离、医院床位和发病率数据来确定可达性指数（AI）。对医院与人口所在地之间3.58亿个距离的分析显示，德国东北部地区的可达性指数较低。城市化与可达性之间存在相关性，相关系数r = 0.31（p < 0.001）。此外，10%的人口居住在内科和外科空间可达性显著较低的地区（神经科：20%）。分析显示，心力衰竭的可达性最高（AI = 7.33），中风的可达性最低（AI = 0.69）。所应用的方法被证明能够揭示空间可达性的重要方面，即需要解决的地理差异。然而，对于大多数德国人口来说，普通住院护理的可达性要么很高，要么至少没有显著偏低，这表明德国大部分地区的医院资源分配较为合理。
