Unraveling social inequalities in urban health care accessibility in Montevideo: A space-time approach

Access to urban health care opportunities is a major factor in explaining health outcomes. We propose an innovative methodology to analyze spatio-temporal accessibility considering spatial, temporal, and individual variability on both the demand and the supply side. To construct the measure, we use three primary sources: an exhaustive survey of the space-time provision of pediatric services in Montevideo (i.e., a survey of the times when pediatric care appointments are available at particular clinic locations), a representative sample of pediatric health care users, and a fine-grained travel-time matrix for different transport modes. Our results show that, while different socioeconomic groups have similar levels of access at the aggregate level, access is not evenly distributed. Poorer households compose the highest percentage of households facing a critical lack of access. In addition, we find that space-time constraints associated with employment limit access for low-socioeconomic households more so than for other socioeconomic groups. This methodological contribution allows us to reveal existing inequality patterns in health care access and indicates the need for policymakers to consider the space-time dimensions of access when developing health care policies.