Floating Catchment Area (FCA) methods are a popular choice for modelling accessibility to healthcare services because of their ability to consider both supply and demand. However, FCA methods do not fully consider aspects of travel and choicemaking behaviour as the only behavioural component is the impedance function. FCA approaches also tend to assign population demand to clinics and levels-of-service to population zones in an overlapping manner that has been shown to inflate/deflate supply and demand. While the adjustments proposed in the recent “Balanced FCA” method can rectify this, it apportions population and levels of service in a fractional manner. In response, this research proposes a utility-based measure of healthcare accessibility based on a multinomial logit (MNL) destination choice model that avoids the multiple-counting issue in FCA methods. It also considers additional behavioural aspects that define the appeal of clinics in addition to the travel time required to reach them, including their capacity and level of crowding. Comparisons of the MNL approach with the original and balanced FCA models using data for the City of Hamilton, Canada, suggest that while the accessibility patterns produced by each method are broadly similar, some key differences exist in the calculated accessibilities and their spatial patterns. The MNL model in particular estimates higher accessibilities in suburban and rural areas. After considering their strengths and weaknesses, we argue that both the FCA and MNL approaches offer merit for planning and policy.

浮动集水区 (FCA) 方法是对医疗保健服务的可及性进行建模的流行选择，因为它们能够同时考虑供需。然而，FCA 方法并没有充分考虑旅行和选择行为的各个方面，因为唯一的行为组件是阻抗函数。FCA 方法还倾向于以重叠的方式将人口需求分配给诊所，并将服务水平分配给人口区域，这已被证明会导致供需膨胀/收缩。虽然最近“平衡 FCA”方法中提出的调整可以纠正这一点，但它以部分方式分配人口和服务水平。作为回应，本研究提出了一种基于多项 logit (MNL) 目的地选择模型的基于效用的医疗保健可及性度量，该模型避免了 FCA 方法中的多重计数问题。它还考虑了定义诊所吸引力的其他行为方面，以及到达诊所所需的旅行时间，包括他们的容量和拥挤程度。MNL 方法与使用加拿大汉密尔顿市数据的原始平衡 FCA 模型的比较表明，虽然每种方法产生的可达性模式大体相似，但计算的可达性及其空间模式存在一些关键差异。特别是 MNL 模型估计郊区和农村地区的可达性更高。在考虑了他们的优势和劣势之后，