IDEAS home Printed from https://ideas.repec.org/a/gam/jsusta/v17y2025i18p8210-d1747706.html
   My bibliography  Save this article

Regional Disparities and Determinants of Paediatric Healthcare Accessibility in Poland: A Multi-Level Assessment of Socio-Economic Drivers and Spatial Convergence (2010–2023)

Author

Listed:
  • Tadeusz Zienkiewicz

    (Department of Management, Lublin University of Technology, 20-059 Lublin, Poland)

  • Aleksandra Zalewska

    (Department of Management, Lublin University of Technology, 20-059 Lublin, Poland)

  • Ewa Zienkiewicz

    (Faculty of Paediatrics, Medical University of Lublin, 20-093 Lublin, Poland)

Abstract

This study examines regional disparities and convergence dynamics in paediatric healthcare accessibility across Poland’s 16 provinces between 2010 and 2023. A synthetic Paediatric Service Accessibility Index (PSA Index), constructed with Hellwig’s method, is combined with socio-economic indicators such as employment, urbanisation, and disposable income to evaluate the alignment between healthcare provision and regional development. The analysis employs non-parametric regional tests (Spearman’s rank correlation, Wilcoxon signed-rank test) and national panel regression models (Fixed and Random Effects). Results demonstrate significant spatial heterogeneity: economically advanced regions, including Mazowieckie and Małopolskie, show moderate to strong convergence between socio-economic progress and healthcare access, whereas structurally weaker regions such as Lubuskie and Podkarpackie reveal persistent divergence. Disposable income and urbanisation emerge as significant predictors of healthcare availability ( p < 0.01), while employment is not statistically significant. The findings highlight enduring inequalities that are relevant in the context of the European Union’s (EU) cohesion policy and indicate that economic growth alone is insufficient to ensure equitable access to paediatric care. Comparative evidence from Romania, Bulgaria, and Spain points to similar patterns and emphasises the importance of EU Structural and Investment Funds in promoting healthcare equity. The study concludes that territorially sensitive, multidimensional interventions are necessary to advance social sustainability and to align healthcare infrastructure with the Sustainable Development Goals, particularly SDG 3 (Good Health and Well-Being) and SDG 10 (Reduced Inequalities).

Suggested Citation

  • Tadeusz Zienkiewicz & Aleksandra Zalewska & Ewa Zienkiewicz, 2025. "Regional Disparities and Determinants of Paediatric Healthcare Accessibility in Poland: A Multi-Level Assessment of Socio-Economic Drivers and Spatial Convergence (2010–2023)," Sustainability, MDPI, vol. 17(18), pages 1-18, September.
  • Handle: RePEc:gam:jsusta:v:17:y:2025:i:18:p:8210-:d:1747706
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/2071-1050/17/18/8210/pdf
    Download Restriction: no

