The future of general practitioner care in Lower Saxony, Germany: an analysis of actual vs target states using a GIS-based floating catchment area method

Submitted: 22 August 2024
Accepted: 28 November 2024
Published: 19 February 2025
Abstract Views: 253
PDF: 80
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Ensuring universal and equitable accessibility to healthcare services is crucial for fostering equal living conditions aligned with global and national objectives. This study examines disparities in accessing General Practitioner (GP) care within Lower Saxony and Bremen, Germany, using the two-step floating catchment area method for spatial analysis at street section level, incorporating various transportation modes. Findings are compared with needs-related planning guidelines to uncover spatial disparities and deviations between prescribed guidelines (target state) and empirical findings (actual state). The analysis reveals significant discrepancies, with over 50% of the population inadequately supplied due to accessibility or capacity issues, particularly in rural and some urban areas, challenging assumptions of sufficient urban healthcare provision. This is the first detailed analysis of primary care provision at this granular level in Lower Saxony, exposing substantial gaps between current GP care and planning targets. Fine-grained spatial analysis proves essential for revealing healthcare accessibility inequities and offers a roadmap for targeted policy interventions. Despite limitations, such as not fully capturing real-world dynamics or patient preferences, the study provides valuable insights into enhancing geographically equitable GP care. It contributes to the discourse on achieving equal living conditions through equitable healthcare accessibility, advocating a more refined, localised approach to healthcare planning, emphasizing the importance of detailed spatial analysis for informed decision-making and promoting health equity.

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Akakba A, Lahmar B, 2023. Identification and analysis of spatial access disparities related to primary healthcare in Batna City, Algeria. Geospat Health 18:2. DOI: https://doi.org/10.4081/gh.2023.1238
Anselin L, 1995. Local Indicators of Spatial Association—LISA. Geogr Anal 27:93-115. DOI: https://doi.org/10.1111/j.1538-4632.1995.tb00338.x
Association of Statutory Health Insurance Physicians Bremen, 2023a. Data on all authorised doctors and psychotherapists in Bremen [Online]. Bremen, KVHB.
Association of Statutory Health Insurance Physicians Bremen, 2023b. Übersicht Bedarfsplanung alle Fachgruppen / Planungsbereich Bremen-Stadt: [Overview of need related planning for all specialist groups / planning area Bremen-Stadt] [Online]. Bremen. Accessed 8 June 2023. Available at https://www.kvhb.de/fileadmin/kvhb/pdf/Bedarfsplan/bedarfsplan-bremen.pdf
Association of Statutory Health Insurance Physicians Bremen, 2023c. Übersicht Bedarfsplanung alle Fachgruppen / Planungsbereich Bremerhaven-Stadt: [Overview of need related planning for all specialist groups / planning area Bremerhaven-Stadt] [Online]. Bremen. Accessed 8 June 2023. Available at https://www.kvhb.de/fileadmin/kvhb/pdf/Bedarfsplan/bedarfsplan-bremerhaven.pdf
