Hospitals as social infrastructure: accessible for all?

Most modern healthcare systems aim to ensure equal access for all citizens, which is often understood as financial rather than spatial accessibility. In this chapter, first, different quantitative measures of spatial accessibility are described and juxtaposed. The measures are divided into three broad categories: (1) supply per population, (2) travel time and distance, and (3) gravity-based measures. In the second part, empirical research on existing regional and socio-economic inequities in spatial accessibilities of inpatient services is reviewed and summarized. Finally, the current evidence base on the consequences of (in)accessible hospital care on service utilization and, more generally, on population well-being is delineated. The literature review shows that most of the published work on the accessibility of inpatient care is descriptive, lacking causal evidence on which policy interventions might be based. This is especially crucial due to the potentially confounding effects of spatial or geographical sorting.