Department of Economics, School of Economics, Minzu University of China, Beijing, China.
Research Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, China.
Front Public Health. 2021 Sep 16;9:710810. doi: 10.3389/fpubh.2021.710810. eCollection 2021.
Elite hospitals represent the highest level of Chinese hospitals in medical service and management, medical quality and safety, technical level and efficiency, which are also one of the important indicators reflecting high-quality medical resources in the region, and their spatial allocation is directly related to the fairness of health resource allocation. We explored the allocation pattern of high-quality resources and its influencing factors in the development of China's health system using geographic weighted regression (GWR), Multi-scale Geographically Weighted Regression (MGWR), GWR and MGWR with Spatial Autocorrelation(GWR-SAR and MGWR-SAR), spatial lag model (SLM), and spatial error model (SEM). The results of OLS regression showed that city level, number of medical colleges, urbanization rate, permanent population and GDP per capita were its significant variables. And spatial auto-correlation of elite hospitals in China is of great significance. Further, its spatial agglomeration phenomenon was confirmed through SLM and SEM. Among them, the city level is the most important factor affecting the spatial allocation of elite hospitals in China. Its action intensity shows a solid and weak mosaic trend in the Middle East, relatively concentrated in some areas with medium intensity and concentrated in the West China. Obviously, China's elite hospitals are unevenly distributed and have evident spatial heterogeneity. Therefore, we suggest that we should pay attention to the spatial governance of high-quality medical resources, attract medical elites in the region, increase investment in medical education in the scarce areas of elite hospitals and develop tele-medicine service.
顶尖医院代表了中国医院在医疗服务和管理、医疗质量和安全、技术水平和效率方面的最高水平，也是反映该地区优质医疗资源的重要指标之一，其空间配置直接关系到卫生资源分配的公平性。我们使用地理加权回归（GWR）、多尺度地理加权回归（MGWR）、带有空间自相关的 GWR（GWR-SAR）和 MGWR（MGWR-SAR）、空间滞后模型（SLM）和空间误差模型（SEM）探讨了中国卫生系统发展中优质资源的配置模式及其影响因素。OLS 回归结果表明，城市级别、医学院数量、城市化率、常住人口和人均 GDP 是其显著变量。中国顶尖医院的空间自相关具有重要意义。此外，通过 SLM 和 SEM 进一步证实了其空间集聚现象。其中，城市级别是影响中国顶尖医院空间配置的最重要因素。其作用强度在中东呈稳固而微弱的镶嵌趋势，在一些中强度地区相对集中，在西部集中。显然，中国的顶尖医院分布不均，具有明显的空间异质性。因此，我们建议应关注优质医疗资源的空间治理，吸引区域内的医疗精英，增加稀缺地区顶尖医院的医疗教育投入，发展远程医疗服务。