Association of Statutory Health Insurance Physicians Lower Saxony, 2022. Bedarfsplanung HausärztInnen. Planungsblatt zur Dokumentation des Standes der Vertragsärztlichen Versorgung: [Need related planning for general practitioners. Planning sheet for documenting the status of contract medical care] [Online]. Hannover, KVN. Accessed 31 May 2023. Available at https://www.kvn.de/internetmedia/Mitglieder/Zulassung/Bedarfsplanung/Bedarfsplanung+Haus%C3%A4rzte-p-13222.pdf
Baier N, Pieper J, Schweikart J, Busse R, Vogt V, 2020. Capturing modelled and perceived spatial access to ambulatory health care services in rural and urban areas in Germany. Soc Sci Med 265:113328. DOI: https://doi.org/10.1016/j.socscimed.2020.113328
Bauer J, Groneberg DA, 2016. Measuring Spatial Accessibility of Health Care Providers - Introduction of a Variable Distance Decay Function within the Floating Catchment Area (FCA) Method. PLoS One 11:e0159148. DOI: https://doi.org/10.1371/journal.pone.0159148
Bauer J, Klingelhöfer D, Maier W, Schwettmann L, Groneberg DA, 2020. Spatial accessibility of general inpatient care in Germany: an analysis of surgery, internal medicine and neurology. Sci Rep 10:19157. DOI: https://doi.org/10.1038/s41598-020-76212-0
Brosi P, 2023. GTFS für Deutschland: [GTFS for Germany] [Online]. Accessed 31 May 2023. Available at https://gtfs.de/
Chen L, Zeng H, Wu L, Tian Q, Zhang N, He R, Xue H, Zheng J, Liu J, Liang F, Zhu B, 2023. Spatial Accessibility Evaluation and Location Optimization of Primary Healthcare in China: A Case Study of Shenzhen. GeoHealth 7:e2022GH000753. DOI: https://doi.org/10.1029/2022GH000753
Dai D, Wang F, 2011. Geographic disparities in accessibility to food stores in southwest Mississippi. Environ Plann B Plann Des 38:659-677. DOI: https://doi.org/10.1068/b36149
Deitelhoff N, Groh-Samberg O, Middell M, 2020. Gesellschaftlicher Zusammenhalt: Ein interdisziplinärer Dialog [Social Cohesion: An Interdisciplinary Dialogue]. Frankfurt am Main, Campus Verlag. DOI: https://doi.org/10.12907/978-3-593-44646-2
Delamater PL, 2013. Spatial accessibility in suboptimally configured health care systems: a modified two-step floating catchment area (M2SFCA) metric. Health & Place 24:30–43. DOI: https://doi.org/10.1016/j.healthplace.2013.07.012
Delamater PL, Shortridge AM, Kilcoyne RC, 2019. Using floating catchment area (FCA) metrics to predict health care utilization patterns. BMC Health Serv Res 19:144. DOI: https://doi.org/10.1186/s12913-019-3969-5
Ester M, Kriegel H.-P, Sander J, Xu X, 1996. A Density-Based Algorithm for Discovering Clusters in Large Spatial Databases with Noise. In: Han J, Fayyad U.M, Simoudis E (eds) Second Int. Conf. on Knowledge Discovery and Data Mining: Proceedings: KDD-96. Menlo Park, California, AAAI Press, pp. 226-231.
European Commission, 2011. Communication from the commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions: a quality framework for services of general interest in Europe [Online]. Brussels, Belgium. Accessed 18 January 2024. Available at https://ec.europa.eu/archives/commission2010-2014/president/news/speeches-statements/pdf/201112201_en.pdf
Fayyaz SK, Liu XC, Zhang G, 2017. An efficient General Transit Feed Specification (GTFS) enabled algorithm for dynamic transit accessibility analysis. PLoS One 12:e0185333. DOI: https://doi.org/10.1371/journal.pone.0185333
Federal Institute for Research on Building, Urban Affairs and Spatial Development, 2017. Daseinsvorsorge sichern: [Securing services of general interest], 2017th edn. Bonn, BBSR.
