Eduarda Marques da Costa, born in Lisbon in 1966, is associate professor of the Institute of Geography and Spatial Planning of University of Lisbon. She teaches Geography and Spatial Planning since 1990, she is researcher in the Centre of Geographical Studies, since 1987 and since 2009 that is coordinator of Modelling and Spatial Planning Research Group. Between 2010-2020, was coordinator of the graduation in Spatial Planning (2010-2020) and since 2020 the co-coordination of the master on Spatial Planning and Urbanism. The main scientific areas of their interest are Regional, Urban and Local Planning, Urban Geography, Health cities, Cohesion Policy and Evaluation of Public Policies. https://orcid.org/0000-0001-5070-3562
Marques da Costa, E.
Elderly patterns of access to primary health care services – when inequities come from urbanization model
Eduarda Marques da Costa, Universidade de Lisboa, Center of Geographical Studies-Institute of Geography and Spatial Planning
Nuno Marques da Costa, Ana Louro, Marcela Barata, Universidade de Lisboa, Lisboa
Several authors have reflected on access to health services, considering the existence of several dimensions that go beyond availability and accessibility but others report that the issue most important is accessibility, because of its impact on others. This statement is particularly evident when communities with equal accessibility potentials have different patterns according to population characteristics.
In the context of ageing that characterizes societies, age is thus an increasingly relevant factor, because for the same population figures, an older population needs more health care. In addition, factors stemming from the economic constraints resulting from the crisis contracted demand from elderly. This communication aims to verify the access of the elderly population to primary health care in the Lisbon Metropolitan Area (AML) and confront them with their demand patterns.
This approach considers two methodological phases: in the first, using GIS Network Analysis, the potential of population coverage to an area covered by a 15-minute physical accessibility to health facilities is calculated, considering the two-way pedestrian mode. speeds; the second is the result of a survey conducted at AML, which analyzes the demand for health equipment (mode and time of travel).
This study showed the determinants factors of primary healthcare access for the older population in Lisbon Metropolitan Area: – the first corresponds to a set of social determinants associated with the population socioeconomic characteristics (such as income and automobile-ownership) that provides greater travelling flexibility and, consequently, access to services; the second corresponds to settlement and distribution of primary healthcare units. The portions with higher population and building density naturally represent the areas with greater health services density. For portions with lower and more dispersed population density, to the existing primary health services to reach minimum demand thresholds to function, their area of influence needs to be wider; thus, access times are higher. That is, considering the analyzed portions, Lisbon central area presents greater population density, older population density, and primary healthcare services density; as we move away, to low population and building density the area of influence increases. Thus, some AML portions do not meet the desired coverage levels: to reach a primary healthcare service within less than 15 minutes by walking. Results shoes intra-regional differences related with socioeconomic conditions of the elderly, their family background, mode of transport and type of service. It was concluded that despite primary healthcare equipment is programmed as a proximity service, the differentiation in service deliver from the different socioeconomic characteristics, but also from the urbanization model, highlighting the insufficiencies of the sprawl models to provide the proximity service, determining the inequities.