A three-step floating catchment area method for analyzing spatial access to health services

Gravity-based spatial access models have been widely used to estimate spatial access to healthcare services in an attempt to capture the interaction of various factors. However, these models are inadequate in informing health resource allocation work due to their inappropriate assumption of healthcare demand. For the purpose of effective healthcare resource planning, this article proposes a three-step floating catchment area (3SFCA) method to minimize the healthcare-demand overestimation problem. Specifically, a spatial impedance-based competition scheme is incorporated into the enhanced two-step floating catchment area (E2SFCA) method to account for a reasonable model of healthcare supply and demand. A case study of spatial access to primary care physicians along the Austin–San Antonio corridor area in central Texas showed that the proposed method effectively minimizes the overestimation of healthcare demand and reflects a more balanced geographic pattern of spatial access than E2SFCA. In addition, by using an adjusted spatial access index, the 3SFCA method indicates strong potential for identifying health professional shortage areas. The study concludes that 3SFCA is a promising method to provide health professionals and decision makers with useful healthcare accessibility information.     

Spatial Access to Health Care Services and Disparities in Colorectal Cancer Stage at Diagnosis in Texas

Early diagnosis of colorectal cancer (CRC) is important for improving the survival rate of the disease. Disparities in CRC diagnosis among different population groups have persisted in the United States. This study examines whether spatial access to medical services contributes to disparities of late-stage diagnosis of CRC in Texas. Analysis results suggest that there are significant disparities in late-stage CRC diagnosis by race/ethnicity, socioeconomic status, and geographic location in Texas. It is concluded that spatial access to primary care is associated with CRC stage at diagnosis, but not with racial/ethnic and socioeconomic disparities.     

An environmental justice assessment of public beach access in Miami,Florida

The scope of empirical environmental justice (EJ) research has expanded beyond hazards exposure to scrutinize social inequities in access to amenities, but no prior study has examined the EJ implications of public beach access. Furthermore, quantitative research on white privilege is very scarce. To address these knowledge gaps, our study examines racial/ethnic and socioeconomic inequities in access to public beaches in the Miami metropolitan statistical area, Florida. Public beach accessibility is modeled with an innovative geospatial approach that involves population weighted distances to beach access sites. To assess EJ implications of public beach access for various racial/ethnic and socioeconomically vulnerable groups, spatial regression models are estimated using census tract-level data. Results indicate that beaches are more accessible to neighborhoods with a higher proportion of non-Hispanic Whites, while neighborhoods with higher percentages of Hispanics and socioeconomically disadvantaged residents have limited access. This study demonstrates the importance of assessing white privilege and access to environmental amenities in EJ research to better understand social inequities.     

基于改进两步移动搜索法的县域医疗卫生服务空间可达性研究

针对县域医疗卫生服务设施的空间布局问题,应用改进两步移动搜索法对德清县医疗卫生服务的空间可达性进行评价。具体改进包括：引入核密度型距离衰减函数对两步移动搜索法进行扩展、考虑医疗设施资源的未充分利用、对不同规模等级医疗机构设置不同服务阈值。计算结果表明：① 浙江省德清县域医疗卫生服务空间可达性呈圈层式空间分布特征,高可达性区域主要集中于县城及邻接区域,边缘地区缺医明显;② 基于改进两步移动搜索法和传统两步移动搜索法的可达性计算结果具有不同的整体特征,但前者可达性计算结果及空间分布更符合实际。     

Disparities in Spatial Accessibility of Pharmacies in Baton Rouge,Louisiana

This study examines spatial accessibility of pharmacies in Baton Rouge, Louisiana. Two popular geographic information systems (GIS)—based methods are compared: the proximity method uses the distance (travel time) from the nearest pharmacy, and the two‐step floating catchment area (2SFCA) method considers the match ratio between providers and population as well as the complex spatial interaction between them. The study indicates that disproportionally higher percentages of African‐Americans are in areas with shorter travel time to the nearest pharmacies than whites, but suffer from poorer accessibility measured by the 2SFCA method—that is, fewer pharmacies per 10,000 residents. Seniors, particularly those of seventy‐five years or older, tend to be disproportionally concentrated in areas that not only are closer to pharmacies, but also have more pharmacies per 10,000 residents. The two methods used in the study capture different elements in spatial accessibility: one being physically close to a facility and another adding the crowdedness in service. Both properties can be valuable for residents. The two may not always coincide with each other in spatial variability, as it is the case for racial disparity in our study area. However, when they do, as in the case for seniors, it may imply a true (dis)advantage for a demographic group in terms of both properties of spatial accessibility.     

