Examining access to GP services in rural Ireland using microsimulation analysis

This paper analyses the effect accessibility has on General Practitioner (GP) utilisationrates at the sub-national level for Ireland. Specifically, the aim of this paper is to estimatewhether there is an urban–rural differential in GP utilisation rates. We do this bysimulating micro-level healthcare data. Using this synthetic data, simple logit models areemployed to estimate the likelihood that individuals in different jurisdictions will attend aGP surgery. These individual logit estimates are then inputted into a spatial interactionmodel to highlight areas with low GP accessibility given their health status. The policyimplications of these results are discussed in relation to both the healthcare literature andcurrent Irish healthcare policy.

[1]  P. Townsend,et al.  Health and Deprivation: Inequality and the North , 1987 .

[2]  T. Nakaya,et al.  An analysis of inter-municipal migration flows in Japan using GIS and spatial interaction modeling , 2000 .

[3]  V. Carstairs,et al.  Deprivation: explaining differences in mortality between Scotland and England and Wales. , 1989, BMJ.

[4]  Graham P. Clarke,et al.  Spatial microsimulation modelling for retail market analysis at the small-area level , 2007, Comput. Environ. Urban Syst..

[5]  J T Hart,et al.  THE INVERSE CARE LAW , 1971 .

[6]  Alan Wilson.  Urban and regional models in geography and planning , 1974 .

[7]  A. Hope,et al.  Influence of sociodemographic and neighbourhood factors on self rated health and quality of life in rural communities: findings from the Agriproject in the Republic of Ireland , 2004, Journal of Epidemiology and Community Health.

[8]  D. Madden,et al.  GP reimbursement and visiting behaviour in Ireland. , 2005, Health economics.

[9]  A. Pienta,et al.  Inequality in men's mortality: the socioeconomic status gradient and geographic context. , 1997, Journal of health and social behavior.

[10]  Graham Clarke,et al.  Building a static farm level spatial microsimulation model for rural development and agricultural policy analysis in Ireland , 2009 .

[11]  I Diamond,et al.  A multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness , 2001, Journal of epidemiology and community health.

[12]  R. Reading,et al.  A rural advantage? Urban-rural health differences in northern England. , 1992, Journal of public health medicine.

[13]  Martin Clarke,et al.  Synthesis—A Synthetic Spatial Information System for Urban and Regional Analysis: Methods and Examples , 1988 .

[14]  Graham Clarke,et al.  Modelling the Local Impacts of National Social Policies: A Spatial Microsimulation Approach , 2001 .

[15]  C. Guy,et al.  Deriving Indicators of Access to Food Retail Provision in British Cities: Studies of Cardiff, Leeds and Bradford , 2002 .

[16]  I Diamond,et al.  Interrelations between three proxies of health care need at the small area level: an urban/rural comparison , 2002, Journal of epidemiology and community health.

[17]  M. O'Kelly,et al.  Activity Levels at Hub Facilities in Interacting Networks , 2010 .

[18]  Graham Clarke,et al.  Spatial microsimulation for rural policy analysis in Ireland: The implications of CAP reforms for the national spatial strategy , 2006 .

[19]  Tomoki Nakaya,et al.  Combining microsimulation and spatial interaction models for retail location analysis , 2007, J. Geogr. Syst..

[20]  J. Cox.  Poverty in rural areas , 1998, BMJ.

[21]  Peter Congdon.  The Impact of Area Context on Long Term Illness and Premature Mortality: An Illustration of Multi-level Analysis , 1995 .

[22]  Tomoki Nakaya,et al.  Hierarchical Destination Choice and Spatial Interaction Modelling: A Simulation Experiment , 2001 .

[23]  Graham Clarke,et al.  SimBritain: a spatial microsimulation approach to population dynamics , 2005 .

[24]  R. Haynes,et al.  Mortality, long-term illness and deprivation in rural and metropolitan wards of England and Wales. , 1999, Health & place.