Spatial access, need and equity : an analysis of the accessibility of primary health facilities for the elderly in parts of east Kent

The medical care produced by the National Health Service can be regarded as a form of impure public good, partly because medical care is available from health facilities with varying spatial accessibility for the population. The cost of health care may be inequitable since ’subjective' as well as 'objective' friction of distance can affect the cost for individuals of obtaining health care. Information on'perceived' and 'objective' spatial access to health facilities is therefore relevant to planning decisions for health service provision. The elderly represent a client group that is particularly likely to experience poor spatial access to facilities, yet they have a high need for services. Also individual elderly people with certain characteristics are especially susceptible to problems of spatial access to health care. Clearly the spatial organization of service facilities is also significant in any study of variation in spatial accessibility between clients. An empirical study was made of primary care facilities in East Kent, focusing on aspects of spatial access for elderly residents of two Medical Practice Areas. Location-allocation analysis of surgery positions demonstrated how their spatial organization might influence aggregate travel costs and variation in travel costs for clients. A survey was conducted of a sample of elderly respondents drawn from a group particularly likely to experience access difficulty. 'Perceived' difficulty of access to the doctor's surgery among interviewees was found to be associated with 'objective' indicators of low accessibility and was inequitable in view of their health care needs. Individual and aggregated responses suggested some explanations for the perceptions recorded. The implications of the study for public service provision to the elderly are considered.