In the current political climate of evidence-based research, GIS has emerged as
a powerful research tool as it allows spatial and social health inequality to be
explored efficiently. This article explores the impact health reforms had on
geographical accessibility to hospital emergency department (ED) services in New
Zealand from 1991 to 2001. Travel time was calculated using least-cost path
analysis, which identified the shortest travel time from each census enumeration
district through a road network to the nearest ED. This research found that the
population further than 60 minutes from an ED has increased with some areas
being affected more than others. Some of this increase is attributed to
increases in population rather than the closing of hospitals. The findings will
be discussed within the context of the health policy reform era and changes to
health service provision.
Pool I.People (= population) and public policy in New Zealand
. New Zealand Population Review1999; 25;
57-79
.
2.
Somjen A.Distinguishing features of reform in Australia and New Zealand. In
Bloom A L
ed. Health Reform in Australia and New Zealand.
Melbourne: Oxford University Press
, 2000.
3.
Barnett R.Rationalising hospital services: reflections on hospital restructuring and
its impacts in New Zealand
. New Zealand Geographer2000; 56 (1);
5-21
.
4.
Jessop B.Post-Fordism and the state. In
Admin A.
ed. Post-Fordism: A Reader251-279.
Oxford: Blackwell
, 1994.
5.
Brabyn L
,
Skelly C.Geographic Access to Services, Health (GASH): modelling population access
to New Zealand public hospitals
. In Spatial Information Research Center Conference Proceedings2001, University of Otago, Dunedin, New Zealand.
6.
Connor R A
,
Kralewski J E
,
Hillson S D.Measuring geographic access to health care in rural areas
. Medical Care Research & Review1994; 51 (3);
337-337
.
7.
Benoit C.Moving in the right direction? Regionalizing maternity care services in British
Columbia, Canada. Unpublished report prepared for the National Network on
Environments and Women’s Health,
York University
, 2001.
8.
Lin G.A GIS method to assess distance effects on hospitalisations. Unpublished
research paper,
Department of Geology and Geography, West Virginia University
, 2002.
9.
Driscoll S L
,
Coutts E
,
Kirkland-Smith I.Time/Travel Analysis for Maternity Hospitals in the Waikato Hospital Board: A
Research and Development Project.
Waikato Hospital Board, Hamilton, New Zealand
, 1984.
10.
Scott L M.Evaluating intra-metropolitan accessibility in the information age:
operational issues, objectives and implementation. In
Janelle D G
,
Hodge D C
eds Information, Place and Cyberspace: Issues in Accessibility.
Berlin: Springer
, 2000.
11.
Kwan M.Feminist visualization: re-envisioning GIS as a method in feminist research
. Annals of the Association of American Geographers2002; 92 (4);
645-661
.
12.
Pickles J.Ground Truth: The Social Implications of Geographic Information Systems.
New York: Guilford
, 1995.
13.
Kohli K
,
Sahlen K
,
Silvertun A
,
Lofman O
,
Trell E
,
Wigertz O.Distance from the primary health center: a GIS method to study geographical
access to health care
. Journal of Medical Systems1995; 19;
425-436
.
14.
Twigg L.Health based geographical information systems: their potential examined in
the light of existing data sources
. Social Science and Medicine1990; 30;
143-155
.
15.
Zwarenstein M
,
Kringe D
,
Wolff B.The use of a geographical information system for hospital catchment area
research in Natal/Kwazulu
. South African Medical Journal1991; 80;
467-500
.
16.
Perry B
,
Gesler W.Physical access to primary health care in Andean Bolivia
. Social Science and Medicine2000; 50;
1177-1188
.
17.
Lovett A
,
Haynes R
,
Sunnenberg G
,
Gale S.Accessibility of primary health care services in East Anglia.
School of Health Policy and Practice, University of East Anglia
, 2000.
18.
Rawlinson C
,
Crews P.Access to quality health services in rural areas. Emergency medical
services: a literature review. In Rural Healthy People 2010: A
Companion Document to Healthy People 2010 vol. 2.
College Station, TX: Texas A&M
University System Health Science Center, School of Rural Public Health,
Southwest Rural Health Research Center
, 2003.
19.
Brabyn L
,
Barnett R.Population need and geographical access to general practitioners in rural
New Zealand
. The New Zealand Medical Journal2004; 117 (1199). http://www.nzma.org.nz/journal/117-1199/996/.
20.
Couclelis H
,
Getis A.Conceptualising and measuring accessibility within physical and virtual
spaces. In
Janelle D
,
Hodge D
eds Information, Place and Cyberspace: Issues and Accessibility.
Berlin: Springer
, 2000.
21.
21 Review of Maternity Services in New Zealand. Unpublished report,
National Health Committee, 1999.
22.
Mayer J D.The distance behaviour of hospital patients: a disaggregated analysis
. Social Science Medicine1983; 17 (12);
819-827
.
23.
Malcolm L.Major inequalities between district health boards in referred services
expenditure: a critical challenge facing the primary health care strategy
. The New Zealand Medical Journal2002; 115(1167). http://www.nzma.org.nz/journal/115-1167/273/.
24.
Baxter J.Barriers to health care for Maori with known diabetes. Unpublished report
prepared for the New Zealand National Working Group on Diabetes, 2002.
25.
Jones C.Maori-Pakeha health disparities: can treaty settlements reverse the impacts of
racism? Unpublished report prepared for the Ian Axford (New Zealand)
Fellowships in Public Policy,
Wellington
, 1999.