基于最优供需分配的公共设施空间可达性分析

空间可达性是衡量公共服务设施公平性的重要指标,在医疗、教育、休闲等公共服务的布局规划中得到广泛应用。然而已有设施服务可达性模型难以充分反映服务供需关系,计算指标也缺乏物理意义。本文提出新的最优供需分配的公共设施空间可达性计算方法（OSD）取代现有方法。该方法基于最优供需分配模型,将设施服务分配给需求者,根据分配结果计算空间可达性指标。给定服务设施与需求的空间分布,以最小化旅行成本为目标,顾及设施服务能力,采用经典的运输问题模型确定最优的服务供需分配方案,进而度量服务的空间可达性。以郑州市金水区社区卫生服务为例,求解25个中心与1333个居住小区的最优服务配置。使用最优配置结果确定每个设施的服务范围、每个居住小区使用服务的旅行时间,以及特定时间阈值的服务覆盖比率。与流行的两步移动搜索法相比,新方法的计算指标具有明确的物理意义。本文提出的可达性评价方法无需参数,计算高效,结果易于解释,在公共服务评价及设施布局规划方面具有应用潜力。     

Spatial assimilation and its discontents: Asian ethnic neighborhood change in California

This study investigates the geographic and compositional dynamics of ethnic neighborhoods over time among the fastest growing racial group in California, Asian Americans. I conduct spatial analysis of Census data from 2000 and 2010 to represent changes in ethnic neighborhood boundaries and their associated structural and demographic characteristics. First, I document changing ethnic neighborhood patterns among four Asian national origin groups—Chinese, Filipino, Korean, and Vietnamese Americans. Second, I synthesize this information, assessing the theoretical implications of these changes by describing indications of spatial assimilation, ethnic stratification, and resurgent ethnicity among ethnic neighborhoods and the potential repercussions for the successful incorporation of both immigrant and native-born Asian Americans. Overall, this paper demonstrates that Asian ethnic neighborhood dynamics are far from monolithic and that different spatial incorporation processes manifest both within and between groups.     

Inverted Two-Step Floating Catchment Area Method for Measuring Facility Crowdedness

The popular two-step floating catchment area (2SFCA) method has been widely used in the literature to measure spatial accessibility of residents for a service. The 2SFCA method accounts for the ratio between the supply capacity and demand amount of the service as well as the complex spatial interaction between them. This article introduces an inverted two-step floating catchment area (i2SFCA) method that is derived from an extension of the classic Huff model and used to capture the “crowdedness” (scarcity of resource or intensity of competition) for facilities. The method is illustrated and validated by a case study of evaluating hospital inpatient services in Florida. Several possible uses of the measure are also discussed.     

The role of socio-economic status and spatial effects on fresh food access: Two case studies in Canada

This article comprehensively explores the effects of socio-economic status on residents' fresh food access in Saskatoon and Regina, Saskatchewan, Canada. Spatial effects potentially resulting from agglomeration of food retailers and clustering of neighborhoods with similar characteristics have been integrated into analysis using spatial regression models. Key findings include: areas with a larger percentage of population density, single-parent households, senior populations, higher educational populations, and minority groups tend to have higher access to supermarkets and local grocery stores, although the effects vary by city. Areas with higher private car access are more inclined to be farther from these food retailers, meanwhile the influence of public transportation is found to be insignificant in both cities. Regression results demonstrate that ignoring spatial interaction leads to overestimates of the true disparities when investigating food-access inequality among residents with different socio-economic status.     

Measuring spatial accessibility to primary care in rural areas: Improving the effectiveness of the two-step floating catchment area method

Quantifying spatial accessibility in relation to the provision of rural health services has proven difficult. This article critically appraises the two-step floating catchment area (2SFCA) method, a recent solution for measuring primary care service accessibility across rural areas of Victoria, Australia. The 2SFCA method is demonstrated to have two fundamental shortcomings – specifically the use of only one catchment size for all populations, and secondly the assumption that proximity is undifferentiated within a catchment (especially problematic when the catchment is large). Despite its advantages over simple population-to-provider ratios, the 2SFCA method needs to be used with caution.     

