Advanced search


Full Text:


The population access to health care services is conditioned on the offer of medical services, which being unevenly distributed determines a limited access of the population, especially in rural areas. The inequalities in the distribution of health resources in Botosani County show a different accessibility levels to health services, depending on the living environment, but also on some financial, educational and social aspects. Using statistical data in the period 2000–2013 and spatial analysis, this paper focuses on the assessing and interpretation of the population accessibility indicators to health services in Botosani county – a small county located in the NE part of the Romania, and which is part of the poorest region of the Romanian country, in order to highlight the inequalities outlined in the county between the rural and urban areas. The inequalities of population accessibility to health care services are due to the lack of medical facilities, the poor quality of transport infrastructure and the lack of income.

About the Author

Teodora Estera Ursulica
“Simion Mehedinţi” Doctoral School, University of Bucharest
Russian Federation


1. Aday, L.A., Andersen, R. (1981) Equity of access to medical care: a conceptual and empirical overview. Medical Care. Vol. XIX: 12 (supplement): 4–27.

2. Allin S., Masseria C., Sorenson C., Papanicolas I. and Mossialos E. (2007), Measuring inequalities in access to health care. A review of the indices, The London school of economics and political science, Manuscript completed in June 2007.

3. Basu J., Friedman B. Preventable illness and out-of-area travel of children in New York counties. Health Economics. 2001; 10: 67–78.

4. Black M., Ebener S., Najera Aguilar P., El Morjani Z., Ray N., Vidaurre M., (2004). Using GIS to Measure Physical Accessibility to Health Care. WHO-PAHO, Paper presented during the 2004 International Health Users conference, Washington DC.

5. Ciutan M., (2008), Aspects of health service provision in rural areas, Management in health; 2008, p. 29–30, 96.

6. Connor, R.A., J.E. Kralewski and S.D. Hillson, (1994), Measure Geographic Access to Health Care in Rural Areas, Medical Care Research and Review 51 (3): 337–77.

7. Cromley E.K. and McLafferty S.L., (2012), GIS and Public Health New York and London: The Guilford Press; 2012.

8. Culyer A.J. and Wagstaff A., (1993), Equity and equality in health and health care. Journal of Health Economics,12, 1993, p. 431–457.

9. Curtis A., Mills J.W. and Leitner M., (2006), Spatial confidentiality and GIS: re-engineering mortality locations from published maps about Hurricane Katrina. International Journal of Health Geographics; 2006, 5 (44).

10. Deak, I., (2012), Romania, the European red flashlight in the health system. Wirtschaftsblatt radiographs the situation in Eastern European countries, Health Journal, March 25, 2012.

11. Dumitrache, L., (2003), Medical geography – methods and techniques of investigation, Editura Universitară, Bucharest.

12. Dumitrache, L., (2004), The health of the Romanian population – geographical approach, Editura Univers Enciclopedic; Bucharest.

13. Dumitrache L., Dumbraveanu D., (2008), Geographic distribution of sanitary resourcesin Romania and its consequences on individual and public health, Human Geography, Journal os Studies and Research in Human Geography, disponibil online,

14. Dragomiristeanu A., (2010), Reducing inequities in healthcare: a priority for European policies and measure. Management in Health. 2010; 16 (1): 14–19.

15. Ebener S., El Morjani Z., Ray N., Black M. (2005). Physical Accessibility to health care: From Isotropy

16. to Anisotropy.

17. Fryer G.E., Jr., Drisko J., Krugman R.D., Vojir C.P., Prochazka A., Miyoshi T.J., Miller M.E. (1999), Multi-method assessment of access to primary medical care in rural Colorado. Journal of Rural Health. 1999; 15: 113–121.

18. Fortney J., Rost K., Zhang M., Warren J., (1999), The Impact of Geographic Accessibility on the Intensity and Quality of Depression Treatment. Medical Care. 1999; 37 (9): 884–93.

19. Goodman D.C., Barff R.A. and Fisher E.S., (1992), Geographic barriers to child health services in rural northern New England: 1980 to 1989. Journal of Rural Health; 1992, 8 (2), p. 106–113.

20. Gwatkin D.R., (2001), Poverty and inequalities in health within developing countries: filling the information gap.

21. Guagliardo, M.F., (2004), Spatial accessibility of primary care: concepts, methods and challenges. International Journal of Health Geographics, 3 (3).

