Beyond distance: integrating economic burden into large-scale primary healthcare accessibility analysis

Background
Access to primary healthcare (PHC) services is a critical determinant of population health outcomes and a key indicator of health system performance. However, comprehensive methods for batch assessment of PHC accessibility and the associated economic burden are relatively scarce. This gap is particularly evident in developing countries, where accessibility challenges are often more pronounced.

Methods
We developed an integrated assessment methodology for the large-scale calculation of travel costs to access PHC services. This methodology combines high-resolution friction surface mapping, the construction of a comprehensive PHC facility spatial dataset, and the application of least-cost path algorithms. The batch processing capability of the methodology ensures efficient computation while maintaining high spatial resolution, enabling a detailed evaluation of PHC accessibility and its economic burden across diverse geographical contexts.

Results
Our analysis revealed that 88.70% of Chinese mainland’s population could access PHC facilities within an hour, indicating relatively good overall accessibility to primary healthcare services. However, significant regional disparities in accessibility and associated economic burdens were observed. While urban areas, particularly in eastern and coastal regions, generally exhibit high levels of accessibility, rural and remote areas, especially in the western and northwestern regions, face substantial challenges in reaching PHC facilities. The total economic burden associated with travel to PHC facilities in Chinese mainland is estimated at approximately 38.29 billion CNY annually. The southern, northern, and northwestern regions accounted for 62.91%, 21.72%, and 14.94% of the total burden respectively, with northwestern provinces facing a disproportionately high economic burden relative to their GDP.

Conclusions
Our methodology supports future large-scale, high-resolution accessibility analyses that can guide interventions aimed at addressing healthcare disparities and improving equity. The empirical application of this methodology in Chinese mainland revealed significant disparities in PHC access across the country and quantified the substantial economic costs associated with these disparities.