University of Oulu

Huotari, T., Rusanen, J., Keistinen, T. et al. Effect of centralization on geographic accessibility of maternity hospitals in Finland. BMC Health Serv Res 20, 337 (2020).

Effect of centralization on geographic accessibility of maternity hospitals in Finland

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Author: Huotari, Tiina1; Rusanen, Jarmo1; Keistinen, Timo2;
Organizations: 1Geography Research Unit, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
2Ministry of Social Affairs and Health, Finland, PO Box 33, FI-00023 Government, Helsinki, Finland
3Research Unit of Mathematical Sciences, University of Oulu, PO Box 3000, FI-90014 University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Springer Nature, 2020
Publish Date: 2020-06-29


Background: In the past two decades, the number of maternity hospitals in Finland has been reduced from 42 to 22. Notwithstanding the benefits of centralization for larger units in terms of increased safety, the closures will inevitably impair geographical accessibility of services.

Methods: This study aimed to employ a set of location-allocation methods to assess the potential impact on accessibility, should the number of maternity hospitals be reduced from 22 to 16. Accurate population grid data combined with road network and hospital facilities data is analyzed with three different location-allocation methods: straight, sequential and capacitated p-median.

Results: Depending on the method used to assess the impact of further reduction in the number of maternity hospitals, 0.6 to 2.7% of mothers would have more than a two-hour travel time to the nearest maternity hospital, while the corresponding figure is 0.5 in the current situation. The analyses highlight the areas where the number of births is low, but a maternity hospital is still important in terms of accessibility, and the areas where even one unit would be enough to take care of a considerable volume of births.

Conclusions: Even if the reduction in the number of hospitals might not drastically harm accessibility at the level of the entire population, considerable changes in accessibility can occur for clients living close to a maternity hospital facing closure. As different location-allocation analyses can result in different configurations of hospitals, decision-makers should be aware of their differences to ensure adequate accessibility for clients, especially in remote, sparsely populated areas.

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Series: BMC health services research
ISSN: 1472-6963
ISSN-E: 1472-6963
ISSN-L: 1472-6963
Volume: 20
Issue: 1
Article number: 337
DOI: 10.1186/s12913-020-05222-5
Type of Publication: A1 Journal article – refereed
Field of Science: 3141 Health care science
119 Other natural sciences
Funding: This work was supported by the Ministry of Social Affairs and Health of Finland; the University of Oulu Graduate School (UniOGS); IMPRO – Improved knowledge base and service optimisation to support health and social services reform, Strategic Research Funding, Academy of Finland (grant numbers 312705 and 312703); Tauno Tönning Foundation; the Research Council for Health of the Academy of Finland (grant number 266314); the Future Makers program of the Jane and Aatos Erkko Foundation and the Technology Industries of Finland Centennial Foundation; the Infotech Oulu research institute; and the Academy of Finland Profi 5 funding for mathematics and AI: data insight for high-dimensional dynamics.
Academy of Finland Grant Number: 312705
Detailed Information: 312705 (Academy of Finland Funding decision)
312703 (Academy of Finland Funding decision)
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