Identifying Aging Villages with Primary Care Shortages: A Geographic Information System Approach 615 Identifying Aging Villages with Primary Care Shortages: A Geographic Information System Approach Tsanyu Kuo College of Social Science, National Chengchi University (NCCU), Taiwan [email protected]* Abstract the public sector’s responsibility to step in and increase the supply. This study aims to identify villages with low or no This study focuses on the relationship between public medical resources. Two counties in Taiwan— medical resource and aging population and is Chiayi and Yunlin—were selected for this purpose motivated by the prediction that Taiwan will become a because they have the highest aging ratio in Taiwan, super-aged society (i.e., with more than 20% of the which could potentially lead to high demands for primary population over age 65) by 2026 and the estimation care clinics. The enhanced two-step floating catchment that there will be zero population growth before 2027. area method was used to calculate the potential spatial This would lead to a growth of medical demands. It is accessibility of each village. Spatial autocorrelation important for health authorities to ensure good spatial analysis was further used to locate spatial clusters of distribution of medical institutions, not only for the villages with low clinic accessibility. This study found physical welfare of the elderly but also to alleviate the that 45.4% of the population living in the villages in burden of the working population. Chiayi and Yunlin had insufficient medical resources Among all medical institutions, primary care clinics while 0.74% (8,799 people) had no access to primary care are the most accessible. They diagnose illnesses in the clinics at all. The study recommends that health early stages and provide a direct referral to nearby authorities shift public medical resources from hospitals, which is especially crucial for the older oversupplied areas (i.e., southwestern Chiayi) to shortage population. According to American Academy of areas (i.e., eastern Chiayi and western Yunlin) to increase their medical resources. Family Physicians, improvement of primary care clinics can result in better health care, as family Keywords: Aging society, Primary care services, GIS, physicians are familiar with their patients’ medical Spatial accessibility, Spatial autocorrelation history. This has been proven to decrease overall outpatient visits to medical institutions. Primary care can be further broken down into family medicine, 1 Introduction internal medicine, paediatric medicine, obstetrics, and gynaecology [1-3]. This study investigates the accessibility of primary This study investigates the potential accessibility of care clinics and its relationship with aging primary medical care in Chiayi County and Yunlin communities. The goal is to identify villages (1) with County in Taiwan, as both have the highest ratio of the low spatial accessibility of primary care clinics, (2) a aging population at 19.68% and 18.52%, respectively. high aging percentage, and (3) low distribution of Despite its proximity to Chiayi County, Chiayi City is public clinics. Meeting all three criteria means that a excluded from the study because it has a relatively village is suffering from a medical resource shortage. lower percentage (15.94%) of elderly. Having low clinic accessibility means that a village The National Health Insurance Administration has a low supply of medical resources and a high (NHIA) is aware of the conditions in Chiayi and percentage of the population that are over 65 years old, Yunlin and has implemented mobile health care which means that the village has a high potential for services (MHS) to improve the medical resource medical demands. This study adds a third layer to this accessibility in these areas. This program provides analysis: the distribution of public clinics. Taiwan’s incentives to encourages doctors to provide services in medical operators are mostly private. The value of villages where there are currently no registered medical health authorities is to fill the supply gaps that are institutions. The present study also evaluates if the ignored by the market-driven medical providers. In program is allocating resources to the areas where other words, if a village has a high medical demand but services are most needed. low medical supply due to the market mechanism, it is In recent years, the development of Geography *Corresponding Author: Tsanyu Kuo; E-mail: [email protected] DOI: 10.3966/160792642021052203011 616 Journal of Internet Technology Volume 22 (2021) No.3 Information System (GIS) has allowed researchers to Potential accessibility signifies the probable entry have more discussions on the connection between into the health care system and, specifically, the medical resource accessibility and medical treatment number of potential patients and their possible outcome. This type of research tends to calculate the characteristics. Revealed accessibility focuses on the ratio between medical resources and population [4]. actual use of health care services, that is, patients’ Other studies have investigated the distance or travel actual medical visits and their subjective satisfaction of time that patients need to reach medical service points the services. Spatial accessibility stresses the [5-6]. By obtaining spatial analysis data, researchers importance of the spatial or distance variables, which have also been able to identify areas with lower can be a barrier or a facilitator while investigating the medical resources accessibility, and thus provide impact of proximity on patients’ access to medical policy suggestions for improvement [4]. services. Aspatial accessibility emphasises the non- The current study uses the demographic data from geographic barriers, such as social class, income, the Ministry of Interior and the primary care clinic data ethnicity, age, or gender. Its goal is to understand if from the NHIA to conduct an enhanced two-step accessibility is influenced by patients’ socioeconomic floating catchment area analysis (E2SFCA) to status or other personal traits. calculate the accessibility indicator. Moreover, this GIS-based research on accessibility focuses on the study uses spatial autocorrelation to identify potential spatial interaction between patients and medical cold spots where medical resources are scarce. providers. Joseph and Philips [9] introduced the ideas Health authorities usually evaluate medical services of potential and revealed accessibility. The former by calculating the medical resource-to-population ratio signifies medical service accessibility within a space; within an administrative region. However, this ratio the latter emphasises patients’ actual utilisation of does not consider the impact of distance on patients’ medical resources. Anderson [10] simply defined medical-seeking behaviour and the possibility of potential accessibility as “the presence of enabling patients traveling to other regions to receive treatment. resources”. Khan [8] further described it as the The E2SFCA allows us to consider these two factors availability of medical resources within a certain and provides us with a more comprehensive method to spatial region or a certain distance. To reach medical evaluate medical resource accessibility. In Taiwan’s resources, one would need to locate the points of case, Change, Wen and Lai [7] have pointed out that services, define the maximum service distance, and there are significant differences between the result of assume the entire population consists of potential E2SFCA and NHIA’s medical resource evaluation medical users. The basic units of analysis are medical method. The latter ignores the spatial aspect and could service areas—be it defined by travel time or spatial result in a medical resource supply-demand mismatch. distance—rather than administrative regions. Spatial accessibility, based on the method of Chang, In sum, this study focuses on citizens’ potential Wen and Lai [7], is then combined with non-spatial spatial accessibility to primary care clinics. Revealed accessibility indicators (e.g., aging ratio) to identify accessibility is not included due to the limitation of villages with low accessibility and high potential resources for field research on patients’ actual medical- medical needs. Low medical supply may be due to the seeking behaviour. The study defines accessibility as market mechanism; we thus investigate if public “the potential medical resource that citizens have primary care clinics have helped to improve the access to within a reasonable spatial distance”. We also villages’ medical accessibility and fill the gap between examine the correlation between accessibility and other patients’ needs and private providers’ supply. non-spatial elements such as aging population and In short, this study aims to combine spatial and non- public clinic distribution. The aim is to identify spatial perspective to identify villages that suffer from villages that are suffering from a shortage of primary primary care shortages. This method is repeatable and health care. helps government agencies to target the regions that need resources the most. 2.2 Measuring Potential Accessibility In the field of paediatric research, Gnanasekaran, 2 Literature Review Boudreau, Soobader, Yucel, Hill and Kuhlthau [11] calculated the ratio between the number of paediatric This section reviews the studies on medical specialists and the number of children, to emphasize accessibility