Federal Joint Committee, 2018. Beschluss des Gemeinsamen Bundesausschusses zur Abnahme des Endberichts „Gutachten zur Weiterentwicklung der Bedarfsplanung i.S.d. §§ 99 ff. SGB V zur Sicherung der vertragsärztlichen Versorgung": [Decision of the Federal Joint Committee to accept the final report "Expert opinion on the further development of need related planning within the meaning of §§ 99 ff. SGB V to safeguard the provision of care by SHI-accredited physicians"] [Online]. Berlin. Accessed 9 August 2023. Available at https://www.g-ba.de/downloads/39-261-3493/2018-09-20_Endbericht-Gutachten-Weiterentwicklung-Bedarfsplanung.pdf
Federal Joint Committee, 2023. Richtlinie über die Bedarfsplanung sowie die Maßstäbe zur Feststellung von Überversorgung und Unterversorgung in der vertragsärztlichen Versorgung: [Directive on need related planning and the standards for determining oversupply and undersupply in SHI-accredited medical care] [Online]. Accessed 12 April 2024. Available at https://www.g-ba.de/downloads/62-492-3160/BPL-RL2023-03-16iK-2023-06-03.pdf
Federal Ministry for Digital and Transport, 2021. Regionalstatistische Raumtypologie (RegioStaR): [Regional statistical spatial typology (RegioStar7)] [Online]. Accessed 2 August 2023. Available at https://bmdv.bund.de/SharedDocs/DE/Artikel/G/regionalstatistische-raumtypologie.html and https://bmdv.bund.de/SharedDocs/DE/Anlage/G/regiostar-referenzdateien.xlsx
Federal Statistical Office, 2023. Daten aus dem Gemeindeverzeichnis. Regionalstatistische Raumtypologie (RegioStaR 17) nach Fläche, Bevölkerung und Bevölkerungsdichte: [Data from the municipal directory. Regional statistical spatial typology (RegioStaR 17) by area, population and population density] [Online]. Accessed 17 January 2024. Available at https://www.destatis.de/DE/Themen/Laender-Regionen/Regionales/Gemeindeverzeichnis/Administrativ/15-regiostar.html
Fortin P, Morency C, Trépanier M, 2016. Innovative GTFS Data Application for Transit Network Analysis Using a Graph-Oriented Method. J. Public Transp 19:18–37. DOI: https://doi.org/10.5038/2375-0901.19.4.2
Gao F, Jaffrelot M, Deguen S, 2021. Measuring hospital spatial accessibility using the enhanced two-step floating catchment area method to assess the impact of spatial accessibility to hospital and non-hospital care on the length of hospital stay. BMC Health Serv Res 21:1078. DOI: https://doi.org/10.1186/s12913-021-07046-3
Gao F, Kihal W, Le Meur N, Souris M, Deguen S, 2016. Assessment of the spatial accessibility to health professionals at French census block level. Int J Equity Health 15:125. DOI: https://doi.org/10.1186/s12939-016-0411-z
Geofabrik, 2023. OpenStreetMap Data Extracts [Online]. Karlsruhe, Geofabrik. Accessed 12 April 2024. Available at https://download.geofabrik.de/europe/germany/niedersachsen.html
Gerlinger T, 2021. Daseinsvorsorge in der Gesundheitspolitik [Public Services in Health Policy]. In: Blank F, Schäfer C, Spannagel D (eds) Grundsicherung weiterdenken [Rethinking Basic Security]. Transcript Verlag, pp. 189–208. DOI: https://doi.org/10.1515/9783839455944-010
Getis A, Ord JK, 1992. The Analysis of Spatial Association by Use of Distance Statistics. Geogr Anal 24:189–206. DOI: https://doi.org/10.1111/j.1538-4632.1992.tb00261.x
GfK SE, 2022. Population data at street section level [Online].
Guagliardo MF, 2004. Spatial accessibility of primary care: concepts, methods and challenges. Int. J Health Geogr 3:3. DOI: https://doi.org/10.1186/1476-072X-3-3
Guo X, Zeng S, Namaiti A, Zeng J, 2023. Evaluation of Supply–Demand Matching of Public Health Resources Based on Ga2SFCA: A Case Study of the Central Urban Area of Tianjin. ISPRS Int J Geo-Inf 12:156. DOI: https://doi.org/10.3390/ijgi12040156
Huang Y, Meyer P, Jin L, 2019. Spatial access to health care and elderly ambulatory care sensitive hospitalizations. Public Health 169:76–83. DOI: https://doi.org/10.1016/j.puhe.2019.01.005
Jörg R, Haldimann L, 2023. MHV3SFCA: A new measure to capture the spatial accessibility of health care systems. Health Place 79:102974. DOI: https://doi.org/10.1016/j.healthplace.2023.102974
Kahl W, Lorenzen J, 2019. Verfassungsrechtliche Grundlagen der Regionalpolitik in Deutschland [Constitutional Foundations of Regional Policy in Germany]. In: Hüther M (ed) Die Zukunft der Regionen in Deutschland: Zwischen Vielfalt und Gleichwertigkeit [The Future of Regions in Germany: Between Diversity and Equality]. Köln, iW Medien, pp. 49–66.
