Assessing Geographic Inaccessibility to Health Care Using GIS Network Based Methods

1. Sudha Yerramilli and David BandiNational Center for Biodefense Communications, Jackson State University Assessing Geographic Inaccessibility to Health Care Using GIS Network Based Methods 2013 URISA GIS in Public Health Conference

2. Health Care • Health care is the basic care for person’s well being • Targets better health outcomes and greaterequity in health • Cost of Services and access to care are important issues • Healthy people = Healthy Economy 2013 URISA GIS in Public Health Conference, Miami, FL

3. Features for Optimal Health Care • Optimal health care services are multidimensional : • Availability : Health facilities, Health personnel • Accessibility : Time and distance • Affordability : Economic status, insurance etc • Geographic Accessibility- A critical determinant ofhuman health around the globe (World Health Organization) and is considered more a determinant than vectors • Geographical accessibility is defined as the ability to obtain right kind of services in right kind of timewhen needed. 2013 URISA GIS in Public Health Conference, Miami, FL

4. Geographic Access to Health Care • The effective use of geography in health care can be traced back to 1854 John Snow’s research • Measuring health care through a geographical expression displays the levels of aggregation where inaccessibility/disparity could be reduced • Significant geographical expression that contributes to health status and outcomes is the distance/travel time to health care facility. • Travel time a better assessor of geographic accessibility than distance (WHO) 2013 URISA GIS in Public Health Conference, Miami, FL

5. Role of Geography: Efficient Health Care • The framework centers on two elements • Geographical accessibility • Spatial Location of facilities • Efficient Road network • Physical distance and travel time • Health Service Availability when needed : • Right kind of Health personnel • Right kind of services • Appropriate kind of materials and equipment 2013 URISA GIS in Public Health Conference, Miami, FL

6. Status of Health Care in Mississippi • Mississippi's rural nature: Uneven distribution of physicians, geographic inaccessibility exist in access to health care services • The latest data available from the Kids Count Data Center at the Annie E. Casey Foundation Mississippi ranked : • 49th in child death, • 50th in low birth weight, infant mortality • According to Kaiser's State Health Facts 2008 data: • 900,000 Mississippians, or almost 32 percent of the population, live in areas designated as Primary Care Health Professional Shortage Areas. 2013 URISA GIS in Public Health Conference, Miami, FL

7. Methodology • Focuses on four types of health care services in a 10-county study region • Obstetrician/Gynecology • Pediatrics • Trauma and Burn centers • Family/Internal Medicine • The optimum travel time (to reduce mortality rates) required to reach the health center: • Obstetrician/Gynecology : 20 Minutes • Pediatrics : 30 Minutes • Trauma/Burn Centers : 30 Minutes • Internal/Family Medicine : 30 Minutes 2013 URISA GIS in Public Health Conference, Miami, FL

8. Methodology • The frame work involves mapping the demographical spatial distribution at a census block level • Obstetrician/Gynecology : women in child bearing age • Pediatrics : Children under 10 years of age • Trauma/Burn Centers : General Population • Internal/Family Medicine : Population 65 years and above • Using network analyst functionalities in GIS, travel time based service areas are generated for each health facility • The intended population outside the service areas is mapped and estimated • The concentration of the populations residing outside the optimal travel time areas are identified 2013 URISA GIS in Public Health Conference, Miami, FL

9. Obstetrician/Gynecology 2013 URISA GIS in Public Health Conference, Miami, FL

10. Obstetrician/Gynecology • Blocks located outside 20min service area= 11538 with 26685 population • Blocks with CBA> 50 outside 20min service area= 34 with 2935 population with most highly populated block with 274 CBA located in Claiborne (rural) 2013 URISA GIS in Public Health Conference, Miami, FL

11. Pediatrics Specialized 2013 URISA GIS in Public Health Conference, Miami, FL

12. Pediatrics Specialized • 10660 children are located outside 30min service area • Blocks with number of children under 10 years> 25 outside 30min service area= 2400 population 2013 URISA GIS in Public Health Conference, Miami, FL

13. Trauma/Burn Center Specialized 2013 URISA GIS in Public Health Conference, Miami, FL

14. Trauma/Burn Center Specialized • With only ONE burn center for the whole state, removal of this facility leaves the state of MS vulnerable • 100% of the Population outside 30 minute service area are rural 2013 URISA GIS in Public Health Conference, Miami, FL

15. Internal/Family Medicine Specialized 2013 URISA GIS in Public Health Conference, Miami, FL

16. Internal/Family Medicine Specialized • No Urban population outside 30 minute service areas • Blocks with number of people above 65 years > 25 and outside 30min service area= 4235 population 2013 URISA GIS in Public Health Conference, Miami, FL

17. Conclusions • This methodology provides an advantageous approach in assessing community’s health care needs from a geographical perspective • Geographical inaccessibility is clearly seen among rural populations. • Out of the four health specialties assessed, OBS/GYN specialized health care is the most still needed with the populations of women in Child Bearing Age out side the service areas • With only one burn center in MS, closure of this facility leaves the whole population in a vulnerable state. • Assessing the geographic inaccessibility from various health specialty perspective provides the requirement of right kind of services to the right kind of people in need. 2013 URISA GIS in Public Health Conference, Miami, FL

18. THANK YOU 2013 URISA GIS in Public Health Conference, Miami, FL