Universal Journal of Public Health 1(3): 40-50, 2013 http://www.hrpub.org DOI: 10.13189/ujph.2013.010302 The Shortage-Surplus Paradox: A Literature Review of Primary Health Care Accessibility Melissa M Terry, Daniel R Terry * , Ha Hoang, Chona Hannah University Department of Rural Health, University of Tasmania, Locked Bag 1372, Launceston, Tasmania 7250, Australia *Corresponding Author: Daniel.Terry@utas.edu.au Copyright © 2013 Horizon Research Publishing All rights reserved. Abstract The National Primary Health Care Strategy in Australia recommends primary health care services need to be clinically and culturally appropriate and delivered in a timely and affordable manner. However simultaneously recognised, access is still inequitable in among various population groups and many areas of Australia. Geographical Information System (GIS) have been used to explore geographical health disparities, planning health care service delivery and provide data in a meaningful way to inform public health strategies. Moreover, GIS has also been used to spatially analyse, measure and provide insight into a population’s accessibility to health care services. A literature search was conducted to identify studies which examined primary health care accessibility using GIS techniques among various urban and rural populations. A limited number of studies demonstrated in addition to distance; time; and location, low socioeconomic status, Culturally and Linguistically Diverse (CALD) background among other factors influences health care access. In addition, other factors were identified to impact health care access, which is an individualised process, influenced by individual characteristics, beliefs, attitudes, and an individual’s activity space. As health care accessibility becomes more prominent within policy, among practitioners and increasingly researched, it has the potential to move beyond recognising areas of poor accessibility among individuals and communities. With a greater integration of both spatial and aspatial data, the process has the likelihood, to provide greater insight into patient behaviour, public perception, amelioration service quality and improve population health and wellbeing. Keywords Health Care Access, Rural, Spatial Accessibility, Primary Health Care, GIS 1. Introduction The Department of Health and Ageing [1], stated in the National Primary Health Care Strategy that all “Australians should have access to primary health care services which keep people well and manage ill-health”. As such, it was recommended that primary health care services needed to be clinically and culturally appropriate and delivered in a timely and affordable manner. However, it was recognised that with an average of 5.1 GP services per capita, access was still inequitable in many areas of Australia and among various population groups. [1] This was made obvious in a recent article, where a super clinic in South Australia was being built where other services already existed, while five kilometres away a community with high socio-economic disadvantage had lost their last GP. Accessing this new clinic was problematic as many in the community did not drive and were aiming to walk or use public transport to access the new super clinic. [2] Health care has many definitions and meanings as it is more than the absence of disease. [3] To some, health care and health oriented services is hospital or medical care, while to others it may mean a plethora of other ‘health’ oriented services, from primary health care right through non-medical services or complementary and alternative medical care. [4] Nevertheless, as primary health care services is the first-point-of-contact which occurs between the community and the national health system in Australia, this will be used to define access to health care within this literature review. [4-6] Similar to defining health care, access to health care is complex and may mean many things to different people. It is “not limited to the availability of care, the ability to get to and pay for available care, or the act of seeking and utilising available care”. [7] Potential or realised access is influenced by many other social and geographical aspects. [5,8-10] Thus by its own nature, access has many complex and challenging meanings with no clear consensus in terms of definition, meaning or how it can be measured. [4,11] Penchansky and Thomas [12], state “‘Access’ is defined here as a concept representing the degree of ‘fit’ between the clients and the system”. The framework they outline highlights five interdependent dimensions to determine and aid individuals to understand what access may mean. These dimensions include availability, accessibility, accommodation, affordability, and acceptability. [12] Khan and Bhardwaj