title: Developing a composite index of spatial accessibility across different health care sectors: A German example.
abstract: The evolving lack of ambulatory care providers especially in rural areas increasingly challenges the strict separation between ambulatory and inpatient care in Germany. Some consider allowing hospitals to treat ambulatory patients to tackle potential shortages of ambulatory care in underserved areas. In this paper, we develop an integrated index of spatial accessibility covering multiple dimensions of health care. This index may contribute to the empirical evidence concerning potential risks and benefits of integrating the currently separated health care sectors. Accessibility is measured separately for each type of care based on official data at the district level. Applying an Improved Gravity Model allows us to factor in potential cross-border utilization. We combine the accessibilities for each type of care into a univariate index by adapting the concept of regional multiple deprivation measurement to allow for a limited substitutability between health care sectors. The results suggest that better health care accessibility in urban areas persists when taking a holistic view. We believe that this new index may provide an empirical basis for an inter-sectoral capacity planning.
authors.affiliation: Berlin Centre of Health Economics Research (BerlinHECOR), Department of Health Care Management, Technische Universität Berlin, H80, Straße des 17. Juni 135, 10623 Berlin, Germany.. Electronic address: martin.siegel@tu-berlin.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Siegel
authors.affiliation: Department of Health Services Management, Ludwig-Maximilians-Universität München, Schackstraße 4, 80539 München, Germany. Electronic address: koller@bwl.lmu.de.
authors.forename: Daniela
authors.initials: D
authors.lastname: Koller
authors.affiliation: Berlin Centre of Health Economics Research (BerlinHECOR), Department of Health Care Management, Technische Universität Berlin, H80, Straße des 17. Juni 135, 10623 Berlin, Germany.. Electronic address: verena.vogt@tu-berlin.de.
authors.forename: Verena
authors.initials: V
authors.lastname: Vogt
authors.affiliation: Department of Health Services Management, Ludwig-Maximilians-Universität München, Schackstraße 4, 80539 München, Germany. Electronic address: sundmacher@bwl.lmu.de.
authors.forename: Leonie
authors.initials: L
authors.lastname: Sundmacher
mesh_terms: D000554:Ambulatory Care Facilities / Q000600:supply & distribution*; D057191:Capacity Building; D005858:Germany; D019981:Health Care Sector; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans
keywords: Access to health care; Ambulatory care; Capacity planning; Germany; Health geography; Inpatient care; Measurement