Pediatric Care Proximity in Germany: A Comparative Study of Regional Accessibility

Abstract In Germany, healthcare provision is governed by the Bedarfsplanungs-Richtlinie (Needs Planning Directive), which sets national guidelines for determining regional treatment capacities based on population-to-physician ratios and morbidity rates. Despite these regulations, spatial imbalances persist, resulting in physician oversupply in attractive and undersupply in peripheral areas, impacting pediatric care accessibility. This study examines changes in the distribution, accessibility, and capacity of pediatricians nationwide using official location data from 2011 and 2021. Utilizing Kernel Density Estimate, Raster-Based Accessibility Analysis and Enhanced Two-Step Floating Catchment Area Analysis methods, disparities in pediatrician accessibility, particularly between rural and non-rural areas as well as between the individually available means of transport car, bicycle, foot, and foot plus public transport are identified. The analysis results suggest that disparities in pediatrician accessibility exists especially between rural and non-rural areas. Generally, throughout all analyzed means of transport, non-rural regions tend to have higher rates of pediatrician accessibility, whereas rural areas and especially the rural hinterland experience the opposite, often with significantly lower accessibility levels or even inaccessibility, especially when it comes to the means of transport bicycle, foot, and foot plus public transport. This suggests that rural regions face distinct challenges in accessing pediatric healthcare, closely related to the availability of individually usable modes of transportation, warranting targeted interventions.