Going the Extra Mile:

Transport Equity and Healthcare Access
for Seniors in Singapore

2023



By Alice Lee
Under the Supervision of Dr Lynette Cheah and Dr Thi Anh Hong Nguyen

Singapore University of Technology and Design

AIM ONE

Determine the relative accessibility of healthcare services by comparing the travel times and costs between public transport and private vehicle travel modes, and last-mile proximity from transit stops for community-dwelling seniors in Singapore.

Part One - Spatial Analysis Methodology

AIM TWO

Assess and identify environmental barriers or enablers that seniors using public transport services might face when making the last-mile trip from the nearest transit stop to healthcare facilities in Singapore.

PART Two - Walkability Assessment Methodology

Part One: Spatial Analysis

Singapore is divided into 228 residential precincts defined as “subzones” by the Urban Redevelopment Authority (URA). 226 subzones with at least one senior resident aged 65 and above were included in the study. 40 healthcare facilities that community-dwelling seniors are likely to access based on their healthcare needs were included in this study, including 23 polyclinics, 8 government restructured hospitals (RHs) and 9 community hospitals (CHs).

Data was extracted using Google Distance Matrix API and LTA DataMall, and processed for analysing:

Absolute and relative accessibility in terms of travel time and costs from each subzone to each target healthcare facility, using public transport versus a private vehicle.

The public transport/walking time for each subzone:healthcare facility pair was assumed to be the fastest (minimum) travel time across 7 public transit modes using Google’s Distance Matrix API.

Last-mile walking distances from nearest transit stop to each healthcare facility.

PART ONE FINDINGS

Part Two: Walkability Assessment

Addressing AIM TWO, the walkability assessment aims to gather insights on potential areas of improvement to facilitate seniors' access to restructured hospitals (RHs). The assessment involved a survey of the last-mile routes - from the nearest MRT station* or bus stop - to each of the 8 RHs, by three researchers (May to June 2023).

The walkability survey instrument was developed comprising eleven variables representing three walkability dimensions (convenience, safety and comfort) that have been found to affect seniors' walking behaviours in research.

SURVEY DIMENSIONS



* MRT routes for AH, CGH, SGH and KTPH are excluded as they already provide shuttle bus services from the nearest MRT station.

Direct

According to the Walking and Cycling Design Guide (2018) by LTA and URA, paths should be direct and easily navigable to enhance accessibility for pedestrians. Three observation areas:
(i) Path continuity

(ii) Path inclination (iii) Wayfinding aids

Safety

Safety is a crucial factor influencing seniors' mobility.
For segments with footpaths, this dimension examines the extent of potential interaction with vehicular traffic.

For segments with crossings, the focus is on the presence of tactile indicators as cues for visually-impaired pedestrians.

Comfort

Comfort entails ensuring pathways are easy to use, and provide protection from weather elements. Assessing comfort focuses on the observation area of pavement conditions:

  • Pavement quality (condition of the pavement, taking into account the presence of cracks or unevenness)
  • Pavement width (narrowest part through which pedestrians must navigate, avoiding vegetation and obstacles)
  • Shelter/shade from weather elements


Total Walkability Scores (Across all 11 variables)

Back to Part Two Methodology

Spatial Analysis Findings

How accessible are healthcare facilities based on transport mode choice?

Compared to private vehicle users, public transport users face on average:

2.8

times

as much travel time

10

%

of travel costs

18.3

mins

longer travel time

making public transport a less attractive option for seniors who can afford taking private vehicles.

$6.75

less travel cost

compelling price-sensitive seniors to continue using public transport.

Back to Part One

Public Transport:Private Vehicle Travel Time Ratios


(A) Restructured Hospitals

Back to Part One

(B) Community Hospitals

Back to Part One

(C) Polyclinics

Back to Part One

Walkability Assessment Findings

Back to Survey Dimensions
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Total Walkability Scores


Back to Survey Dimensions

Key Walkability Issues

Based on the walkability assessment, key barriers were identified based on specific segments along routes from transit stops to the nearest restructured hospitals.

Wayfinding

Lack of pictograms and staff to assist illiterate seniors
Lack of diversity of wayfinding signage locations, causing crucial signage to be missed.

Safety

Exposure to vehicular traffic on footpaths, posing potential risk to seniors with diminished ability to react to vehicular traffic.
Lack of tactile tiles for visually-impaired

Accessibility Issues for Wheelchair Users

Narrow pavement width
Level changes or uneven pavements
Lack of shelter/shade from weather elements

© Copyright 2023 Alice Lee
Correspondence: lynette@sutd.edu.sg