22. Higgs G., (2004), A literature review of the use of GIS-based measures of access to health care services. Health Service and Outcomes Research Methodology; 2005, 5, p. 119–139.

23. Jordan H., Roderick P., Martin D., (2004), The index of multiple deprivation 2000 and accessibility effects on health., J. Epidemiol Community Health. 2004; 58: 250–7.

24. Joseph, A.E. and Bantock P.R., (1982), Measuring potential physical accessibility to general practitioners in rural areas: a method and case study. Social Science and Medicine, 16, 86–90.

25. Lalonde, M., (1974), A new perspective on the health of Canadians. A working document Ottawa, Government of Canada, 1974.

26. Luo, W., Wang, F., (2003), Measures of spatial accessibility to healthcare in a GIS environment: Synthesis and a case study in Chicago region.Environment and Planning B 2003, 30 (6): 865–884. + html

27. Kasper J.D., (2000), Health-care utilization and barriers ton health care, in Handbook of social studies in health and medicine, G.L. Albrecht, R. Fitzpatric k, and S. Scrimshaw, Editors. Sage: London. p. 323–338.

28. Kirby J.B., Kaneda T., (2005), Neighborhood socioeconomic disadvantage and access to health care. J. Health Sci Behav 2005, 46: 15–31.

29. Meyer S.P.,(2012), Comparing spatial accessibility to conventional medicine and complementary and alternative medicine in Ontario, Canada. Health and Place; 2012, 18, p. 305–314.

30. Monnet E., Collin-Naudet E., Bresson-Hadni S., Minello A., Di Martino V., Carel D., Jooste V., Cagnaire A., Evrard P., Obert-Clerc B., Miguet J.P. and Hillon P., (2006), Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study. Journal of Hepatology; 2006, 44, p. 499–506.

31. Morrill R.L., Earickson R.J., Rees P., (1970), Factors influencing distances traveled to hospitals, Economic Geography 1970, 46 (2): 161–171.

32. National School of Public Health and Health Management, (2008), Final report of the project to reform health sector, Ministry of Public Health of Romania, vol. 1., p. 22–28.

33. Oliver A., Mossialos E., (2004), Equity of Access to Health Care: Outlining the Foundations for Action. Journal of Epidemiology and Community Health 58: 655–658.

34. Onega T., Duell E.J., Shi X., Wang D., Demidenko E. and Goodman D., (2008), Geographic access to cancer care in the US. American Cancer Society; 2008, 112 (4), 909–918.

35. Parker E.B., Campbell J.L., (1998), Measuring access to primary medical care; some examples of use of Geographical Information Systems, Health and Place 4: 183–193.

36. Penchansky, R. and Thomas, J.W. (1981), The concept of access: definition and relationship to consumer satisfaction. Med Care, 19 (2), 127–140.

37. Robst, J. & Graham, G. (2004). The relationship between the supply of primary care physicians and measures of health. Eastern Economic Journal, 30, 467–486.

38. Stanciu M., (2013), The public healthcare Romanian system in the European context, The magazine Quality of life, XXIV, nr. 1, 2013, p. 47–80.

39. Verter V., Lapierre S.D. (2002), Location of Preventive Health Care Facilities, Annals of Operations Research, Volume 110, Issue 1–4, p. 123–132.

40. Victora C.G., Wagstaff A., Schellenberg J.A., Gwatkin D., Claeson M., Habicht J.P. (2003), Applying an equity lens to child health and mortality: more of the same is not enough, The Lancet Volume 362, No. 9379, p. 233–241, 19 July, 2003.

41. Zamfir D., Dumitrache L., StoicaV, Virdol D., (2015), Spatial inequalities in health care provision in Romania: milestones for territorial sustainable development Carpathian Journal of Earth and Environmental Sciences, august 2015, Vol. 10, No 3, p. 177–188.

42. Wang F., Luo W., (2005), Assessing Spatial and Non-spatial Factors for Healthcare Access: Towards an Integrated Approach to Defining Health Professional Shortage Areas, Health & Place 11: 131–146.

43. Wang F., (2012), Measurement, optimization, and impact of health careaccessibility: A Methodological Review. Annals of the Association of American Geographers; 2012, 102 (5), p. 1104–1112.


For citations:


Views: 809

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2071-9388 (Print)
ISSN 2542-1565 (Online)