Framework for examining the spatial equity and sustainability of general practitioner services

Abstract

Objective: To propose a framework for examining both the spatial equity and sustainability of GP services.

Design: A conceptual discussion based on a systematic literature review of spatial equity definitions and methods.

Setting: Improving the spatial equity of health services is a key step in achieving health equity. Health systems should contribute to achieving health equity and maintain equitable services into the future. The GP services are a key component of primary health care, which often aims to promote health equity. Despite the importance of spatially equitable and sustainable GP services, a framework for analysis has not yet been established.

Main outcome measure: Examples of how the proposed framework could be implemented are provided from the New Zealand health care context.

Result: The framework entails three steps: (i) defining spatial equity and sustainability; (ii) estimating current and future distributions of health services and needs; and (iii) quantifying spatial equity and sustainability. In step (i), a needs-based distribution is the most common definition of spatial equity, while sustainability is the ability to provide ongoing equitable access. Step (ii) depends on current and future estimates of access and need within a well-defined geographical area. In step (iii), spatial equity and sustainability should be quantified through measures, such as the Gini coefficient. Current and future levels of spatial equity should then be compared to assess the sustainability of equitable GP services.

Conclusion: This article outlines a novel conceptual framework for examining the spatial equitability and sustainability of GP services.

Keywords: access; health services access; new models and frameworks; primary health care; rural general practice.