Langford M, Higgs G, Fry R, 2016. Multi-modal two-step floating catchment area analysis of primary health care accessibility. Health Place 38:70–81. DOI: https://doi.org/10.1016/j.healthplace.2015.11.007
Liu L, Lyu H, Zhao Y, Zhou D, 2022. An Improved Two-Step Floating Catchment Area (2SFCA) Method for Measuring Spatial Accessibility to Elderly Care Facilities in Xi'an, China. Int. J Environ Res Public Health 19:11465. DOI: https://doi.org/10.3390/ijerph191811465
Luo W, Wang F, 2003. Measures of Spatial Accessibility to Healthcare in a GIS Environment: Synthesis and a Case Study in Chicago Region. Environ Plann B Plann Des 30:865–84. DOI: https://doi.org/10.1068/b29120
McGrail MR, 2012. Spatial accessibility of primary health care utilising the two-step floating catchment area method: an assessment of recent improvements. Int J Health Geogr 11:50. DOI: https://doi.org/10.1186/1476-072X-11-50
McGrail MR, Humphreys JS, 2015. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health 10:358. DOI: https://doi.org/10.4081/gh.2015.358
Neumeier S, 2017. Regionale Erreichbarkeit von ausgewählten Fachärzten, Apotheken, ambulanten Pflegediensten und weiteren ausgewählten Medizindienstleistungen in Deutschland: Abschätzung auf Basis des Thünen-Erreichbarkeitsmodells [Regional Accessibility of Selected Specialists, Pharmacies, Outpatient Care Services, and Other Selected Medical Services in Germany: An Estimate Based on the Thünen Accessibility Model]: Thünen Working Paper No. 77. Braunschweig, Thünen-Institut.
Ozegowski S, Sundmacher L, 2013. Bedarfsplanung – quo vadis? [Need related Planning – Where to Go?]. Gesundheits- und Sozialpolitik 67:60–67. DOI: https://doi.org/10.5771/1611-5821-2013-6-60
Park J, Goldberg DW, 2021. A Review of Recent Spatial Accessibility Studies That Benefitted from Advanced Geospatial Information: Multimodal Transportation and Spatiotemporal Disaggregation. ISPRS Int J Geo-Inf 10:532. DOI: https://doi.org/10.3390/ijgi10080532
Penchansky R, Thomas JW, 1981. The concept of access: definition and relationship to consumer satisfaction. Med Care 19:127–140. DOI: https://doi.org/10.1097/00005650-198102000-00001
Pieper J, Schweikart J, 2009. Kleinräumige Modellierung der vertragsärztlichen Versorgungssituation in Berlin [Small-scale Modeling of the Contractual Medical Care Situation in Berlin]. In: Amt für Statistik Berlin-Brandenburg (ed) Zeitschrift für amtliche Statistik: Berlin Brandenburg. Berlin, Amt für Statistik Berlin-Brandenburg, pp. 22–29.
Rauch S, Stangl S, Haas T, Rauh J, Heuschmann PU, 2023. Spatial inequalities in preventive breast cancer care: A comparison of different accessibility approaches for prevention facilities in Bavaria, Germany. J Transp Health 29:101567. DOI: https://doi.org/10.1016/j.jth.2023.101567
Schweikart J, Pieper J, 2019. Kleinräumige Analyse der ambulanten ärztlichen Versorgung im Berliner Bezirk Mitte: Unter Berücksichtigung ausgewählter Nachbarschaften, insbesondere Alexanderplatzviertel/Karl-Marx-Allee [Small-scale Analysis of Outpatient Medical Care in the Berlin District of Mitte: Considering Selected Neighborhoods, Especially Alexanderplatzviertel/Karl-Marx-Allee]. Eine Studie im Auftrag des Bezirks Mitte. (Studienbericht und Dokumentation. Zweite, revidierte Fassung). Berlin.
