The Annals of Applied Statistics

Spatial accessibility of pediatric primary healthcare: Measurement and inference

Mallory Nobles, Nicoleta Serban, and Julie Swann

Full-text: Open access

Abstract

Although improving financial access is in the spotlight of the current U.S. health policy agenda, this alone does not address universal and comprehensive healthcare. Affordability is one barrier to healthcare, but others such as availability and accessibility, together defined as spatial accessibility, are equally important. In this paper, we develop a measurement and modeling framework that can be used to infer the impact of policy changes on disparities in spatial accessibility within and across different population groups. The underlying model for measuring spatial accessibility is optimization-based and accounts for constraints in the healthcare delivery system. The measurement method is complemented by statistical modeling and inference on the impact of various potential contributing factors to disparities in spatial accessibility. The emphasis of this study is on children’s accessibility to primary care pediatricians, piloted for the state of Georgia. We focus on disparities in accessibility between and within two populations: children insured by Medicaid and other children. We find that disparities in spatial accessibility to pediatric primary care in Georgia are significant, and resistant to many policy interventions, suggesting the need for major changes to the structure of Georgia’s pediatric healthcare provider network.

Article information

Source
Ann. Appl. Stat., Volume 8, Number 4 (2014), 1922-1946.

Dates
First available in Project Euclid: 19 December 2014

Permanent link to this document
https://projecteuclid.org/euclid.aoas/1419001727

Digital Object Identifier
doi:10.1214/14-AOAS728

Mathematical Reviews number (MathSciNet)
MR3292481

Zentralblatt MATH identifier
06408762

Keywords
Healthcare access optimization model pediatric healthcare spatial accessibility spatial-varying coefficient model

Citation

Nobles, Mallory; Serban, Nicoleta; Swann, Julie. Spatial accessibility of pediatric primary healthcare: Measurement and inference. Ann. Appl. Stat. 8 (2014), no. 4, 1922--1946. doi:10.1214/14-AOAS728. https://projecteuclid.org/euclid.aoas/1419001727


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See also

  • Editorial: Spatial accessibility of pediatric primary healthcare: Measurement and inference.
  • Discusion: Discussion of “Spatial accessibility of pediatric primary healthcare: Measurement and inference”.
  • Discusion: Discussion of “Spatial accessibility of pediatric primary healthcare: Measurement and inference”.
  • Discusion: Discussion of “Spatial accessibility of pediatric primary healthcare: Measurement and inference”.
  • Rejoinder: “Spatial accessibility of pediatric primary healthcare: Measurement and inference”.

Supplemental materials

  • Supplementary material: Supplement to “Spatial accessibility of pediatric primary healthcare: Measurement and inference”. Supplementary Materials A, B, C and D contain four sections [Nobles, Serban and Swann (2014)]. In Supplementary Material A we describe methods that we utilized in our study but which are not essential components of our measurement and inference approach. In Supplementary Material B we give further details about the estimation of our space-varying coefficient model. In Supplementary Material C we provide additional details on the data sources we used to implement our models. In Supplementary Material D we present further results on children’s accessibility to primary care pediatricians in Georgia.