Spatial Models of Health Outcomes and Health Behaviors: The Role of Health Care Accessibility and Availability

It is still open to debate whether increased availability and accessibility of physicians and health care services has a significant beneficial impact on the health status of populations in the United States. While there is convincing evidence that increased availability and accessibility has a significant beneficial impact on the health status of populations in developing countries (see, e.g., Lavy et al. 1996; Frankenberger 1995; Perry and Gesler 2000), a large body of literature suggests that additional resources spent on health do not significantly reduce mortality in the United States (Thornton 2002; Hadley 1982; Auster et al. 1969). A recent review of the literature on primary care and health in developed countries, however, suggests that the supply of primary care physicians is positively related to population health (Starfield et al. 2005). Moreover, medical care may not influence gross mortality but it may affect mortality rates of particular subgroups, the morbidity of the population, and preventative health behaviors (Anderson and Morrison 1989). In addition, spatial variations in the use and quality of medical care (Skinner 2006; Chan et al. 2006) may confound a simple link between access to health care and health care outcomes. The mixed evidence on the link between population health and health service provision and accessibility challenges policymakers who have to determine how to equitably allocate medical resources to improve public health, particularly in medically underserved areas.