Stacherl B, Sauzet O, 2023. Gravity models for potential spatial healthcare access measurement: a systematic methodological review. Int J Health Geogr 22:34. DOI: https://doi.org/10.1186/s12942-023-00358-z
Statistical Office of Bremen, 2022. Bremen in Zahlen 2023: [Bremen in numbers 2023] [Online]. Accessed 24 January 2024. Available at file://C:/Users/nutzerin/Downloads/biz2023Auflage3_pdfa.pdf
Statistical Office of Lower Saxony, 2021. Flächenerhebung nach Art der tatsächlichen Nutzung - Statistische Berichte: [Area data collection by type of actual use - Statistical reports] [Online]. Accessed 24 January 2024. Available at https://www.statistik.niedersachsen.de/flaechenerhebung/flachenerhebung-nach-art-der-tatsachlichen-nutzung-statistische-berichte-87671.html
Statistical Office of Lower Saxony, 2022. Bevölkerungsstand: Einwohnerzahl Niedersachsens - Tabellen: [Population: Population of Lower Saxony - Tables] [Online]. Accessed 24 January 2024. Available at https://www.statistik.niedersachsen.de/startseite/themen/bevoelkerung/bevolkerungsstandeinwohnerzahlniedersachsens/bevolkerungsstand-einwohnerzahl-niedersachsens-tabellen-201964.html
Subal J, Paal P, Krisp JM, 2021. Quantifying spatial accessibility of general practitioners by applying a modified huff three-step floating catchment area (MH3SFCA) method. Int J Health Geogr 20:9. DOI: https://doi.org/10.1186/s12942-021-00263-3
Tang JH, Chiu YH, Chiang PH, Su MD, Chan TC, 2017. A flow-based statistical model integrating spatial and nonspatial dimensions to measure healthcare access. Health Place 47:126–138. DOI: https://doi.org/10.1016/j.healthplace.2017.08.006
Tao Z, Cheng Y, Liu J, 2020. Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China. Int J Equity Health 19:164. DOI: https://doi.org/10.1186/s12939-020-01280-7
Terfrüchte T, 2019. Gleichwertige Lebensverhältnisse zwischen Raumordnung und Regionalpolitik [Equal Living Conditions between Spatial Planning and Regional Policy]. Wirtschaftsdienst 99:24–30. DOI: https://doi.org/10.1007/s10273-019-2428-6
Thielscher C, 2021. Handbuch Medizinökonomie I [Handbook of Medical Economics I]. Wiesbaden, Springer Fachmedien Wiesbaden.
UN Regional Information Centre, 2023. Goal 3: Ensure healthy lives and promote well-being for all at all ages [Online]. Brussels, Belgium, UN Regional Information Centre. Accessed 17 January 2024. Available at https://unric.org/en/sdg-3/
United Nations General Assembly, 2012. Resolution adopted by the General Assembly on 27 July 2012: 66/288. The future we want [Online]. New York, United Nations, Sixty-sixth United Nations General Assembly. Accessed 30 January 2024. Available at https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/ARES66_288.pdf
Voigtländer S, Deiters T, 2015. Mindeststandards für die räumliche Erreichbarkeit hausärztlicher Versorgung: Ein systematischer Review [Minimum Standards for the Spatial Accessibility of General Practice Services: A Systematic Review]. Gesundheitswesen 77:949–957. DOI: https://doi.org/10.1055/s-0035-1548805
Wang F, Luo W, 2005. Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas. Health Place 11:131–146. DOI: https://doi.org/10.1016/j.healthplace.2004.02.003
World Health Organization (WHO), 1978. Declaration of Alma-Ata: Paper presented at the International conference on primary health care [Online]. Geneva, Switzerland, WHO Press. Accessed 17 January 2024. Available at https://www.who.int/docs/default-source/documents/almaata-declaration-en.pdf

How to Cite

Schoo, J., & Schüssler, F. (2025). The future of general practitioner care in Lower Saxony, Germany: an analysis of actual <i>vs</i> target states using a GIS-based floating catchment area method. Geospatial Health, 20(1). https://doi.org/10.4081/gh.2025.1339