“Geographies” of primary healthcare access for older adults in the Lisbon Metropolitan Area, Portugal - a territory of differences

Costa, Eduarda Marques da; Costa, Nuno Marques da; Louro, Ana; Barata, Marcela

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Dossier • Saude soc. 29 (2) • 2020 • https://doi.org/10.1590/S0104-12902020200108 copy

“Geographies” of primary healthcare access for older adults in the Lisbon Metropolitan Area, Portugal - a territory of differences⁴ 4 This article was developed in the context of the research project GRAMPCITY - Para uma mobilidade e acessibilidade mais amigas dos idosos em áreas urbanas/Moving smartly towards accessible & inclusive urban environments for our elders, PTDC/GES-TRA/32121/2017, developed by four Portuguese universities. M. Barata is scholarship holder FCT in this project.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Several authors have reflected upon access to health services considering several dimensions, such as availability and accessibility. Due to the aging of societies, the older population’s demands for healthcare increase, and accessibility to these units acquires special importance. Our study aims to characterize the access of older people to healthcare services, facing the possibilities arising from service supply and demand patters. From the supply and demand confrontation, comes the possibility of identifying intraregional dynamics and associating them with the various socioeconomic conditions of older people, family background, modes of transportation, and type of service. This approach considers two methodological phases: calculating the potential for primary healthcare coverage, considering physical accessibility for pedestrian and highway modes; and confronting these values with services demand, determined from surveys conducted with residents. We concluded that, although healthcare centers were designed as a proximity service, service provision, socioeconomic aspects, and the urbanization model entail meaningful inequalities of access in the context of the Lisbon Metropolitan Area.

Keywords:
Accessibility; Primary Healthcare; Older Population; Network Analysis; Lisbon Metropolitan Area

	Maximum operating capacity of equipment (No. of inhabitants)	Potential supplied population (%)	Population supplied by equipment open until 18h or 20h (%)	Population supplied by equipment open on weekends/holidays until 14h (%)
Central Area - Lisbon	515.195	101.8	87.9	63.6
1st ring	1.061.269	108.3	95.5	68.9
2nd ring	303.294	110.7	40	40
3rd ring	603.262	97.8	90.5	66.7
4th ring	518.066	113.5	78.3	68.1
Potential supply population	3.001.086	105.9	88.4	78.4
Total LMA population	2.821.876

Travel time	Pedestrian						Highway
	Total population		Older population				Older population
	Speed 4.5km/h		Speed 3.5km/h		Speed 1.6km/h		Maximum travel speed in the stretch of road
	No.	%	No.	%	No.	%	No.	%
<15 min	1.136.111	40%	154.056	30%	35.883	7%	509.442	99%
&091;15-30 min&091;	1.136.364	40%	206.901	40%	98.509	19%	3.041	1%
&091;30-60 min&091;	448.580	16%	121.059	24%	223.345	43%	744	0%
>60 min	100.821	4%	31.826	6%	156.105	30%	615	0%
Total	2.821.876	100%	513.842	100%	513.842	100%	513.842	100%

Mode of transportation	≤15 min	15-30 min	30-60 min	Did not answer	Total
Individual transport	48.1	28.6	33.3	12.5	39.3
Public transport	7.4	47.6	33.3	0	18
Smooth modes	35.2	14.3	0	0	24.7
Modes combination	9.3	9.5	33.3	12.5	11.2
Did not answer	0	0	0	75	6.7
Total	100	100	100	100	100

Faculdade de Saúde Pública, Universidade de São Paulo. Associação Paulista de Saúde Pública. Av. dr. Arnaldo, 715, Prédio da Biblioteca, 2º andar sala 2, 01246-904 São Paulo - SP - Brasil, Tel./Fax: +55 11 3061-7880 - São Paulo - SP - Brazil
E-mail: saudesoc@usp.br

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[1] Correspondence Eduarda Marques da Costa Universidade de Lisboa, Instituto de Geografia e Ordenamento do Território. Rua Branca Edmée Marques, 1600-276. Lisboa, Portugal. CEP 1600-276.