A three-step floating catchment area method for analyzing spatial access to health services

Gravity-based spatial access models have been widely used to estimate spatial access to healthcare services in an attempt to capture the interaction of various factors. However, these models are inadequate in informing health resource allocation work due to their inappropriate assumption of healthcare demand. For the purpose of effective healthcare resource planning, this article proposes a three-step floating catchment area (3SFCA) method to minimize the healthcare-demand overestimation problem. Specifically, a spatial impedance-based competition scheme is incorporated into the enhanced two-step floating catchment area (E2SFCA) method to account for a reasonable model of healthcare supply and demand. A case study of spatial access to primary care physicians along the Austin-San Antonio corridor area in central Texas showed that the proposed method effectively minimizes the overestimation of healthcare demand and reflects a more balanced geographic pattern of spatial access than E2SFCA. In addition, by using an adjusted spatial access index, the 3SFCA method indicates strong potential for identifying health professional shortage areas. The study concludes that 3SFCA is a promising method to provide health professionals and decision makers with useful healthcare accessibility information.