Spatial Accessibility and Health-System Concentration of Reachable Hospital Capacity in New Jersey
- 1Rutgers University
Abstract
BackgroundHospital consolidation increasingly places multiple hospitals under common system control. However, spatial accessibility estimates alone do not indicate whether that accessibility is distributed across many health systems or concentrated within a few.
MethodsWe used the enhanced two-step floating catchment area (E2SFCA) method to estimate tract-level spatial accessibility to staffed beds at general hospitals reachable within 30 minutes by car. For tracts with positive E2SFCA scores, we aggregated hospital contributions by health system and calculated a Herfindahl-Hirschman Index (HHI) from each systems share of the tracts total E2SFCA score. We used Spearman rank correlations to examine associations with tract-level sociodemographic characteristics.
ResultsOf 163 reachable hospitals, 94 were outside New Jersey and accounted for 62.7% of staffed beds among these hospitals. Across 2,172 tracts, mean and median E2SFCA scores were 1.98 and 1.99 staffed hospital beds per 1,000 population, respectively. Among 2,161 tracts with positive E2SFCA scores, mean and median HHI values were 0.36 and 0.31. Using 2.0 for E2SFCA and 0.18 for HHI as descriptive reference values, 934 tracts had E2SFCA < 2.0 and HHI [≥] 0.18, while 655 had E2SFCA [≥] 2.0 and HHI [≥] 0.18. For seven of eight sociodemographic characteristics, correlations with E2SFCA and HHI were in opposite directions.
ConclusionsConsidering E2SFCA and HHI together provides a community-level view of spatial accessibility and how that accessibility is distributed across health systems. This framework may inform assessments of hospital consolidation and proposed service or capacity changes.
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BibTeX
@misc{zheng2026spatial,
title = {{Spatial Accessibility and Health-System Concentration of Reachable Hospital Capacity in New Jersey}},
author = {Y. Zheng},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.02.26362067},
url = {https://www.medrxiv.org/content/10.64898/2026.09.02.26362067v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Spatial Accessibility and Health-System Concentration of Reachable Hospital Capacity in New Jersey
AU - Y. Zheng
PY - 2026
DA - 2026/09/02
PB - medRxiv
DO - 10.64898/2026.09.02.26362067
UR - https://www.medrxiv.org/content/10.64898/2026.09.02.26362067v1
AB - BackgroundHospital consolidation increasingly places multiple hospitals under common system control. However, spatial accessibility estimates alone do not indicate whether that accessibility is distributed across many health systems or concentrated within a few. MethodsWe used the enhanced two-step floating catchment area (E2SFCA) method to estimate tract-level spatial accessibility to staffed beds at general hospitals reachable within 30 minutes by car. For tracts with positive E2SFCA scores, we aggregated hospital contributions by health system and calculated a Herfindahl-Hirschman Index (HHI) from each systems share of the tracts total E2SFCA score. We used Spearman rank correlations to examine associations with tract-level sociodemographic characteristics. ResultsOf 163 reachable hospitals, 94 were outside New Jersey and accounted for 62.7% of staffed beds among these hospitals. Across 2,172 tracts, mean and median E2SFCA scores were 1.98 and 1.99 staffed hospital beds per 1,000 population, respectively. Among 2,161 tracts with positive E2SFCA scores, mean and median HHI values were 0.36 and 0.31. Using 2.0 for E2SFCA and 0.18 for HHI as descriptive reference values, 934 tracts had E2SFCA < 2.0 and HHI [≥] 0.18, while 655 had E2SFCA [≥] 2.0 and HHI [≥] 0.18. For seven of eight sociodemographic characteristics, correlations with E2SFCA and HHI were in opposite directions. ConclusionsConsidering E2SFCA and HHI together provides a community-level view of spatial accessibility and how that accessibility is distributed across health systems. This framework may inform assessments of hospital consolidation and proposed service or capacity changes.
ER -