Work

Impact of spatial accessibility to primary care physicians on health care outcomes and costs

Year: 2025

Type: article

Abstract: BACKGROUND: This study is the first in Taiwan to apply the enhanced two-step floating catchment area (E2SFCA) method to evaluate the spatial accessibility of primary care. Traditional physician-to-population ratios by administrative region overlook cross-boundary healthcare-seeking and travel distance barriers. This study accounts for these limitations and further examines the impact of accessibility on healthcare utilization and outcomes. METHODS: We used national health insurance claims, physician registry data, and GIS-based road networks to measure accessibility with the E2SFCA method, defining it as the number of primary care physicians per 10,000 residents within a 30-minute travel time. A retrospective cohort of 2 million adults was analyzed. Generalized estimating equations with appropriate regression models assessed associations between accessibility and healthcare utilization, expenditures, avoidable emergency department (ED), and avoidable hospitalizations. RESULTS: Spatial analysis identified 15 townships (114,915 residents, 0.49%) with no primary care physicians and another 15 townships (114,430 residents, 0.49%) with low accessibility. These underserved areas were concentrated in central and eastern Taiwan, whereas metropolitan regions had sufficient resources. Higher accessibility was significantly associated with fewer ED visits (ratio = 0.994; 95% CI: 0.990-0.997, P< 0.001), ED expenditures (ratio = 0.993; 95% CI: 0.989-0.997, P< 0.001), the odds of avoidable ED visits (odds ratio = 0.993; 95% CI: 0.988-0.998, P = 0.005), and the number of avoidable ED visits (ratio = 0.993; 95% CI: 0.988-0.998, P = 0.004). Accessibility also reduced the odds of avoidable hospitalization (odds ratio = 0.995; 95% CI: 0.990-0.999, P = 0.017). CONCLUSION: Greater spatial accessibility to primary care was linked to reductions in ED visits, ED costs, avoidable ED use, and avoidable hospitalization. The E2SFCA method provides a more accurate tool for identifying underserved regions and can inform equitable allocation of healthcare resources. Telemedicine and mobile services should be expanded to address shortages in remote areas.

Source: International Journal of Health Geographics

DOI: 10.1186/s12942-025-00430-w

Authors: Yi-Xiang Weng, Ching-Chen Hsieh, Hsin-Chung Liao, Yu-Chi Tung