A national accessibility mapping method shows hospice access declining sharply outside Germany's cities, and offers a transferable way to measure it

A national study compared four spatial-accessibility methods — including two-step and enhanced two-step floating catchment area (2SFCA/E2SFCA) methods — across 295 inpatient hospices in Germany, finding 90.3% of the population within 30 minutes’ drive of a hospice under a simple travel-time measure Audit/Data (Petzold et al.1). Once distance-decay methods, which weight accessibility down as travel time increases within that 30-minute threshold rather than treating it as a simple cut-off, were applied, accessibility declined sharply in rural areas.

The study is methodological as much as descriptive: its principal contribution is a replicable, more precise way of quantifying accessibility, rather than a service capacity or funding recommendation.

The practical value for any national or regional palliative care service is the method itself: a 2SFCA/E2SFCA-style spatial-accessibility analysis offers a way of quantifying rural hospice and specialist palliative care access directly, rather than relying on simple provider-to-population ratios that this study’s own findings suggest can understate rural disadvantage.