Geographic and Perceived Healthcare Access Equity among Patients with Acute Cardiovascular Event in China

Introduction: In acute cardiovascular event (ACE) such as stroke and myocardial infarction, access to comprehensive, timely, and quality healthcare services was critical for receiving appropriate treatment and improving prognosis. However, due to significant disparities on distribution of healthcare resources, allocating the limited resources to regions and population in needs was a key challenge for China. This study aimed to evaluate both geographic and perceived healthcare access of ACE patients in China, find inconsistency and furtherly improve it.Methods: This study was conducted in Hangzhou (a capital city of Zhejiang Province in southeast China) city. We conducted a ground-truthed field census to locate and confirm all institutions based on their locations. Geographic Information System (GIS) was used to analyze the geographic healthcare access (e.g. distance to nearest institution, density of institutions in the area etc.) and potential distribution disparities. Meanwhile, we sampled 21 ACE patients from one typical hospital in Shangcheng District in a pilot study, and a questionnaire-based face-to-face survey was conducted to collect data on perceptions of healthcare access, including perceived presence of institutions, perceived distance to nearest institution, perceived affordability of healthcare etc.Results: A number of 2,763 healthcare institutions were recognized, confirmed and geocoded in the GIS. The geographic healthcare access was excellent for city residents and over 95% of the city areas were within 15-minute access-buffer. However, only 10.2% institutions could provide emergency services and among them only 7.8% institutions could provide emergency services for ACE patients. Based on patient survey, approximately 33.3% ACE patients reported healthcare access was not good in their living areas. Average perceived distance and time to the nearest healthcare institution were 6.9±4.7 km and 23.8±13.7 minutes, respectively. The majority of the patients reported that no emergency services were localized near their homes. When the ACEs happened, 85.7% of the patients were transported by the ambulance.Discussion: The knowledge generated from this study could form a basis for understanding of healthcare access in China. Access to emergency healthcare services was poor in some areas in the city. The mapping data showed an excellent healthcare access for residents, but the patients did not all perceive this. Compared to geographic data, patients perceived longer distance and duration of time to the nearest healthcare institution. The inconsistence might be due to the traffic condition in city area, urban planning, mode of transportation, and inconsistence of accessibility captured by GIS and perceptions.Lessons learned: The findings of this proposed study would guide policy deliberations and healthcare resources allocations. It would provide instrumental information for policy makers to target interventions to improve both geographic and perceived healthcare access.Limitations: The recruitment of patient survey was limited at the pilot stage.

Business · Cartography · Census · China · Economic growth · Environmental health · Equity (law · Family medicine · Geographic information system · Geography · Health care · Medical emergency · Political science · Population · Socioeconomics · Chronic Disease Management Strategies · Healthcare Systems and Practices · Medicine · Patient Satisfaction in Healthcare