Patient-centred method to evaluate the spatial accessibility of primary health care in a case study in Shanghai

Quantitative methodology investigating medical resource accessibility does not incorporate patients' feelings about the adequacy and fairness of primary health care (PHC). In this study we quantified the spatial accessibility of PHC from the patient perspective. The main obstacles regarding access to PHC services are: (1) distance from the medical facility; and (2) waiting times after reaching the facility. The total time cost to access PHC is calculated as the sum of the time cost to access the PHC facility and the time cost waiting to receive health care; the total time cost was used in this study to reflect the potential spatial accessibility (i.e. probable entry into the healthcare system) of PHC. In Shanghai, it took residents approximately 13 min to reach the nearest primary care facility, with an approximate 23 min wait time after arriving at the facility. Thus, the spatial accessibility of PHC in Shanghai is approximately 36 min. The method of assessing the spatial accessibility of PHC from the perspective of patients is more explanatory and easier to interpret. In the case of Shanghai, the regional accessibility of PHC is much better than its regional availability. Relevant managers should focus on increasing the resource supply capacity of existing facilities providing primary care in the suburbs of Shanghai.