Associations between spatial access to medical facilities and health-seeking behaviors: A mixed geographically weighted regression analysis in Shanghai, China

Enhancing the spatial accessibility to medical facilities is an important public health strategy in many countries. However, it is not clear whether enhancing spatial accessibility is capable of addressing medical care issues due to the complexity of individuals' health-seeking behavior. This study draws from Andersen's behavioral model to identify enabling factors in the associations of spatial accessibility to medical facilities and socio-institutional factors with individuals' health-seeking behavior. Logistic regression and mixed geographically weighted regression techniques are used to analyze large-scale health survey data collected in Shanghai, China. The results show that spatial accessibility to medical facilities plays a significant role in health-seeking behaviors, but the mechanism at play is complicated, involving people's preference for high-grade hospitals and the demand for easy access to public transit. Moreover, there is spatial heterogeneity in the relationship between spatial accessibility to medical facilities and health-seeking behaviors. Especially, people who live in the inner suburb of Shanghai have worse access to these facilities and thus are more likely to perform self-treatment compared with urban residents. Moreover, localized contexts formed by the interweaving of spatial accessibility and socio-institutional factors, such as registered residence status (hukou), complicate the association between spatial accessibility and health-seeking behaviors.