Network and Spatial Analysis to Assess and Guide Decisions about Equitable Accessibility to Health Services: The Public Palliative Care System in Extremadura (Spain)

Background: More than 50 million people die every year in the world. A vast majority, however, does not have access to minimum measures to alleviate unnecessary suffering, or even less, to palliative care. Even in places where such care exists, availability of services does not mean, automatically, that they are equally accessible to the population that needs them. Methods: With data from the Autonomous Community of Extremadura in Spain, we generated a mapping model using ArcGIS 10 as a network and spatial analysis tool, which takes into account estimating time to access physical facilities and professionals, and equity indices, to illustrate how potential accessibility could be affected by the presence or removal of administrative, policy-driven restrictions. Results: The approach allowed multiple levels of analysis of administrative restrictions impact on potential accessibility of services. First, it was shown how the minimum average access time to the closest palliative care services in the eight administrative areas of the Autonomous Community was much shorter than the national average. A similar picture was shown in relation to access times to the nearest hospital-based teams. As the measures used did not take into account the population of the municipalities, a third analysis considered potential demand levels, and involved Gini indices and Lorenz Curves, revealing that administrative restrictions may lead to inequity in access to palliative care services. Conclusion: The simultaneous use of maps of accessibility and coverage, illustrating the relative distribution of the resources in a population, while displaying the levels of coverage according to access time to physical facilities and professionals, with and without administrative restrictions, could be of great value to decision makers attempting to promote optimal levels of equity in a large, low-density geographic areas.


Francisco Javier Jaraíz-Cabanillas, José Antonio Gutiérrez-Gallego, Emilio Herrera-Molina, Silvia Librada- Flores, Jin Su Jeong, María Nabal-Vicuña and Alejandro R Jadad

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