Geographical Access of Elderly to Health Care Centers during a 20 Years Period (1996-2016): a Case Study of Kermanshah , Iran

AbstractBackgroundIdentifying the spatial distribution of Health Care Centers (HCC) and equitable access for all members of society (especially the elderly), can be effective in health policy making. This study aimed to determine the geographical accessibility of elderly to HCC in Kermanshah metropolis during a 20 year period (1996-2016).MethodsThis was a cross-sectional applied study. The statistical population included all elderly people in Kermanshah metropolis (65 years and above). The data of this study included statistical blocks and locations of Health Centers of Kermanshah during 1996 to 2016. After data collection through the Iranian Statistical Center and Kermanshah Health Center, digitization of HCC and urban roads network was done in Geographic Information System (GIS). In addition, the walking of 12.30 minutes was determined as access time for the elderly, and the number of elderly with appropriate and inappropriate access was determined using the Network Analysis tool. Finally, the Standard Deviation Ellipse (SDE) model was used for spatial analysis of HCC and the distribution of the elderly population.ResultsThe elderly people with inappropriate access to HCC was 48.15%, 47.85%, and 36.12% in 1996, 2006 and 2016, respectively. The results also showed that there was a 14% increase in the number of new HCC in the period of 1996-2006 (14%) and 136% during 2006 to 2016. During the 20 years, the expansion of HCC was toward the northwest and west of city, and the trend of elderly population expansion was toward the south and central parts of Kermanshah.ConclusionDespite the doubling of HCC during 1996-2016, more than one-third of the elderly still do not have appropriate access to HCC. This situation indicates inappropriate spatial distribution of HCC in Kermanshah metropolis and should be considered as a challenge by health managers and policy makers.