Health care in rural areas: spatial and temporal aspects of accessibility

The aim of the article is to assess the availability of medical services to the population of the Vologda Oblast in terms of intermediary factors such as means of communication as an important component of regional infrastructure which is the basic condition for “soft infrastructure” operating, and the evaluation of access time to certain medical facilities. The common assessment of spatial accessibility of health facilities in the districts of the Vologda Oblast is presented. The authors come to the conclusion that geographical accessibility of health facilities in the regions of the European North, and in the Vologda Oblast particularly, is limited by both the objective factors, and factors connected with the executive authorities’ activity. The first group of factors include the settlement system which complex from the point of view of ensuring universal coverage and accessibility and is characterized by low density of population and the vastness of the territories. These are the objective obstacles for both the construction of a dense road network and for the formation of compacted networks of medical facilities. There is a significant differentiation regarding spatial remoteness of health care institutions, particularly of central regional hospitals where the patients can get sufficient diagnostic procedures and treatment, however a significant part of the population in most municipalities of the region is at a critical distance from medical facilities. The findings of the research will be useful for improving regional social policy and development of health care infrastructure. The research prospects are concerned with the deepening and detailed design of the centers of the regional health care social infrastructure.