基于改进3SFCA的乡村地区公共医疗设施空间可达性与公平性评价——以海口市为例

公共医疗设施配置合理与否影响城乡居民健康和福祉,科学客观测算乡村地区公共医疗设施公平可达性具有重要意义。乡村地区人口规模较小且分散居住,居民就医行为有别于城市居民,2SFCA或3SFCA方法难以客观揭示乡村地区人口分布规律和就医出行特征,导致评估乡村地区医疗设施可达性时效果不佳。论文根据海口市乡村居民就医出行规律选择距离衰减函数,格网化研究区形成人口需求点,考虑不同等级医疗机构对居民就医的吸引,改进了3SFCA算法,建立乡村地区公共医疗设施可达性与空间公平性评估方法体系,并以海口市为案例进行实证分析。结果表明：① 基于改进3SFCA法建立的可达性评价模型可以获得更精准客观的评价结果;② 海口市乡村地区公共医疗设施可达性整体较差且空间分异明显,高值区分布在东部的三江、云龙及甲子镇,低值区主要集中在研究区西部;③ 海口市乡村地区公共医疗设施配置的公平性不佳,少量的高和较高公平等级区域均位于中低人口密度区,而低和极低公平等级区域覆盖了广大的高人口密度区,医疗资源配置的公平性亟需改善。     

A comparative analysis of accessibility measures by the two-step floating catchment area (2SFCA) method

The recent decade has witnessed a new wave of development in the place-based accessibility theory, revolving around the two-step floating catchment area (2SFCA) method. The 2SFCA method, initially serving to evaluate the spatial inequity of health care services, has been further applied to other urban planning and facility access issues. Among these applications, different distance decay functions have been incorporated in the thread of model development, but their applicability and limitations have not been thoroughly examined. To this end, the paper has employed a place-based accessibility framework to compare the performance of twenty-four 2SFCA models in a comprehensive manner. Two important conclusions are drawn from this analysis: on a small analysis scale (e.g., community level), the catchment size is the most critical model component; on a large analysis scale (e.g., statewide), the distance decay function is of elevated importance. In sum, this comparative analysis provides the theoretical support necessary to the choice of the catchment size and the distance decay function in the 2SFCA method. Justification of model parameters through empirical evidence (e.g., field surveys about local travel activities) and model validation through sensitivity analysis are needed in future 2SFCA applications for various urban planning, service delivery, and spatial equity scenarios.     

就医空间可达性分析的两步移动搜索法——以江苏省东海县为例

精确评价医疗设施可达性的空间分异样状况是合理配置医疗资源的前提。本文在回顾国内外关于医疗空间可达性研究的基础上, 采用两步移动搜索法, 以江苏省贫困县--东海县为案例, 以行政村和医院为分析单元, 基于迪卡斯特拉算法计算出各村到医院(卫生院)的最短通行时间, 进而分析各村医疗空间可达性分异情况。采用不用服务时间阈值范围进行空间敏感性分析, 综合研判缺医地区分布特点。与传统的医卫人员和人口比值的方法相比, 两步移动搜索法能有效显示县域范围内医疗可达性的空间分异情况。采用较大的时间阈值, 医疗空间可达性分异较为平滑, 采用较小服务阈值则空间分异显著, 缺医范围也较大。东海县医疗空间可达性整体呈单核结构, 并沿主要交通线延伸, 缺医地区多分布于边缘乡镇。提高边缘乡镇的行政村的甲级卫生院等级和乡村道路等级将会改善边缘乡镇的就医可达性。     

Enhancing the Two-Step Floating Catchment Area Model for Community Food Access Mapping: Case of the Supplemental Nutrition Assistance Program

In this article, a Gaussian-based two-step floating catchment area (2SFCA) model is applied to evaluate the geographical accessibility to Supplemental Nutrition Assistance Program (SNAP)-authorized retailers. First, the proposed method considers the interaction between the food supply (in terms of categorized benefit redemptions) and demand (in terms of benefit-receiving households). Second, the model is used to visualize food access patterns at the level of refined administrative units (i.e., census block groups). The developed food access metric was compared to the U.S. Department of Agriculture (USDA) Food Access Research Atlas, justifying the validity of this new method for small area estimation. The following are important observations: (1) the choice of catchment size had a considerable impact on the accessibility measure in urban areas (or when small statistical units are used); (2) the 2SFCA measurement had a higher level of correspondence with that of the USDA Atlas at a smaller catchment size for identifying low food access units; and (3) there was no significant inequality regarding SNAP accessibility with respect to different socioeconomic deprivation variables. This new method can better assist the SNAP administration with store authorization on a refined geographic scale. Key Words: food access, inequality, scale, Supplemental Nutrition Assistance Program (SNAP), two-step floating catchment area (2SFCA).     

