Spatial accessibility to pediatric services.

The objective of this study was to assess spatial accessibility (SA) to pediatric healthcare services at hospitals in Chiba Prefecture, Japan in 2006. We considered the distribution of general pediatricians and neonatologists relative to the geographical distribution of children using the two-step floating catchment area method, which accounts for the pediatrician-to-children ratios within catchment areas with defined travel distance (TD) thresholds. All measurements were carried out within a geographic information system. We found varied growth rate trends of children within the 61 municipalities of Chiba Prefecture between 1995 and 2006. The eastern and southern areas of the prefecture were less populated and had a small number of children in contrast to the central and northwestern areas, which had higher density of child population, less negative growth rates and even positive growth rate trends in some municipalities. For neonatology services, we used the number of live births (LB) and low birth weight (LBW) infants as populations. Lower LBW rates were found within the northern area while higher LBW rates were found within the southern area (minimum, 3.1%; maximum, 18.4%). The average LBW rate was 9.0% in Chiba Prefecture, whereas it was 9.5% for all Japan in 2005. SA analysis showed that 98.8% of children distributed within a 10 km TD threshold from a hospital with general pediatric services, and that 82.3% of LB and LBW distributed within a 30 km TD threshold from a hospital with neonatology services. The distribution of pediatricians relative to the population they serve was not homogeneous at local level. Through the methodology applied, we visualized areas short of pediatric services. The assessment of SA at local level provided informative results to achieve social equity in hospital access. The practical implications of this study are the need for reliable data for research purposes and policy development for children.