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. 2021 Mar:273:113773.
doi: 10.1016/j.socscimed.2021.113773. Epub 2021 Feb 12.

Geographic access to COVID-19 healthcare in Brazil using a balanced float catchment area approach

Rafael H M Pereira  1 , Carlos Kauê Vieira Braga  2 , Luciana Mendes Servo  2 , Bernardo Serra  3 , Pedro Amaral  4 , Nelson Gouveia  5 , Antonio Paez  6
Affiliations

Geographic access to COVID-19 healthcare in Brazil using a balanced float catchment area approach

Rafael H M Pereira et al. Soc Sci Med. 2021 Mar.

Abstract

The rapid spread of COVID-19 across the world has raised concerns about the responsiveness of cities and healthcare systems during pandemics. Recent studies try to model how the number of COVID-19 infections will likely grow and impact the demand for hospitalization services at national and regional levels. However, less attention has been paid to the geographic access to COVID-19 healthcare services and to hospitals' response capacity at the local level, particularly in urban areas in the Global South. This paper shows how transport accessibility analysis can provide actionable information to help improve healthcare coverage and responsiveness. It analyzes accessibility to COVID-19 healthcare at high spatial resolution in the 20 largest cities of Brazil. Using network-distance metrics, we estimate the vulnerable population living in areas with poor access to healthcare facilities that could either screen or hospitalize COVID-19 patients. We then use a new balanced floating catchment area (BFCA) indicator to estimate spatial, income, and racial inequalities in access to hospitals with intensive care unit (ICU) beds and mechanical ventilators while taking into account congestion effects. Based on this analysis, we identify substantial social and spatial inequalities in access to health services during the pandemic. The availability of ICU equipment varies considerably between cities, and it is substantially lower among black and poor communities. The study maps territorial inequalities in healthcare access and reflects on different policy lessons that can be learned for other countries based on the Brazilian case.

Keywords: Accessibility; Brazil; COVID-19; Equity; Floating catchment area; ICU; Race; Ventilators.

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Figures

Fig. 1
Fig. 1
Access to COVID-19 healthcare in São Paulo (A) and Manaus (B), 2020. (Panel 1) Vulnerable populations that cannot access a primary healthcare facility in less than 30 min walking. (Panel 2) Vulnerable populations that live farther than 5 km to the nearest hospital with ICU bed and mechanical ventilator.
Fig. 2
Fig. 2
Access to COVID-19 healthcare in Rio de Janeiro (A) and Fortaleza (B), 2020. (Panel 1) Vulnerable populations that cannot access a primary healthcare facility in less than 30 min walking. (Panel 2) Vulnerable populations that live farther than 5 km to the nearest hospital with ICU bed and mechanical ventilator.
Fig. 3
Fig. 3
Spatial distribution of hospitals with adult ICU beds and ventilators (1), the level of access to these services considering competition effects (2), and population distribution (3) in São Paulo (A) and Manaus (B), 2020.
Fig. 4
Fig. 4
Spatial distribution of hospitals with adult ICU beds and ventilators (Panel 1), the level of access to these services considering competition effects (Panel 2) and population distribution (Panel 3) in Rio de Janeiro (A) and Fortaleza (B), 2020.
Fig. 5
Fig. 5
Income and racial inequalities in access to ICU beds and ventilators considering competition effects. Brazil's 20 largest cities, 2020.
figs1
figs1
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