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

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.