Access to healthcare: A field survey in Istanbul

Access to healthcare is a multi-dimensional concept that depends on the characteristics of supply (healthcare system) and demand (population). When healthcare facilities are located, the spatial and non-spatial dimensions of access to healthcare should be evaluated in conjunction. Spatial dimension emphasizes the importance of distance, while non-spatial dimension addresses factors such as level of income, educational attainment level, culture, ethnicity, age and sex.

In this study, various aspects of access to healthcare in Istanbul, which is the most populated, complex, multi-centered and multi-cultural city in Turkey, were examined by a field survey conducted with the participation of 756 households. The results of the survey reveal that hospital choices differ based on level of income. For the middle and low income groups, ‘accessibility’ and ‘affordability’ have higher importance, while the upper and upper-middle income groups prioritize ‘acceptability’.

The article also elaborates on the acceptable and realized travel time and travel distances to the hospitals in Istanbul. According to international standards and the literature on the topic, the maximum travel time to the nearest hospital is generally accepted as ‘30 minutes’, which proves to be parallel to the findings of the survey. However, the realized travel distance varies based on the type of the hospital in terms of ownership (public, private) and level of services (regional, local).

Along with addressing the spatial and non-spatial dimensions of access to healthcare, the article contributes to the available literature by discussing the supply of health services from various aspects and by revealing the relation between user (patient) behavior -which changes in relation to the type and nature of the health supply and the characteristics of the city- and the related distance thresholds and border-crossings.