Measuring potential physical accessibility to general practitioners in rural areas: A method and case study

The general practitioner is the key element within most rural health care delivery systems, virtually controlling referal to higher levels of care as well as providing basic care. In consequence of the progressive urban-based centralization of health care facilities and specialized personnel encouraged by the desire to take advantage of economies of scale in supply, the role of the general practitioner within rural health care delivery has become increasingly crucial. However, the supply of general practitioners in rural areas has not kept pace with demands, and accessibility to physicians has become a pressing issue in many rural areas. Although 'accessibility' is not taken to be synonymous with physical or geographical accessibility, the dispersed settlement characteristic of most rural areas elevates the latter to a position of primary importance. Following a discussion of the merits of measures of accessibility based upon utilization versus measures based upon the relative location of population and physicians, a measure on potential physical accessibility is presented and applied to a Canadian data set. The results suggest that although considerable differences in potential accessibility exist between rural areas near and far from urban centres, the smaller catchment populations of most rural general practitioners may partly compensate for isolation from major, urban concentrations of physicians.