Does Health Service Funding Go Where the Need Is? A Prototype Spatial Access Analysis for New Urban Contracts Data

Abstract

Much of spatial access research measures the proximity to health service locations. We advance
this research by focusing on spatial access to health services by taking health service funding
into account. This is made possible by a new administrative data source: financial contracts data
for those human services that are delivered by nonprofits under contract with the government. In
a prototypical spatial access study we draw on 2018 data about contracted nonprofit health
services funded by the Chicago Department of Public Health (CDPH) that CDPH collected for
the purpose of this study. We find that the common container approach of aggregating contract
amounts by provider headquarter locations in a given area (ignoring satellite service sites)
underestimates the share of funding that goes to Chicago neighborhoods with higher hardship.
Once service sites and spatial access are taken into account, a larger share of CDPH funds was
found to be within walkable reach of Chicago’s high hardship areas. This was followed by low
hardship areas (which could be driven by more headquarter locations there that do serve areas
throughout the city). Medium hardship areas trail both, perhaps warranting closer attention. We
explore these results by program type and neighborhood with a spatial decision support system
developed for the health department.

Keywords: health services, administrative contracts data, spatial access