Measuring accessibility to hospitals by public transport: An assessment of eight Canadian metropolitan regions

Introduction: The ability to access healthcare services has long been considered a 'right' by Canadian citizens and is protected as such under the Canada Health Act. However, socio-spatial factors can limit access to healthcare services, especially for vulnerable populations. This paper aims to quantify the spatial accessibility to healthcare services by public transport across eight major Canadian metropolitan areas and compare accessibility to healthcare across vulnerable population groups. This is the first study, to the authors' knowledge, to conduct an assessment of accessibility to hospitals by public transport across multiple metropolitan regions in Canada, thereby allowing to identify common trends, challenges, as well as knowledge gaps. Methods: Spatial accessibility to general medical and surgical hospitals by public transport was measured through a two-step floating catchment area method, considering both service-to population ratios and travel time to these health services. For each metropolitan area, the average accessibility of all census tracts and the average accessibility of the 20% most vulnerable census tracts were calculated. To quantify vertical equity, an indicator was subsequently developed using the Spearman's rank correlation coefficient between accessibility and vulnerability. Main findings: Within metropolitan areas (except for Vancouver), residents of vulnerable census tracts generally have greater access to hospitals by public transport. Yet, larger metropolitan areas (Calgary, Toronto-Hamilton, and Vancouver) tend to underperform in terms of vertical equity and average accessibility. In line with this, vulnerable census tracts in these metropolitan areas are characterized by the lowest levels of accessibility compared to vulnerable census tracts in the other metropolitan areas. Conclusion: This research highlights the challenges associated with the suburbanization of poverty in large Canadian metropolitan regions and the need to provide efficient public transport services to reach hospitals located in the periphery. It also shed lights on the necessity to conduct more empirical research to inform the implementation of guidelines in terms of accessibility to healthcare in Canada. This study is of relevance to researchers, planners and policy-makers wishing to improve accessibility to healthcare, especially for vulnerable populations.