Is Neighborhood Access to Health Care Provision Associated with Individual‐Level Utilization and Satisfaction?

OBJECTIVE: To explore whether travel time access to the nearest general practitioner (GP) surgery (which is equivalent to U.S. primary care physician PCP office) and pharmacy predicts individual-level health service utilization and satisfaction. DATA SOURCES: GP and pharmacy addresses were obtained from the New Zealand Ministry of Health in 2003 and merged with a geographic boundaries data set. Travel times derived from these data were appended to the 2002/03 New Zealand Health Survey (N=12,529). STUDY DESIGN: Multilevel logistic regression was used to model the relationship between travel time access and five health service outcomes: GP consultation, blood pressure test, cholesterol test, visit to pharmacy, and satisfaction with latest GP consultation. DATA COLLECTION/EXTRACTION: Travel times between each census meshblock centroid and the nearest GP and pharmacy were calculated using Geographical Information System. PRINCIPAL FINDINGS: When travel times were long, blood pressure tests were less likely in urban areas (odds ratio OR 0.75 0.59-0.97), GP consultations were less likely in rural centers (OR 0.42 0.22-0.78) and pharmacy visits were less likely in highly rural areas (OR 0.36 0.13-0.99). There was some evidence of lower utilization in rural areas. CONCLUSIONS: Locational access to GP surgeries and pharmacies appears to sometimes be associated with health service use but not satisfaction.