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Int J Equity Health. 2016 Aug 2;15(1):125. doi: 10.1186/s12939-016-0411-z.

Assessment of the spatial accessibility to health professionals at French census block level.

Author information

EHESP Rennes, Sorbonne Paris Cité, Rennes, France.
Inserm, UMR IRSET Institut de recherche sur la santé l'environnement et le travail, Rennes, 1085, France.
Department of Quantitative Methods for Public Health, EHESP School of Public Health, Avenue du Professeur Léon Bernard, 35043, Rennes, France.
EHESP Rennes, Sorbonne Paris Cité, Rennes, France.
Inserm, UMR IRSET Institut de recherche sur la santé l'environnement et le travail, Rennes, 1085, France.
EHESP, EA 7348 MOS Management des organisations en santé, Rennes, France.
IRD, UMR_D 190 "Emergence des Pathologies Virales" (IRD French Institute of Research for Development, Aix-Marseille University, EHESP French School of Public Health), Marseille, France.



The evaluation of geographical healthcare accessibility in residential areas provides crucial information to public policy. Traditional methods - such as Physician Population Ratios (PPR) or shortest travel time - offer only a one-dimensional view of accessibility. This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the smallest available infra-urban level, that is, the Îlot Regroupé pour des Indicateurs Statistiques.


This study was carried out in the department of Nord, France. Healthcare professionals are geolocalized using postal addresses available on the French state health insurance website. ISA is derived from an Enhanced Two-Step Floating Catchment Area (E2FCA). We have constructed a catchment for each healthcare provider, by taking into account residential building centroids, car travel time as calculated by Google Maps and the edge effect. Principal Component Analyses (PCA) were used to build a composite ISA to describe the global accessibility of different kinds of health professionals.


We applied our method to studying geographical healthcare accessibility for pregnant women, by selecting three types of healthcare provider: general practitioners, gynecologists and midwives. A total of 3587 healthcare providers are potentially able to provide care for inhabitants of the department of Nord. On average there are 92 general practitioners, 22 midwives and 21 gynecologists per 100,000 residents. The composite ISA for the three types of healthcare provider is 39 per 100,000 residents. A comparative analysis between ISA and physician-population ratios indicates that ISA represents a more even distribution whereas the physician-population ratios show an 'all-or-nothing' approach.


ISA is a multidimensional and improved measure, which combines the volume of services relative to population size with the proximity of services relative to the population's location, available at the smallest feasible geographical scale. It could guide policy makers towards highlighting critical areas in need of more healthcare providers, and these areas should be earmarked for further knowledge-based policy making.


Department of Nord; E2SFCA; Geographic information systems; Potential spatial accessibility of healthcare professionals; Pregnant women; Spatial analyses

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