    File URL: https://www.mdpi.com/2071-1050/17/18/8210/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Reibling, Nadine & Ariaans, Mareike & Wendt, Claus, 2019. "Worlds of Healthcare: A Healthcare System Typology of OECD Countries," Health Policy, Elsevier, vol. 123(7), pages 611-620.
    2. Daniela, Antonescu & Ioana Cristina, Florescu, 2024. "The dynamics of regional inequalities in Romania. Comparative analysis between the major crises – financial and sanitary," MPRA Paper 120992, University Library of Munich, Germany.
    3. Andrew T. Young & Matthew J. Higgins & Daniel Levy, 2008. "Sigma Convergence versus Beta Convergence: Evidence from U.S. County‐Level Data," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 40(5), pages 1083-1093, August.
    4. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    5. Martin Gächter & Engelbert Theurl, 2010. "Health Status Convergence at the Local Level: Empirical Evidence from Austria," Working Papers 2010-23, Faculty of Economics and Statistics, Universität Innsbruck, revised Mar 2011.
    6. Jacopo Gabani & Sumit Mazumdar & Marc Suhrcke, 2023. "The effect of health financing systems on health system outcomes: A cross‐country panel analysis," Health Economics, John Wiley & Sons, Ltd., vol. 32(3), pages 574-619, March.
    7. Susan Athey & Guido W. Imbens, 2017. "The State of Applied Econometrics: Causality and Policy Evaluation," Journal of Economic Perspectives, American Economic Association, vol. 31(2), pages 3-32, Spring.
    8. Marcin Bogdański & Marcin Janusz, 2025. "Effective Cohesion Policy? Long-Term Economic and Social Convergence in Poland," Sustainability, MDPI, vol. 17(3), pages 1-20, January.
    9. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    10. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    11. Laura Patache & Claudiu Chiru & Iuliana Pârvu, 2021. "Study On Romanian Regional Convergence Under The Impact Of The Health Crisis," Romanian Journal of Regional Science, Romanian Regional Science Association, vol. 15(2), pages 37-52, DECEMBER.
    12. Elena Barcena-Martín & Elías Melchor-Ferrer & Salvador Pérez-Moreno, 2025. "Spatial convergence in the quality of public services: evidence from European regions," Letters in Spatial and Resource Sciences, Springer, vol. 18(1), pages 1-12, December.
    13. Roberto Ezcurra & Andr�s Rodríguez-Pose, 2013. "Political Decentralization, Economic Growth and Regional Disparities in the OECD," Regional Studies, Taylor & Francis Journals, vol. 47(3), pages 388-401, March.
    14. repec:dau:papers:123456789/10510 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    2. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    3. Nicole Black & David W. Johnston & Martin Knapp & Michael A. Shields & Gloria H. Y. Wong, 2025. "Horizontal inequity in the use of mental healthcare in Australia," Health Economics, John Wiley & Sons, Ltd., vol. 34(2), pages 297-315, February.
    4. Eddy van Doorslaer & Owen O'Donnell, 2008. "Measurement and Explanation of Inequality in Health and Health Care in Low-Income Settings," WIDER Working Paper Series DP2008-04, World Institute for Development Economic Research (UNU-WIDER).
    5. Cavagnero, Eleonora & Bilger, Marcel, 2010. "Equity during an economic crisis: Financing of the Argentine health system," Journal of Health Economics, Elsevier, vol. 29(4), pages 479-488, July.
    6. Carmen Herrero & Juan Moreno-Ternero, 2008. "Opportunity analysis of newborn screening programs," Review of Economic Design, Springer;Society for Economic Design, vol. 12(4), pages 259-277, December.
    7. Hani Fares & Jaime Pinilla Domínguez & Jaume Puig-Junoy, 2023. "Differential Probability in Unmet Healthcare Needs Among Migrants in Four European Countries," Journal of International Migration and Integration, Springer, vol. 24(4), pages 1523-1546, December.
    8. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 435-451, April.
    9. Carol Propper & John Rigg & Simon Burgess, 2007. "Child health: evidence on the roles of family income and maternal mental health from a UK birth cohort," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1245-1269, November.
    10. Godøy, Anna & Huitfeldt, Ingrid, 2020. "Regional variation in health care utilization and mortality," Journal of Health Economics, Elsevier, vol. 71(C).
    11. Angelo Castaldo & Maria Alessandra Antonelli & Valeria De Bonis & Giorgia Marini, 2020. "Determinants of health sector efficiency: evidence from a two-step analysis on 30 OECD countries," Economics Bulletin, AccessEcon, vol. 40(2), pages 1651-1666.
    12. Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.
    13. Laudicella, Mauro & Cookson, Richard & Jones, Andrew M. & Rice, Nigel, 2009. "Health care deprivation profiles in the measurement of inequality and inequity: An application to GP fundholding in the English NHS," Journal of Health Economics, Elsevier, vol. 28(6), pages 1048-1061, December.
    14. Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 803-819, October.
    15. Zhao, Guangchuan & Cao, Xinbang & Ma, Chao, 2020. "Accounting for horizontal inequity in the delivery of health care: A framework for measurement and decomposition," International Review of Economics & Finance, Elsevier, vol. 66(C), pages 13-24.
    16. Hai Zhong, 2011. "Effect of patient reimbursement method on health‐care utilization: evidence from China," Health Economics, John Wiley & Sons, Ltd., vol. 20(11), pages 1312-1329, November.
    17. Clarke, Philip & Van Ourti, Tom, 2010. "Calculating the concentration index when income is grouped," Journal of Health Economics, Elsevier, vol. 29(1), pages 151-157, January.
    18. Davillas, Apostolos & de Oliveira, Victor Hugo & Jones, Andrew M., 2023. "Is inconsistent reporting of self-assessed health persistent and systematic? Evidence from the UKHLS," Economics & Human Biology, Elsevier, vol. 49(C).
    19. Daniela Rodrigues & Noemi Kreif & Ara Darzi & Mauricio Barahona & Erik Mayer, 2025. "Digitalization of Access to Primary Care: Is There an Equity‐Efficiency Trade‐Off?," Health Economics, John Wiley & Sons, Ltd., vol. 34(10), pages 1943-1962, October.
    20. Cavalieri, Marina & Ferrante, Livio, 2020. "Convergence, decentralization and spatial effects: An analysis of Italian regional health outcomes," Health Policy, Elsevier, vol. 124(2), pages 164-173.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jsusta:v:17:y:2025:i:18:p:8210-:d:1747706. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.