The geography of health services : case study of Medina, Saudi Arabia
This study examines health services in Medina in relation to the delivery system, the spatial distribution of health services, accessibility and effectiveness of utilization, including satisfaction with the services. A total of 500 patient questionnaires and 31 face-to-face interviews with key decision makers were used in addressing the research questions. Despite many positive aspects to the health services in Medina, such as the ratios of physicians and beds/population compared to the whole Kingdom's average, there are some problems that need to be overcome. The provision of primary health care centres (PHCCs) is very far from the health ministry target, which is one PHCC to serve 5,000 to 10,000 people and they are unevenly distributed. The capacity of state hospitals is almost full, and needs to be expanded by building another general hospital in the east part of Medina to help remedy the current balance in spatial distribution. The lack of a clear spatial distribution policy for Medina's health services is evident in the concentration of general hospitals on one side of the city. Most private hospitals and clinics (doctors) and groups of clinics are concentrated south and south west of the city centre, in a circle of about two kilometres in diameter. Demographic and socio-economic factors appear to be influential in explaining differences in utilization, access, and preference between types of health services (private/state/traditional healers). Accessibility issues had little effect in making health care users switch to private hospitals. It seems that perceptions of accessibility were influenced by the widespread ownership and use of cars. It appears that consumers' satisfaction with accessibility and quality was higher for private health services than state ones in the study area. However public and private provisions are intercalated in complex ways. Overall, the study shows that, given Saudi's expanding population and growing wealth, there is growing demand for new health facilities and access is stile a major planning issue, although it needs to be reconceptualization in the light of car ownership. New agendas are set for service planning, and for medical geography in the Saudi Arabia.