High-Risk Populations in New Jersey Rely on Personal Vehicles to Reach Federally Qualified Health Centers

Background and Purpose: Access to Federally Qualified Health Centers (FQHCs) is crucial for improving health outcomes for New Jersey’s uninsured and underinsured populations. Through a multimodal analysis, this study aims to provide a comprehensive analysis of spatial access to FQHCs in New Jersey.

Methods: Multiple spatial accessibility methods were utilized to determine variation in spatial accessibility to FQHCs. All analyses were modeled in ArcGIS Pro 3.0. A shapefile of New Jersey by 2020 census tracts was used as the spatial reference for these analyses. FQHC locations are geocoded and provided by New Jersey’s Department of Health website.

Euclidean buffer. The straight line, or Euclidean distance measure, was used to measure the distance along a straight-line path between FQHCs and the point closest to the facility on the population centers of high-risk census tract groups. A 10-mile circular buffer was created around each FQHC using ArcGIS buffer analysis.

Origin Destination (OD) Cost Matrix. OD cost matrix analysis measures the shortest travel time distance from an origin to a destination. Measurements of high-risk census tract groups using the shortest travel time during peak hours and non-peak hours were used. Additionally, travel times of 15 and 30 minutes were used for each OD matrix analysis below.

Closest Facility with personal vehicle. The shortest traveling time between the high-risk Census tract centroids to the closest FQHCs was calculated using the OD cost matrix analysis of the Network Analyst Extension.

Closest Facility Train. Train accessibility was simulated in GIS through General Transit Feed Specification (GTFS) data on public transit schedules and routes.

Closest Facility Bus. Bus accessibility was simulated in GIS through GTFS data on public transit schedules and routes.

Results:

Euclidean buffers revealed that 4,189,267 at-risk residents (93% of total at-risk) are within a 10-mile buffer from an FQHC. Nearly all (99%) at-risk individuals were within 30 minutes driving distance of an FQHC during off-peak hours. During peak hours (9 a.m. Monday), 93% of at-risk residents are within 30 minutes of an FQHC. While most of the at-risk population is within 15 minutes of an FQHC during off-peak hours (93%), this number reduced to 69% when evaluated at peak traffic hours. There was little variability in the difference between off-peak and peak hours of travel by bus. Few at-risk populations (8%) could reach FQHCs within 15 minutes regardless of the time or day of the week. This percentage slightly increased (15%) when the time was expanded to 30 minutes. There was slightly higher accessibility by train for the at-risk population to FQHCs from at-risk census tracts during peak hours compared to off-peak hours for both 15-minute intervals (25% vs. 22%) and 30-minute intervals (32% vs. 28%).

Conclusions and Implications: The findings offer valuable insights into the accessibility of FQHCs across New Jersey by establishing that personal vehicles are the most effective mode of transportation for allowing at-risk residents to reach FQHCs within 30 minutes.