UVM Theses and Dissertations
Format:
Print
Author:
Battista, Geoffrey
Dept./Program:
Community Development and Applied Economics
Year:
2014
Degree:
M.S.
Abstract:
Research shows that the health care supply, the transportation system, and personal circumstances shape accessibility to medical services. With their demographic weight and unique health problems, the aging "baby boomer" generation will have a profound impact on the demand for health care services in the United States. This change will be felt strongly in rural areas, where the population is generally older and the supplies of health care services and alternative transportation are limited. This study adds to the existing literature by comprehensively evaluating senior health care accessibility in . the state of Vermont, which has one of the oldest and most rural populations in the United States.
The study employed a mixed-method approach to assess health care accessibility. The first method used geographic information systems to map potential accessibility to health care. The service areas of four health care facility types were calculated in ArcGIS using three modal measurements: automobile driving times, fixed-line transit routing, and operating areas of demand-response transit agencies. The service areas were then indexed to indicate areas at-risk for health care inaccessibility. The second method used a flexible qualitative approach to enrich the quantitatively-derived perspective. Twenty seniors recounted their transportation-to-health care experiences in semi-structured interviews. Their perspectives were synthesized into common themes, which were compared against the objective GIS perspective.
The results suggest the health care supply, transportation system, and individual circumstances influence accessibility to care among rural seniors. Generalist care (general practitioners, nurse practitioners, family practice) was the most accessible health care type among Vermont seniors. The spatial concentration of specialists and dialysis were barriers to care, especially in isolated rural areas where residents face longer driving times and less fixed-line transit access. Health conditions and financial constraints were additional barriers to care. However, Vermont seniors were generally content with their access to care. The universal proliferation of demand-response medical transportation for seniors has ensured a fundamental level of health care accessibility across the state. Social networks, visiting medical specialists, and alternative transportation options further promoted health care accessibility. The research suggests accessibility-enabling solutions should consider these themes as a package. Future research should explore the interaction between institutions, social networks, transportation, and health care accessibility in greater depth.
The study employed a mixed-method approach to assess health care accessibility. The first method used geographic information systems to map potential accessibility to health care. The service areas of four health care facility types were calculated in ArcGIS using three modal measurements: automobile driving times, fixed-line transit routing, and operating areas of demand-response transit agencies. The service areas were then indexed to indicate areas at-risk for health care inaccessibility. The second method used a flexible qualitative approach to enrich the quantitatively-derived perspective. Twenty seniors recounted their transportation-to-health care experiences in semi-structured interviews. Their perspectives were synthesized into common themes, which were compared against the objective GIS perspective.
The results suggest the health care supply, transportation system, and individual circumstances influence accessibility to care among rural seniors. Generalist care (general practitioners, nurse practitioners, family practice) was the most accessible health care type among Vermont seniors. The spatial concentration of specialists and dialysis were barriers to care, especially in isolated rural areas where residents face longer driving times and less fixed-line transit access. Health conditions and financial constraints were additional barriers to care. However, Vermont seniors were generally content with their access to care. The universal proliferation of demand-response medical transportation for seniors has ensured a fundamental level of health care accessibility across the state. Social networks, visiting medical specialists, and alternative transportation options further promoted health care accessibility. The research suggests accessibility-enabling solutions should consider these themes as a package. Future research should explore the interaction between institutions, social networks, transportation, and health care accessibility in greater depth.