Spatial modeling of factors influencing outpatient healthcare accessibility at the municipal level: An empirical analysis (case study of Sverdlovsk oblast)

Abstract

The article examines the factors of spatial accessibility of outpatient healthcare at the municipal level. The study is based on data from 65 municipalities of Sverdlovsk Region for the year 2021. A modified gravity-based accessibility index was applied, accounting for the distribution of medical personnel and the transport connectivity of territories. The impact of explanatory factors was assessed using the Spatial Durbin Model (SDM), while local disparities were identified through LISA analysis. The results confirmed the significant impact of institutional and economic factors on the accessibility of medical services, with this influence manifesting both directly and through mechanisms of resource redistribution between territories. A negative spatial lag coefficient (r = –0.49, p < 0.05) was identified, indicating a systemic crowding-out effect: an increase in accessibility in some territories is accompanied by its decrease in neighboring ones. Local analysis revealed zones of local inefficiency (32% of the sample), where high resource potential does not translate into improved actual healthcare accessibility. The findings refine the understanding of mechanisms of territorial inequality in healthcare and provide a basis for the development of targeted regional policies.