基于改进潜能模型的就医空间可达性度量和缺医地区判断——以江苏省如东县为例

潜能模型广泛应用于就医空间可达性评价,现有模型综合了医疗设施服务能力、居民点人口数量、医疗设施与居民点之间的出行阻抗。在此基础上通过考虑"医疗设施不同等级规模对居民就医选择行为的影响"对模型进行修正。结果表明,改进的潜能模型能够更为合理地评价就医空间可达性,准确揭示居民实际所能获取的医疗资源,结合医疗资源配置相关标准,则能有效判定缺医地区,为政府相关部门规划决策提供依据。     

两步移动搜寻法及其扩展形式研究进展

两步移动搜寻法是公共服务设施空间可达性研究中的重要方法,在国内外公共服务设施布局研究中得到了广泛应用,且发展出了众多扩展形式。但国内研究中对两步移动搜寻法尤其是其扩展形式的应用还较为有限。本文对两步移动搜寻法的主要扩展形式进行系统梳理和总结,将国内外研究中提出的两步移动搜寻法扩展形式归纳为基于引入距离衰减函数的扩展、对搜寻半径的扩展、针对需求或供给竞争的扩展以及基于出行方式的扩展4类,并分析了各种扩展形式的优缺点、适用情景以及未来可能改进方向。旨在为相关研究的方法选择提供参考,促进两步移动搜寻法及其扩展形式在国内相关领域的应用和发展。     

北京市养老设施空间可达性评价

发展养老服务是当前中国社会建设中的重要部分。近年来,北京市养老设施发展迅速,但是由于快速的人口老龄化,北京市养老设施的供给仍难以满足老年人口对养老设施的需求。对北京市养老设施空间可达性进行科学评价是进行合理空间配置的基础,具有重要的现实意义。本文基于GIS技术,应用改进的两步移动搜索法,对北京市养老设施的空间可达性进行了测算,并重点对1小时单一有效服务半径和按养老设施规模划分的三级有效服务半径这两种情形进行了比较分析。结果表明,后者对北京市养老设施的空间可达性评价更具合理性。本文对空间可达性的测算结果识别出了北京市各区域养老设施的稀缺程度,为养老设施的空间布局提出了政策性建议。     

The High Line and the ideal of democratic public space

This study examines New York’s internationally acclaimed High Line with regard to the democratic ideal of urban parks as places of social mixing among diverse groups in the city. Observational surveys were conducted to assess the levels of racial/ethnic diversity among visitors to the High Line and four other Manhattan parks, and census data were collected on the race/ethnicity of residents in surrounding neighborhoods, the borough of Manhattan, and New York City. The data show that the High Line crowd is overwhelmingly White, to a degree that is far out of line with the racial/ethnic demographics of the borough and city, that the level of racial homogeneity significantly exceeds that of other comparable parks, and that the lack of diversity cannot be explained by neighborhood composition. The author concludes that the High Line is failing as a democratic public space and draws on the work of political scientist E. E. Schattschneider to assert the importance of diversity in public spaces.     

ASIANS IN AMERICA'S SUBURBS: PATTERNS AND CONSEQUENCES OF SETTLEMENT*

ABSTRACT. In an effort to provide a more complex and multifaceted understanding of the process of spatial assimilation, this article explores alternative paths in understanding racial/ ethnic minority residential patterns. It scrutinizes patterns of contemporary Asian Indian and Chinese settlement in two metropolitan areas: Austin, Texas and Phoenix, Arizona. Though not particularly evolved in terms of their Asian immigrant settlement or dynamics, Austin and Phoenix represent the growing number of newly emergent Asian centers throughout the nation that have developed with the rapid rise of immigration from these two countries in the past several decades. The analysis utilizes records from the 2000 census to document and map Asian Indian and Chinese settlement within each metropolitan area and to investigate whether‐and to what degree‐each group is clustered or dispersed. The article then raises important questions about the consequences of concentration and dispersal for the incorporation of Asian Indian and Chinese residents.     

Ethnic and Racial Differences in Tornado Hazard Perception,Preparedness, and Shelter Lead Time in Tuscaloosa

The 27 April 2011 EF4 Tuscaloosa tornado directly impacted more than 50,000 residents, causing forty-five fatalities within the city and sixty-five in total. It was a rare urban tornado with varying impacts on the three major ethnic and racial groups within the city. A hybrid survey and interview of open-ended and closed questions was conducted with 211 Tuscaloosa area residents in a two-week period after the tornado. Results indicate significant differences in risk perception, preparedness, and shelter lead time among the three ethnic and racial groups. Furthermore, results were still significant for perception after controlling for the effects of age, education, and experience.