School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 west 168th street, room 727, New York, New York, 10032, USA.
BMC Health Serv Res. 2022 Mar 19;22(1):367. doi: 10.1186/s12913-022-07749-1.
To address patient's unmet social needs and improve health outcomes, health systems have developed programs to refer patients in need to social service agencies. However, the capacity to respond to patient referrals varies tremendously across communities. This study assesses the emergence of disparities in spatial access to social services from 1990 to 2014.
Social service providers in the lower 48 continental U.S. states were identified annually from 1990 to 2014 from the National Establishment Times Series (NETS) database. The addresses of providers were linked in each year to 2010 US Census tract geometries. Time series analyses of annual counts of services per Km were conducted using Generalized Estimating Equations with tracts stratified into tertiles of 1990 population density, quartiles of 1990 poverty rate and quartiles of 1990 to 2010 change in median household income.
Throughout the period, social service agencies/Km increased across tracts. For high population density tracts, in the top quartile of 1990 poverty rate, compared to tracts that experienced the steepest declines in median household income from 1990 to 2010, tracts that experienced the largest increases in income had more services (+ 1.53/Km, 95% CI 1.23, 1.83) in 1990 and also experienced the steepest increases in services from 1990 to 2010: a 0.09 services/Km/year greater increase (95% CI 0.07, 0.11). Similar results were observed for high poverty tracts in the middle third of population density, but not in tracts in the lowest third of population density, where there were very few providers.
From 1990 to 2014 a spatial mismatch emerged between the availability of social services and the expected need for social services as the population characteristics of neighborhoods changed. High poverty tracts that experienced further economic decline from 1990 to 2010, began the period with the lowest access to services and experienced the smallest increases in access to services. Access was highest and grew the fastest in high poverty tracts that experienced the largest increases in median household income. We theorize that agglomeration benefits and the marketization of welfare may explain the emergence of this spatial mismatch.
为了满足患者的未满足的社会需求并改善健康结果，医疗系统已经制定了计划，将有需要的患者转介给社会服务机构。然而，各个社区对患者转介的响应能力差异很大。本研究评估了 1990 年至 2014 年期间社会服务获取方面的差异。
从 1990 年到 2014 年，每年从国家机构时间序列（NETS）数据库中确定美国本土 48 个州的社会服务提供商。在每年将提供商的地址与 2010 年美国人口普查区几何图形联系起来。使用广义估计方程对每年每公里服务次数的年度计数进行了时间序列分析，将这些轨迹分层为 1990 年人口密度的三分位数、1990 年贫困率的四分位数以及 1990 年至 2010 年中位数家庭收入变化的四分位数。
在整个时期，社会服务机构/公里数在各地区都有所增加。对于人口密度较高的地区，在 1990 年贫困率最高的四分位数中，与从 1990 年到 2010 年中位数家庭收入下降最严重的地区相比，收入增长最大的地区在 1990 年拥有更多的服务（+1.53/公里，95%CI1.23，1.83），并且从 1990 年到 2010 年服务的增长幅度最大：每年增加 0.09 服务/公里（95%CI0.07，0.11）。在人口密度处于中等三分之一的高贫困地区观察到了类似的结果，但在人口密度最低的三分之一地区，由于服务提供者很少，因此没有观察到这种结果。
从 1990 年到 2014 年，随着社区人口特征的变化，社会服务的可及性与社会服务的预期需求之间出现了空间不匹配。从 1990 年到 2010 年经济进一步下滑的高贫困地区，开始时服务获取量最低，服务获取量的增长幅度最小。在中等收入家庭收入中位数增长幅度最大的高贫困地区，服务获取量最高，增长速度最快。我们推测，集聚效益和福利市场化可能解释了这种空间不匹配的出现。
