College of Urban and Environmental Sciences, Peking University, Beijing, 100871, China.
School of Urban Planning and Design, Peking University, Shenzhen, Guangdong, 518055, China.
Int J Equity Health. 2018 Jan 15;17(1):7. doi: 10.1186/s12939-018-0720-5.
The two-step floating catchment area (2SFCA) method, which is one of the most widely used methods for measuring healthcare spatial accessibility, defines the catchment area of each facility as the area within a certain distance from the facility. However, in some cases, the service utilization behavior is constrained by administrative boundaries, therefore the definition of catchment area within a certain distance may be inappropriate.
In this study, we aim to propose a modification of the 2SFCA method for measuring spatial accessibility to healthcare services in a system constrained by administrative boundaries. The proposed method defines the catchment areas of healthcare facilities within certain administrative units. The method is applied in a case study of the healthcare services in Yanqing District of Beijing, China. Three types of healthcare facilities, including general hospitals, community healthcare centers and stations, are included.
Based on the sensitivity analysis of the distance-decay parameter β, result of the β = 1 scenario is relatively appropriate and is utilized for further analysis. The difference between spatial accessibility with or without constraint of administrative boundary is relatively significant. The results of the proposed model show that the village-level spatial accessibility to healthcare services shows a significant disparity, and the uneven distribution of general hospitals is the main cause.
The constraint of administrative boundary has a significant impact on healthcare accessibility, which verifies the validity of the modification proposed by this study in empirical studies. The empirical results also lead to policy recommendations to improve healthcare equity in the study area. At the town-level, the improvement of equity in healthcare accessibility could be achieved in two ways. First, the sizes of community healthcare centers in towns with small accessibility scores should be expanded. Second, new general hospitals can be built in the eastern part of Yanqing District. Within each town, to improve the equity in healthcare accessibility, community healthcare stations should be expanded or newly built in the periphery villages.
两步浮动服务区面积（2SFCA）方法是衡量医疗保健空间可达性最广泛使用的方法之一，该方法将每个设施的服务区定义为设施一定距离内的区域。然而，在某些情况下，服务利用行为受到行政边界的限制，因此，在一定距离内定义服务区可能不适当。
本研究旨在提出一种修改两步浮动服务区面积方法，以衡量受行政边界限制的医疗服务空间可达性。该方法将医疗设施的服务区定义为一定行政单位内的区域。该方法应用于北京市延庆区医疗服务的案例研究，包括综合医院、社区卫生服务中心和站。
基于距离衰减参数β的敏感性分析，β=1 情景的结果相对合适，并用于进一步分析。有或无行政边界约束的空间可达性之间的差异相对显著。该模型的结果表明，村级医疗服务的空间可达性存在显著差异，综合医院分布不均是主要原因。
行政边界的约束对医疗可达性有重大影响，这验证了本研究在实证研究中提出的修改的有效性。实证结果还为改善研究区域医疗公平性提出了政策建议。在镇一级，可通过两种方式提高医疗可达性公平性。首先，应扩大可达性得分较低的城镇的社区卫生服务中心的规模。其次，可在延庆区东部新建综合医院。在每个镇内，为了提高医疗可达性公平性，应在周边村庄扩大或新建社区卫生服务站。
