Exploring the inequality in fine-grained primary healthcare accessibility in Macau based on high-resolution geospatial data under the 15-minute city framework

Primary healthcare (PHC) acts as a cornerstone of public health. The 15-min city concept, advocating convenient access to essential urban services such as PHC within a 15-min walk, has gained traction globally. However, there remains a lack of understanding regarding the 15-min accessibility to PHC services, crucial for physically vulnerable individuals requiring regular medical attention. Previous healthcare accessibility studies often use the traditional floating catchment area (FCA) method, which overlooks demand and service supply inflation within catchment areas, potentially leading to inaccuracies in accessibility estimates. This study addresses the gap in understanding fine-grained 15-min accessibility to PHC services by employing an enhanced two-step floating catchment area (E2SFCA) method, which considers the inflation effect. Additionally, our study incorporates hot spot analysis (Getis-Ord Gi∗), bivariate local Moran's I (Bi-LISA), and the Gini index to reveal inter- and intra-parish accessibility inequalities across the 7 parishes in Macau. Findings highlight Nossa Senhora de Fátima parish as having the highest concentration of low-income public housing estates and significant inter- and intra-parish 15-min PHC accessibility inequalities. This emphasizes the need for policymakers to consider integrating PHC facilities when developing public housing estates for low-income residents.