Regional disparities in access to coordinated health care in Poland: development and application of an accessibility index

Coordinated care has been introduced in Poland since 2022 as a nationwide reform to improve healthcare continuity and reduce patient out-of-pocket expenditures. However, the regional implementation of coordinated care remains uneven, with limited evidence on equity and household-level impacts. This study aimed to assess territorial disparities in access to coordinated healthcare in Poland by integrating infrastructural, financial, and perceptual dimensions. We combined administrative data on healthcare providers with anonymized household-level data from the 2023 Household Budget Survey (28,089 households). A synthetic Accessibility and Satisfaction Index (ASI) was developed, incorporating three weighted components: number of coordinated care facilities per 10,000 inhabitants (0.4), Subjective Index of Health Needs Satisfaction (0.3), and Household Economic Burden Index (0.3). Concentration indices (Gini, Theil, Shannon entropy) and correlation analyses (Pearson, Spearman) were applied to assess interregional inequalities and relationships between accessibility, household income, and healthcare expenditures. Although coordinated care facilities were relatively evenly distributed nationwide (Gini = 0.134; Theil = 0.0288; Shannon entropy = 2.744), the ASI revealed significant disparities in effective access. Lubelskie (0.851), Dolnośląskie (0.781), and Świętokrzyskie (0.765) achieved the highest ASI scores, while Wielkopolskie (0.563) and Opolskie (0.543) ranked lowest. Infrastructural availability strongly correlated with ASI values (r = 0.78), whereas subjective satisfaction showed weak associations (r = 0.07). Household income was negatively correlated with the health expenditure burden (r = − 0.46), confirming the regressive character of private health costs. Expenditures on pharmaceuticals were negatively associated with facility availability (r = − 0.28), suggesting self-medication in regions with limited access. The findings confirm that infrastructure is the main determinant of coordinated healthcare accessibility in Poland, while subjective satisfaction plays a minor role. The proposed ASI offers a valid and stable synthetic tool for evaluating spatial disparities in access to coordinated healthcare. Policymakers should prioritize harmonizing regional infrastructure, monitoring waiting times, and integrating financial and perceptual dimensions into health system evaluation.