Bridging the Gap: Competition-Aware MH3SFCA Mapping of Dental Care Accessibility in Germany

Equitable access to dental care across Germany remains constrained by geographic barriers, yet traditional provider-to-population ratios fail to capture spatial complexity. This study employed a Modified Huff Three-Step Floating Catchment Area (MH3SFCA) method to quantify dental care accessibility at the ZIP-code level across all 8171 German postal code zones, integrating 2022 Census demand data, 38,023 dental facilities, and network-based travel times. Results revealed stark geographic disparities: accessibility exhibited strong positive spatial autocorrelation (Moran’s I = 0.97, p < 0.001), with 22.6% of the population in high-access urban clusters concentrated in Berlin, Hamburg, and the Rhine-Ruhr region, while statistically significant cold spots affected only a small share of the national population but formed geographically persistent clusters in rural and peripheral regions. The Gini coefficient of 0.55 indicated moderate overall inequality, substantially higher than for physician distribution (Gini = 0.19). Regional heterogeneity was prominent: Mecklenburg-Western Pomerania had 74.9% of its population in the lowest accessibility quartile (mean index = 0.7), while Berlin achieved near-universal high access (mean = 15.3). The MH3SFCA framework provides German planning bodies with a dynamic tool for routine accessibility monitoring and scenario analysis, supporting targeted, place-based workforce interventions that move beyond static mapping toward more equitable distribution of dental care.