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Spatial access to health care in Costa Rica and its equity: a GIS-based study


  • Rosero-Bixby, Luis


This study assembles a geographic information system (GIS) to relate the 2000 census population (demand) with an inventory of health facilities (supply). It assesses the equity in access to health care by Costa Ricans and the impact on it by the ongoing reform of the health sector. It uses traditional measurements of access based on the distance to the closest facility and proposes a more comprehensive index of accessibility that results from the aggregation of all facilities weighted by their size, proximity, and characteristics of both the population and the facility. The weighting factors of this index were determined with an econometric analysis of clinic choice in a national household sample. Half Costa Ricans reside less than 1Â km away from an outpatient care outlet and 5Â km away from a hospital. In equity terms, 12-14% of population are underserved according to three indicators: having an outpatient outlet within 4Â km, a hospital within 25Â km, and less than 0.2 MD yearly hours per person. The data show substantial improvements in access (and equity) to outpatient care between 1994 and 2000. These improvements are linked to the health sector reform implemented since 1995. The share of the population whose access to outpatient health care (density indicator) was inequitable declined from 30% to 22% in pioneering areas where reform began in 1995-96. By contrast, in areas where reform has not occurred by 2001, the proportion underserved has slightly increased from 7% to 9%. Similar results come from a simpler index based on the distance to the nearest facility. Access to hospital care has held steady in this period. The reform achieved this result by targeting the least privileged population first, and by including such measures as new community medical offices and Basic Teams for Integrated Health Care (EBAIS) to work with these populations. The GIS platform developed for this study allows pinpointing communities with inadequate access to health care, where interventions to improve access would have the greatest impact.

Suggested Citation

  • Rosero-Bixby, Luis, 2004. "Spatial access to health care in Costa Rica and its equity: a GIS-based study," Social Science & Medicine, Elsevier, vol. 58(7), pages 1271-1284, April.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:7:p:1271-1284

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    Cited by:

    1. Erik Hansson & Mahmood Sasa & Kristoffer Mattisson & Arodys Robles & José María Gutiérrez, 2013. "Using Geographical Information Systems to Identify Populations in Need of Improved Accessibility to Antivenom Treatment for Snakebite Envenoming in Costa Rica," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 7(1), pages 1-13, January.
    2. Javier Escobal & Sonia Laszlo, 2008. "Measurement Error in Access to Markets," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 70(2), pages 209-243, April.
    3. Marco Marozzi & Mario Bolzan, 2018. "An Index of Household Accessibility to Basic Services: A Study of Italian Regions," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 136(3), pages 1237-1250, April.
    4. Aoun, Nael & Matsuda, Hirotaka & Sekiyama, Makiko, 2015. "Geographical accessibility to healthcare and malnutrition in Rwanda," Social Science & Medicine, Elsevier, vol. 130(C), pages 135-145.
    5. Jinxia Zhu & Qian Xu & Yi Pan & Lefeng Qiu & Yi Peng & Haijun Bao, 2018. "Land-Acquisition and Resettlement (LAR) Conflicts: A Perspective of Spatial Injustice of Urban Public Resources Allocation," Sustainability, MDPI, Open Access Journal, vol. 10(3), pages 1-15, March.
    6. John Gibson & David McKenzie, 2007. "Using Global Positioning Systems in Household Surveys for Better Economics and Better Policy," World Bank Research Observer, World Bank Group, vol. 22(2), pages 217-241, September.
    7. Welch, Timothy F. & Mishra, Sabyasachee, 2013. "A measure of equity for public transit connectivity," Journal of Transport Geography, Elsevier, vol. 33(C), pages 29-41.
    8. Gerson Javier Pérez Valbuena, 2013. "Barranquilla: avances recientes en sus indicadores socioeconómicos, y logros en la accesibilidad geográfica a la red pública hospitalaria," Documentos de trabajo sobre Economía Regional y Urbana 185, Banco de la Republica de Colombia.
    9. Welch, Timothy F., 2013. "Equity in transport: The distribution of transit access and connectivity among affordable housing units," Transport Policy, Elsevier, vol. 30(C), pages 283-293.
    10. Yao, Jing & Murray, Alan T. & Agadjanian, Victor, 2013. "A geographical perspective on access to sexual and reproductive health care for women in rural Africa," Social Science & Medicine, Elsevier, vol. 96(C), pages 60-68.
    11. Jana, Arnab & Harata, Noboru, 2016. "Provisioning health care infrastructure in communities: Empirical evidences from West Bengal, India," Socio-Economic Planning Sciences, Elsevier, vol. 54(C), pages 37-46.
    12. Gerson Javier Pérez V., 2013. "Accesibilidad geográfica y equidad en la prestación del servicio de salud: un estudio de caso para Barranquilla," BORRADORES DE ECONOMIA 010853, BANCO DE LA REPÚBLICA.
    13. Kruk, Margaret Elizabeth & Freedman, Lynn P., 2008. "Assessing health system performance in developing countries: A review of the literature," Health Policy, Elsevier, vol. 85(3), pages 263-276, March.
    14. Pablo Cabrera-Barona & Thomas Blaschke & Stefan Kienberger, 2017. "Explaining Accessibility and Satisfaction Related to Healthcare: A Mixed-Methods Approach," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 133(2), pages 719-739, September.
    15. Kruk, Margaret Elizabeth & Porignon, Denis & Rockers, Peter C. & Van Lerberghe, Wim, 2010. "The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives," Social Science & Medicine, Elsevier, vol. 70(6), pages 904-911, March.
    16. Páez, Antonio & Scott, Darren M. & Morency, Catherine, 2012. "Measuring accessibility: positive and normative implementations of various accessibility indicators," Journal of Transport Geography, Elsevier, vol. 25(C), pages 141-153.
    17. Corbacho, Ana & Osorio Rivas, Rene, 2012. "Travelling the Distance: A GPS-Based Study of the Access to Birth Registration Services in Latin America and the Caribbean," IDB Publications (Working Papers) 3922, Inter-American Development Bank.
    18. Ana Corbacho & Rene Osorio Rivas, 2012. "Travelling the Distance: A GPS-Based Study of the Access to Birth Registration Services in Latin America and the Caribbean," IDB Publications (Working Papers) 64458, Inter-American Development Bank.
    19. Neutens, Tijs, 2015. "Accessibility, equity and health care: review and research directions for transport geographers," Journal of Transport Geography, Elsevier, vol. 43(C), pages 14-27.


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