The challenge of access to healthcare services as a condition for territorial equity. A methodological approach for sparsely populated rural areas

Access to basic healthcare services poses a significant challenge for sparsely populated rural areas within the European Union, impacting fundamental principles such as territorial equity. This challenge is intensified by current demographic trends, including depopulation and ageing, which affect both the availability of healthcare professionals and the increased demand for efficient healthcare services for the older population. To address this issue, the present study adopts a methodological approach that uses distance and transport time to measure the accessibility of different rural municipalities to healthcare facilities. This study focuses on the Autonomous Region of Castilla-La Mancha (Spain) as a representative territory for the abovementioned demographic dynamics. The main results indicate a clear relationship between negative demographic indicators and poorer healthcare access, especially in rural areas with limited transportation infrastructure. Access to primary healthcare is generally well distributed, with >90 % of rural population living within 15 min of a basic healthcare facility, while hospitals are less accessible for the rural population, with >40 % of the sample needing 30 min to reach one. The sample is also highly sensitive to the population density and ageing rates. As a significant contribution, a universal methodology is presented that can be applied to other rural territories with a significant ageing population, enabling territorial planning policies to optimize quality healthcare in line with the active ageing policies promoted by the United Nations.