Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Nov 2, 2026
Open Peer Review Period: Nov 2, 2026 - Dec 28, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
GIS-Based Screening of Spatial Mismatch Between Primary Health Care Facility Locations and Population Need in Macao: Cross-Sectional Ecological Study
ABSTRACT
Background:
Equitable allocation of primary health care (PHC) facilities is essential for urban health planning. Conventional accessibility assessments may overlook mismatches between facility distribution and population needs, particularly among older adults.
Objective:
To develop a reproducible geographic information system (GIS)–based framework for assessing PHC facility-location equity using total population and older-adult population benchmarks in Macao.
Objective:
To develop a reproducible geographic information system (GIS)–based framework for assessing PHC facility-location equity using total population and older-adult population benchmarks in Macao.
Methods:
This cross-sectional ecological study analyzed 2021 population, PHC facility-location, and outpatient service data across 23 statistical zones. Population-demand shares were compared with facility-location shares to identify allocation gaps. A demand–supply matrix identified high-need zones without facilities. Outpatient volumes provided supplementary context.
Results:
The 2021 analysis covered 681,293 residents, including an estimated 82,741 adults aged 65 years or older, and 10 PHC facilities. Hac Sa Van e Iao Hon exhibited the largest allocation deficits under both benchmarks (−10.11 and −10.16 percentage points). Five zones met the high-need/no-facility criterion: Hac Sa Van e Iao Hon, San Kio, Toi San, Horta e Costa e Ouvidor Arriaga, and Zona Central. Gap direction differed between benchmarks in two zones. Outpatient volumes varied across facility locations but did not reveal patients’ residential origins.
Conclusions:
GIS-based population–facility comparisons can identify zones requiring further PHC planning assessment but cannot establish actual service shortages or unmet needs. Future analyses should incorporate updated demographic data, travel networks, facility capacity, and cross-district utilization.
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© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.