Multiscale Analysis of Spatial Accessibility to Acute Hospitals in Carinthia, Austria

Health care accessibility studies are well established in the US but lacking in Austria, even though both experience high costs and have hospital care as the largest contributor to health care spending. This study aims to examine multiscale spatial accessibility to acute hospitals in Carinthia, Austria. Using the most recent data at census block and 250 meter grid levels, we refine proximity and generalized two-step floating catchment area (G2SFCA) methods while accounting for the modifiable areal unit problem (MAUP) and edge effects. For census blocks and 250 meter grids, the mean travel times to the nearest acute hospitals are 16 and 21 min, respectively, covering 58.8% and 76.2% of the population, which, however, increases to 25 and 31 min to the three nearest hospitals with similar populations. People bypassing the nearest hospital to seek hospitals at a longer distance, termed "bypass behavior", is more influential, as 20% more of the population living in mountainous or rural areas need to travel 30 min longer. The G2SFCA method with a more pronounced distance decay results in a more decentralized polycentric structure of accessibility and identifies poorer access areas. While urban advantage is most evident in Klagenfurt and Villach, not all areas near hospitals enjoy the highest accessibility. A combination of the proximity and G2SFCA methods identifies less accessible areas. The MAUP overestimates accessibility at a coarse level and in less populous areas. Edge effects occur at the border when using proximity only, but they are more sensitive when considering bypass behavior or a weak distance decay effect. This study contributes to our understanding of acute hospitals' accessibility in Carinthia and highlights the need to improve low-accessible areas in addition to universal health coverage. Cautions need to be exercised when using different geographic units or considering edge effects for health care planning and management.