Medical deserts in Finland: measuring the accessibility and availability of primary health care services.

Abstract

Background: Well-functioning primary health care (PHC) systems are needed to meet the challenges of aging populations and increasing care needs. However, "medical deserts", areas with poor accessibility and availability of PHC services, remain a significant issue throughout Europe, contributing to regional inequalities. Identifying the location of these areas is crucial for effective policymaking and for improving health outcomes. Our aim was to locate underserved areas in Finland by developing a medical desert index. In addition, we examined the impact of telehealth, care needs, and multiple funding sources on the index and analyzed its association with key quality indicators.

Methods: The index was calculated using routinely collected municipality-level PHC consultation data from 2022 adjusted for population care needs (availability) and the average travel time to the nearest PHC center (accessibility). Telehealth and occupational healthcare consultations were included separately. Standardized index values were mapped and categorized using descriptive analysis, and compared with indicators of healthcare utilization, care accessibility and availability, care satisfaction, and continuity of care using correlation analysis.

Results: The index displayed clear patterns of medical deserts, primarily in the rural areas of northern and eastern Finland. Approximately 13% of the Finnish population resided in medical deserts, defined as a standard score of -0.5 or lower. The inclusion of telehealth consultations appeared to improve the index values especially in some rural areas. Better accessibility and availability of PHC services, as indicated through the index, was significantly correlated with lower proportion of acute care consultations, fewer hospital care days, and lower continuity of care among clients aged 65 years and older.

Conclusions: We were able to identify medical deserts in Finland utilizing novel methodology distinct from previous indicators, and thus providing important considerations for future research on regional inequalities in accessibility and availability of PHC services. Our findings demonstrated the potential of telehealth services in mitigating medical deserts, though its appropriateness for some population groups and care needs remains unclear. We call for health policy addressing PHC service provision especially in rural areas.