Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index

Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index Marlena Jolanta Piekut, Jolanta Agnieszka Pacian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7663418/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Feb, 2026 Read the published version in BMC Health Services Research → Version 1 posted 13 You are reading this latest preprint version Abstract Background Coordinated care has been introduced in Poland since 2022 as a nationwide reform to improve healthcare continuity and reduce patient out-of-pocket expenditures. However, the regional implementation of coordinated care remains uneven, with limited evidence on equity and household-level impacts. This study aimed to assess territorial disparities in access to coordinated healthcare in Poland by integrating infrastructural, financial, and perceptual dimensions. Methods We combined administrative data on healthcare providers with anonymized household-level data from the 2023 Household Budget Survey (28,089 households). A synthetic Accessibility and Satisfaction Index (ASI) was developed, incorporating three weighted components: number of coordinated care facilities per 10,000 inhabitants (0.4), Subjective Index of Health Needs Satisfaction (0.3), and Household Economic Burden Index (0.3). Concentration indices (Gini, Theil, Shannon entropy) and correlation analyses (Pearson, Spearman) were applied to assess interregional inequalities and relationships between accessibility, household income, and healthcare expenditures. Results Although coordinated care facilities were relatively evenly distributed nationwide (Gini = 0.134; Theil = 0.0288; Shannon entropy = 2.744), the ASI revealed significant disparities in effective access. Lubelskie (0.851), Dolnośląskie (0.781), and Świętokrzyskie (0.765) achieved the highest ASI scores, while Wielkopolskie (0.563) and Opolskie (0.543) ranked lowest. Infrastructural availability strongly correlated with ASI values (r = 0.78), whereas subjective satisfaction showed weak associations (r = 0.07). Household income was negatively correlated with the health expenditure burden (r = − 0.46), confirming the regressive character of private health costs. Expenditures on pharmaceuticals were negatively associated with facility availability (r = − 0.28), suggesting self-medication in regions with limited access. Conclusions The findings confirm that infrastructure is the main determinant of coordinated healthcare accessibility in Poland, while subjective satisfaction plays a minor role. The proposed ASI offers a valid and stable synthetic tool for evaluating spatial disparities in access to coordinated healthcare. Policymakers should prioritize harmonizing regional infrastructure, monitoring waiting times, and integrating financial and perceptual dimensions into health system evaluation. Coordinated care Healthcare accessibility Regional inequalities Household health expenditures Health policy Poland Full Text Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Published Journal Publication published 19 Feb, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 06 Jan, 2026 Reviews received at journal 04 Jan, 2026 Reviewers agreed at journal 16 Dec, 2025 Reviewers agreed at journal 12 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviews received at journal 06 Nov, 2025 Reviewers agreed at journal 21 Oct, 2025 Reviewers agreed at journal 17 Oct, 2025 Reviewers invited by journal 03 Oct, 2025 Editor invited by journal 30 Sep, 2025 Editor assigned by journal 29 Sep, 2025 Submission checks completed at journal 29 Sep, 2025 First submitted to journal 20 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7663418","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528674237,"identity":"3fbbeb6b-1fe0-4164-8c67-ca5edf961be9","order_by":0,"name":"Marlena Jolanta 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Coordinated care, Healthcare accessibility, Regional inequalities, Household health expenditures, Health policy, Poland","lastPublishedDoi":"10.21203/rs.3.rs-7663418/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7663418/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCoordinated care has been introduced in Poland since 2022 as a nationwide reform to improve healthcare continuity and reduce patient out-of-pocket expenditures. However, the regional implementation of coordinated care remains uneven, with limited evidence on equity and household-level impacts. This study aimed to assess territorial disparities in access to coordinated healthcare in Poland by integrating infrastructural, financial, and perceptual dimensions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe combined administrative data on healthcare providers with anonymized household-level data from the 2023 Household Budget Survey (28,089 households). A synthetic \u003cem\u003eAccessibility and Satisfaction Index (ASI)\u003c/em\u003e was developed, incorporating three weighted components: number of coordinated care facilities per 10,000 inhabitants (0.4), Subjective Index of Health Needs Satisfaction (0.3), and Household Economic Burden Index (0.3). Concentration indices (Gini, Theil, Shannon entropy) and correlation analyses (Pearson, Spearman) were applied to assess interregional inequalities and relationships between accessibility, household income, and healthcare expenditures.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAlthough coordinated care facilities were relatively evenly distributed nationwide (Gini\u0026thinsp;=\u0026thinsp;0.134; Theil\u0026thinsp;=\u0026thinsp;0.0288; Shannon entropy\u0026thinsp;=\u0026thinsp;2.744), the ASI revealed significant disparities in effective access. Lubelskie (0.851), Dolnośląskie (0.781), and Świętokrzyskie (0.765) achieved the highest ASI scores, while Wielkopolskie (0.563) and Opolskie (0.543) ranked lowest. Infrastructural availability strongly correlated with ASI values (r\u0026thinsp;=\u0026thinsp;0.78), whereas subjective satisfaction showed weak associations (r\u0026thinsp;=\u0026thinsp;0.07). Household income was negatively correlated with the health expenditure burden (r = \u0026minus;\u0026thinsp;0.46), confirming the regressive character of private health costs. Expenditures on pharmaceuticals were negatively associated with facility availability (r = \u0026minus;\u0026thinsp;0.28), suggesting self-medication in regions with limited access.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe findings confirm that infrastructure is the main determinant of coordinated healthcare accessibility in Poland, while subjective satisfaction plays a minor role. The proposed ASI offers a valid and stable synthetic tool for evaluating spatial disparities in access to coordinated healthcare. Policymakers should prioritize harmonizing regional infrastructure, monitoring waiting times, and integrating financial and perceptual dimensions into health system evaluation.\u003c/p\u003e","manuscriptTitle":"Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-16 04:05:52","doi":"10.21203/rs.3.rs-7663418/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-06T11:13:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-04T19:20:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271216503844090814614044347971685715647","date":"2025-12-16T18:58:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44024933664965313388495978125219456838","date":"2025-12-12T11:48:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242019616490028508989304583280587790520","date":"2025-12-08T15:27:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-06T19:01:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101397001265496415808153132293869374211","date":"2025-10-21T12:49:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280352577660276342481068866821162767437","date":"2025-10-17T07:30:23+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-03T08:18:50+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-30T08:59:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-29T12:06:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-29T12:05:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-20T07:53:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d40e25d7-ab0e-4326-ad03-523dad2a1490","owner":[],"postedDate":"October 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:02:56+00:00","versionOfRecord":{"articleIdentity":"rs-7663418","link":"https://doi.org/10.1186/s12913-026-14220-y","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2026-02-19 15:57:59","publishedOnDateReadable":"February 19th, 2026"},"versionCreatedAt":"2025-10-16 04:05:52","video":"","vorDoi":"10.1186/s12913-026-14220-y","vorDoiUrl":"https://doi.org/10.1186/s12913-026-14220-y","workflowStages":[]},"version":"v1","identity":"rs-7663418","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7663418","identity":"rs-7663418","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}