School of Geography and Tourism, Shaanxi Normal University, Xi'an 710119, China.
Int J Environ Res Public Health. 2020 Dec 26;18(1):112. doi: 10.3390/ijerph18010112.
The contradiction between the supply and demand of public medical resources in China is serious. On the basis of the "graded diagnosis and treatment" model, the Chinese government divides the medical grade and adjusts the allocation of medical facilities so as to alleviate the adverse impact of these issues on residents' health. Although the government tries to guide residents' medical treatment according to the level of medical facilities, there are differences between residents' medical treatment mode and policy rules in reality. Therefore, it is of great significance to explore spatial differences in accessibility to medical services for residents on the basis of the actual medical behavior. This article takes Shaanxi province as the research area, and uses the improved node cost network analysis method with the space-time distance model and the two-step floating catchment area method, respectively, to analyze the spatial differences of accessibility to three-level medical services and evaluate the equity of accessibility in different areas and groups in Shaanxi. Results showed that the overall level of accessibility to primary medical services in the province is good, and spatial distribution is balanced; the polarization of accessibility to secondary and tertiary medical services is a serious issue, and within the research area, a band-shaped multicore spatial structure was formed with the built-up areas of various cities as high-level centers of accessibility. Provincial residents have poor equity to access three-level medical services, and the equity of accessibility to primary medical services is better than that to highly specialized medical services. There is no obvious gap between accessibility to three-level medical services for the aging and the nonaging populations in Shaanxi, but the unfair phenomenon between agricultural and the nonagricultural populations is prominent. In addition, this article found that the improvement in traffic conditions can produce space-time convergence and effectively weaken spatial deprivation. Therefore, developing public transportation is an effective approach to improve the equity of accessibility to medical services.
中国公共医疗资源的供需矛盾较为突出。在“分级诊疗”模式的基础上，中国政府划分了医疗级别，并调整了医疗设施的配置，以缓解这些问题对居民健康的不利影响。虽然政府试图根据医疗设施的水平来引导居民就医，但居民的就医模式与现实中的政策规则存在差异。因此，在实际医疗行为的基础上，探讨居民获得医疗服务的可达性的空间差异具有重要意义。本文以陕西省为研究区域，分别采用改进的节点成本网络分析方法和时空距离模型、两步浮动搜索区域方法，分析了三级医疗服务可达性的空间差异，并评价了陕西省不同地区和群体的可达性公平性。结果表明，该省初级医疗服务的整体可达性水平良好，空间分布均衡；二级和三级医疗服务的可达性极化问题严重，在研究区域内，以各城市建成区为高级可达性中心形成了一条带状多核空间结构。陕西省居民获得三级医疗服务的公平性较差，初级医疗服务的公平性优于专科医疗服务。陕西省老龄化和非老龄化人群获得三级医疗服务的公平性没有明显差距，但城乡居民之间的不公平现象较为突出。此外，本文发现交通条件的改善可以产生时空收敛，有效削弱空间剥夺。因此，发展公共交通是提高医疗服务可及性公平性的有效途径。
