海地东北部的跨境医疗可达性。
Cross-border spatial accessibility of health care in the North-East Department of Haiti.
机构信息
Environmental Equity Laboratory, INRS Centre Urbanisation Culture Société, 385, rue Sherbrooke Est, Montréal, Québec, H2X 1E3, Canada.
Département d'études urbaines et touristiques, Université du Québec à Montréal, Case postale 8888, Succursale Centre-Ville, Montréal, Québec, H3C 3P8, Canada.
出版信息
Int J Health Geogr. 2018 Oct 25;17(1):36. doi: 10.1186/s12942-018-0156-6.
BACKGROUND
The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border.
METHODS
To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios.
RESULTS
The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians' access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans.
CONCLUSION
The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients' behavior.
背景
医疗服务的地理可达性是一个重要问题，特别是在发展中国家，对于那些共享边界的国家来说更是如此，海地和多米尼加共和国就是如此。在过去的 20 年中，许多研究都探讨了在整个国家或大都市区内获得卫生服务的潜在空间可达性。然而，边境对两国之间获得卫生资源的影响却探讨较少。本文的目的是衡量边境对居住在海地-多米尼加边境附近的海地人获得卫生服务的可达性的影响。
方法
为此，采用广泛应用的增强两步浮动集水区(E2SFCA)方法。四个情景模拟了边境不同程度的开放程度。进行了统计分析，以评估 E2SFCA 结果的差异和变化。还使用线性回归模型根据所述情景预测获得医疗保健服务的可达性。
结果
结果表明，当边境开放时，海地一侧的卫生专业人员与人口的可达性比率高于边境关闭时，这表明边境对海地人获得医疗保健资源的影响很大。另一方面，当边境关闭时，多米尼加人的潜在可达性更高。
结论
边境的开放程度对居住在边境附近和居住在条件良好的道路网附近的人口获得医疗保健的空间可达性有很大影响。这些发现因此表明需要卫生当局和卫生机构之间进行有效和高效的跨境合作。未来的研究有必要探讨跨境医疗保健的决定因素，并提供对空间揭示可达性的见解，这可能有助于更好地了解患者的行为。
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