College of Architecture and Environment, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, 610065, China; West China School of Public Health, Sichuan University, No.17 People's South Road, Chengdu, 610041, China.
West China School of Public Health, Sichuan University, No.17 People's South Road, Chengdu, 610041, China.
Soc Sci Med. 2018 Jul;209:14-24. doi: 10.1016/j.socscimed.2018.05.023. Epub 2018 May 10.
Access to primary health care is considered a fundamental right and an important facilitator of overall population health. Township health centers (THCs) and Community health centers (CHCs) serve as central hubs of China's primary health care system and have been emphasized during recent health care reforms. Accessibility of these hubs is poorly understood and a better understanding of the current situation is essential for proper decision making. This study assesses spatial access to health care provided by primary health care institutions (THCs/CHCs) in Sichuan Province as a microcosm in China. The Nearest-Neighbor method, Enhanced Two-Step Floating Catchment Area (E2SFCA) method, and Gini Coefficient are utilized to represent travel impedance, spatial accessibility, and disparity of primary health care resources (hospital beds, doctors, and health professionals). Accessibilities and Gini Coefficients are correlated with social development indexes (GDP, ethnicity, etc.) to identify influencing factors. Spatial access to primary health care is better in southeastern Sichuan compared to northwestern Sichuan in terms of shorter travel time, higher spatial accessibility, and lower inequity. Social development indexes all showed significant correlation with county averaged spatial accessibilities/Gini Coefficients, with population density ranking top. The disparity of access to primary health care is also apparent between ethnic minority and non-minority regions. To improve spatial access to primary health care and narrow the inequity, more township health centers staffed by qualified health professionals are recommended for northwestern Sichuan. Improved road networks will also help. Among areas with insufficient primary health care, the specific counties where demographics are dominated by older people and children due to widespread rural-urban migration of the workforce, and by ethnic minorities, should be especially emphasized in future planning.
基本医疗卫生服务的可及性被视为一项基本权利，也是提高全民健康水平的重要促进因素。乡镇卫生院和社区卫生服务中心作为中国基层医疗卫生服务体系的核心，在最近的医疗卫生改革中得到了强调。这些中心的可达性了解甚少，为了做出正确的决策，了解当前的情况至关重要。本研究以四川省为微观样本，评估了基层医疗卫生机构（乡镇卫生院/社区卫生服务中心）提供的医疗卫生服务的空间可达性。采用最近邻法、增强两步浮动搜索区域法（E2SFCA）和基尼系数来表示出行障碍、空间可达性以及基层医疗卫生资源（床位、医生和卫生专业人员）的差异。可达性和基尼系数与社会发展指标（GDP、民族等）相关联，以确定影响因素。从出行时间较短、空间可达性较高、公平性较低等方面来看，四川省东南部的基层医疗卫生服务空间可达性优于西北部。社会发展指标均与县级平均空间可达性/基尼系数显著相关，人口密度排名最高。少数民族和非少数民族地区之间的基层医疗卫生服务可及性差异也很明显。为了改善基层医疗卫生服务的空间可达性，缩小公平性差距，建议在西北部增加配备合格卫生专业人员的乡镇卫生院。改善道路网络也将有所帮助。在基层医疗卫生服务不足的地区，应特别关注因劳动力广泛向城市转移而导致人口老龄化和儿童化的特定县，以及因少数民族人口众多的县，在未来的规划中应予以特别重视。
