Revealed versus potential spatial accessibility of healthcare and changing patterns during the COVID-19 pandemic

BACKGROUND: Timely access to healthcare is essential but measuring access is challenging. Prior research focused on analyzing potential travel times to healthcare under optimal mobility scenarios that do not incorporate direct observations of human mobility, potentially underestimating the barriers to receiving care for many populations. METHODS: We introduce an approach for measuring accessibility by utilizing travel times to healthcare facilities from aggregated and anonymized smartphone Location History data. We measure these revealed travel times to healthcare facilities in over 100 countries and juxtapose our findings with potential (optimal) travel times estimated using Google Maps directions. We then quantify changes in revealed accessibility associated with the COVID-19 pandemic. RESULTS: We find that revealed travel time differs substantially from potential travel time; in all but 4 countries this difference exceeds 30 minutes, and in 49 countries it exceeds 60 minutes. Substantial variation in revealed healthcare accessibility is observed and correlates with life expectancy (⍴=−0.70) and infant mortality (⍴=0.59), with this association remaining significant after adjusting for potential accessibility and wealth. The COVID-19 pandemic altered the patterns of healthcare access, especially for populations dependent on public transportation. CONCLUSIONS: Our metrics based on empirical data indicate that revealed travel times exceed potential travel times in many regions. During COVID-19, inequitable accessibility was exacerbated. In conjunction with other relevant data, these findings provide a resource to help public health policymakers identify underserved populations and promote health equity by formulating policies and directing resources towards areas and populations most in need.