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

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  • Rosero-Bixby, Luis

Abstract

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.

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  • 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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    1. Vani Borooah, 2000. "The Welfare of Children in Central India: Econometric Analysis and Policy Simulation," Oxford Development Studies, Taylor & Francis Journals, vol. 28(3), pages 263-287.
    2. Geeta Gandhi Kingdon & Jeemol Unni, 2001. "Education and Women's Labour Market Outcomes in India," Education Economics, Taylor & Francis Journals, vol. 9(2), pages 173-195.
    3. Cowell, Frank A & Jenkins, Stephen P, 1995. "How Much Inequality Can We Explain? A Methodology and an Application to the United States," Economic Journal, Royal Economic Society, vol. 105(429), pages 421-430, March.
    4. Basu, Kaushik & Foster, James E, 1998. "On Measuring Literacy," Economic Journal, Royal Economic Society, vol. 108(451), pages 1733-1749, November.
    5. Lavy, Victor & Strauss, John & Thomas, Duncan & de Vreyer, Philippe, 1996. "Quality of health care, survival and health outcomes in Ghana," Journal of Health Economics, Elsevier, vol. 15(3), pages 333-357, June.
    6. Oaxaca, Ronald, 1973. "Male-Female Wage Differentials in Urban Labor Markets," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 14(3), pages 693-709, October.
    7. Borooah, Vani, 2003. "Births, Infants and Children: an Econometric Portrait of Women and Children in India," MPRA Paper 19620, University Library of Munich, Germany.
    8. Klasen, Stephan, 1994. ""Missing women" reconsidered," World Development, Elsevier, vol. 22(7), pages 1061-1071, July.
    9. Mark Rosenzweig & Andrew D. Foster, "undated". "Technical Change and Human Capital Returns and Investments: Evidence from the Green Revolution," Home Pages _065, University of Pennsylvania.
    10. Behrman, Jere R & Wolfe, Barbara L, 1984. "The Socioeconomic Impact of Schooling in a Developing Country," The Review of Economics and Statistics, MIT Press, vol. 66(2), pages 296-303, May.
    11. Gibson, John, 2001. "Literacy and Intrahousehold Externalities," World Development, Elsevier, vol. 29(1), pages 155-166, January.
    12. Ravallion, Martin & Wodon, Quentin, 2000. "Does Child Labour Displace Schooling? Evidence on Behavioural Responses to an Enrollment Subsidy," Economic Journal, Royal Economic Society, vol. 110(462), pages 158-175, March.
    13. Caldwell, John C., 1993. "Health transition: The cultural, social and behavioural determinants of health in the Third World," Social Science & Medicine, Elsevier, pages 125-135.
    14. Nielsen, Helena Skyt, 1998. "Discrimination and detailed decomposition in a logit model," Economics Letters, Elsevier, vol. 61(1), pages 115-120, October.
    15. Foster, Andrew D & Rosenzweig, Mark R, 1996. "Technical Change and Human-Capital Returns and Investments: Evidence from the Green Revolution," American Economic Review, American Economic Association, vol. 86(4), pages 931-953, September.
    Full references (including those not matched with items on IDEAS)

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    Cited by:

    1. Gibson, John & McKenzie, David, 2007. "Using the global positioning system in household surveys for better economics and better policy," Policy Research Working Paper Series 4195, The World Bank.
    2. 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.
    3. repec:spr:soinre:v:133:y:2017:i:2:d:10.1007_s11205-016-1371-9 is not listed on IDEAS
    4. Welch, Timothy F., 2013. "Equity in transport: The distribution of transit access and connectivity among affordable housing units," Transport Policy, Elsevier, pages 283-293.
    5. 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, pages 60-68.
    6. 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.
    7. 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.
    8. 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.
    9. 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.
    10. Aoun, Nael & Matsuda, Hirotaka & Sekiyama, Makiko, 2015. "Geographical accessibility to healthcare and malnutrition in Rwanda," Social Science & Medicine, Elsevier, pages 135-145.
    11. 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.
    12. 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) 3922, Inter-American Development Bank.
    13. 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.

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