Factoring in temporal variations of public transit-based healthcare accessibility and equity

Abstract

Access to healthcare services using public transportation (PT-based healthcare accessibility) is a crucial aspect in achieving healthcare equity as it affects individuals’ ability to receive healthcare. Previous research has focused on the spatial features of healthcare accessibility. However, less attention has been given to its temporal characteristics, which can be influenced by transit schedules, multimodal connectivity, congestion, and other factors. This study proposes a framework to better understand the impacts of temporally varying PT-based healthcare accessibility on healthcare equity. A case study of Shanghai, China is used to illustrate the temporal variation of healthcare accessibility, with a focus on hourly inter- and intra-regional disparities. These disparities are captured using the Gini coefficient and Theil index. Additionally, the study introduces bivariate local Moran’s I to identify healthcare shortage areas and evaluate the spatial autocorrelation between population density and healthcare accessibility. The findings of this study reveal that the accessibility to healthcare services experiences significant fluctuations throughout the day, leading to temporal variations in healthcare equity. Subway service quality contributes more to temporal variations than bus service quality. The lowest point of such equity is reached when PT operates at its full capacity. On a spatial level, individuals residing in newly developed regions, which surround the historical urban core or recently planned city subcenters, tend to experience decreased accessibility to healthcare via public transportation. Consequently, it results in a heightened reliance on motorized transportation in these areas. These findings provide insights that can inform the design of PT accessibility-based strategies, healthcare improvement plans and inclusive housing policies, to address healthcare equity issues in metropolitan areas. By considering both spatial and temporal factors, we can better understand the complex relationships between transportation and healthcare accessibility to promote equitable access to healthcare services and foster social equity.