Geospatial analysis of access to healthcare: child development needs and available care

Abstract

Developmental delay (DD) is one of the most frequent disorders in early childhood affecting 10-15% of all preschool children. Early identification of children with DD is critical to ensure appropriate therapeutic interventions, to support the families, and finally to prevent chronic, life-long health, educational, and social consequences. It is widely acknowledged that early intervention (EI) programs are both ethically mandatory and cost-effective for a society on a long-term perspective. However, data shows that many cases are missed in early childhood. Although research has identified potential risk factors for under-utilization of EI, the spatial distribution of children in need, referring doctors, and therapeutic places have been neglected in many research studies so far. Consequently, we do not know much about the spatial variation in EI, and knowledge on potential influencing factors for spatial variation in referral and utilization is lacking. Therefore, we aimed to quantify accessibility of care in the Canton of Zurich, Switzerland. To do so, a comprehensive data set from all children (age 0-4) admitted to the two Units of Special Needs Education (USNE) in the Canton of Zurich in 2017 (n = 1971) was used and analyzed with the Floating Catchment Area (FCA) set of methods. Our results show major differences between rural and urban regions and better accessibility closer to greater therapy institutions. Our findings highlight spatial inequalities between healthcare needs and services. Our research contributes to a better understanding of spatial access to healthcare and informs healthcare policy to help increase accessibility to EI for children with DD.The Canton of Zurich shows regional inequalities between EI needs and services.Spatial analyses are a valuable tool to find areas of high and low accessibility and understand spatial access to healthcare.