Association for Public Policy Analysis & Management

Abstract. Over the past two decades, spatial distribution and accessibility to healthcare services have become increasingly studied in both urban and state-level contexts. Though the scholarly development of studying spatial equity of healthcare service has presented critical findings to influence policy, most analyses operate under the notion that the healthcare facilities are able to provide the appropriate care for each individual of the population. Individuals identifying as transgender or gender non-binary possess unique sets of medical needs to obtain comparable health outcomes as cis-gendered individuals. At the primary care level, not all physicians possess the content knowledge and/or the level of comfortability to care for patients identifying as transgender or gender non-binary effectively. This differing level of physician preparedness, along with the seemingly polarized public opinion corresponding with the transgender and gender non-binary community, generates a barrier preventing these individuals from seeking adequate primary care. This study aims to replicate past studies of spatial accessibility of various healthcare services in the urban context, but focusing explicitly on the accessibility of primary care physicians available to treat transgender and gender non-binary patients.

Through building a database of primary care physicians with proper resources to treat transgender and gender non-binary patients by communicating with major hospital networks and medical education institutions, healthcare locations in the City of Philadelphia will be mapped utilizing ArcGIS. Employing spatial analysis methods, such as 2-step floating catchment area (2SFCA) and Nearest Neighbor Hierarchical Cluster Analysis (NNHCA) to check for clustering, as well as descriptive statistics to consider critical neighborhood characteristics reported by the 2010 Census data, a more precise picture will begin to form regarding the spatial accessibility of primary care for transgender and gender non-binary individuals. The author hypothesizes a considerable difference in the measured accessibility to primary care for transgender and gender non-binary individuals in comparison to cis-gender individuals in the City of Philadelphia. Though the study is in initial phases, the analyses may be repeated for other urban environments, as well as expanded to assess entire states.