基于改进两步移动搜索法的县域医疗卫生服务空间可达性研究

针对县域医疗卫生服务设施的空间布局问题,应用改进两步移动搜索法对德清县医疗卫生服务的空间可达性进行评价。具体改进包括：引入核密度型距离衰减函数对两步移动搜索法进行扩展、考虑医疗设施资源的未充分利用、对不同规模等级医疗机构设置不同服务阈值。计算结果表明：① 浙江省德清县域医疗卫生服务空间可达性呈圈层式空间分布特征,高可达性区域主要集中于县城及邻接区域,边缘地区缺医明显;② 基于改进两步移动搜索法和传统两步移动搜索法的可达性计算结果具有不同的整体特征,但前者可达性计算结果及空间分布更符合实际。     

基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例

针对贫困山区医疗资源短缺、分布不均衡、服务能力差等问题,以重庆市石柱县为例,基于自然村尺度,采用改进的两步移动搜索法,从供需角度分析研究区医疗服务空间可达性特征。设置不同的时间阻抗进行敏感性分析,探究可达性变化规律。通过对石柱县医疗资源空间布局的均衡性评价,为山区未来医疗布局的合理规划与医疗标准的配备提供决策依据。结果表明:1石柱县整体医疗服务可达性差,低于重庆市平均水平。2县域医疗资源布局不均衡,空间差异明显。高值区主要集中在方斗山中低山区和黄水镇,低值区主要集中在南部中山区,两极分异明显。3医院的规模、级别,道路的等级、疏密对可达性有一定的影响:靠近县城的乡镇、路网密集的地方可达性一般较好。4随着出行阻抗的增大,医疗服务的可达性随之变好,边缘乡镇的可达性随之变差,可达性值变化幅度减缓,医疗服务空间可达性分异变小;医疗资源配备充足的乡镇,随着时间阻抗增加,对周边乡镇可达性的影响增强。     

基于可达性的郑州市医疗资源空间均等化研究

精确评估医疗资源的空间不均等是合理布局医疗资源的决策依据。基于两步移动搜索法的乡镇/街道尺度的医疗可达性,对郑州市医疗资源的空间均等化展开了研究。结果显示:1)级别越高的医院医疗可达性水平越高、空间分布差异越大。三级医院对郑州市整体医疗可达性起主导作用。2)供需过剩及供需平衡的乡镇/街道主要分布在主城区、上街区、中牟县、新郑市,供需不足的乡镇/街道主要分布在城中村及距附属县市中心城区较远的区域。3)郑州市一、二、三级医院及医院整体医疗可达性存在显著的空间正相关性,向高水平方向显著集聚,乡镇/街道医疗可达性高-高集聚区集中分布在主城区。4)郑州市医疗资源集中分布在主城区,附属县市相对缺乏,医疗资源分布不均等的现象十分显著。     

基于交通数据的养老机构可达性及供需关系研究——以北京市为例

针对当前人口老龄化及养老资源分布不均问题,以北京市为例,结合交通数据、多级服务半径和距离衰减函数改进两步移动搜寻法,从乡镇街道尺度测度北京市养老机构的空间可达性和供需关系。结果表明：(1)北京市养老机构规模差异较大,且机构等级越高,集聚程度越高;(2)改进的两步移动搜寻法综合考虑机构等级及时间成本对出行选择的影响,结果更精准客观;(3)北京市养老机构综合可达性水平空间分布不均,主城区可达性水平普遍较高,低值单元主要分布在怀柔区北部、房山区南部、大兴区东南部等地区,两种出行模式下养老机构可达性分布格局差异明显,公交—地铁换乘模式下的可达性水平整体优于出租车出行模式;(4)北京市养老机构供需关系空间分异明显,25.70%单元处于供不应求状态,主要集中在二环至六环地区,供过于求单元(16.09%)零散分布在城市远郊及近郊区,供需不匹配状态亟须改变。     

深圳市公共住房居民就医可达性——基于互联网地图服务和改进两步移动搜索法

基于互联网地图服务测算人才住房、经济适用房、公共租赁房在步行、公共交通和驾车3种出行方式下到达不同等级医院的通勤时间,通过引入高斯距离衰减函数、设立多级搜索半径、考虑供给和需求方竞争效应并利用实时交通大数据改进两步移动搜索法,对深圳市公共住房居民就医可达性进行多维度评价。研究发现：1）紧急就医情境下15%公共住房点驾车30 min内不可抵达三甲医院,普通就医情境下仅10%公共住房点实现15 min就医目标;2）可达性由老经济特区向非经济特区逐渐衰减;3）人才住房可达性最优,其次是经济适用房,最后是公共租赁房;4）公共交通和步行相比于驾车模式下的可达性空间分异更显著。     

特大城市医疗公共服务可达性的空间格局及其影响因素分析——以上海市为例

大城市通常是医疗资源最为丰富的地区,但普遍存在配置不均的问题。精准地衡量城市医疗公共服务的空间异质性、合理规划医疗公共空间,是实现城市稳定健康发展的重要保障。以上海市为例,运用改进两步移动搜索法,从乡镇（街道）尺度测算医疗服务设施的空间可达性,并结合基尼系数和空间自相关分析探究上海市医疗服务设施可达性的空间分异特征,探讨了影响上海市医疗服务资源可达性空间格局的主要因素。研究表明：上海市医疗公共服务可达性自中心城区向郊区逐渐递减;可达性高值区集中在外环线以内及其沿线地区,可达性低值区集中在远郊区。医疗资源呈现向心化集聚,满足了中心城区高密度的人口和体量庞大的老年人口就医需求;中心城区医疗服务资源配置相对均衡,可达性差异较小,而郊区医疗服务的可达性差异较大;上海市医疗服务可达性空间格局受人口密度和经济发展显著影响,上海市政府医疗财政支付对街道尺度的医疗服务设施空间可达性作用较小。在未来,在城市医疗卫生服务资源配置中注重人口集聚导向,建立医疗卫生人员双向流动的常态化机制是提升上海市医疗公共服务能力,优化城市医疗公共设施可达性的重要方向。     

社区尺度的北京儿童服务设施可达性分析

儿童服务设施是建设儿童友好性城市的重要内容。基于北京城区社区人口数据及儿童服务设施数据,通过两步移动搜寻法,以社区为单元分析儿童服务设施可达性的空间格局及分布模式。结果显示,不同类别儿童服务设施空间可达性服务水平差异较大,在1000米阈值范围内小学的空间可达性水平优于幼儿园,3000米阈值范围内儿童诊所的空间可达性优于公园。受儿童人口和儿童服务设施分布的影响,小学、幼儿园、儿科门诊的可达性均呈现“中心高、边缘低”的分布格局,空间分布不均衡;公园分布则相对分散,其可达性呈现边缘区域优于中心区域分布特征。北京城区儿童服务设施可达性情况可分为五种类型区,类型区之间以同心圆的结构进行组合,局部体现出扇形的特征。据此提出针对不同区域儿童服务设施的改善策略。     

基于改进潜能模型的城市医疗设施空间可达性——以上海市杨浦区为例

引入人口规模因子和医疗设施等级规模影响系数改进潜能模型,基于GIS空间分析技术,以上海杨浦区为例对其医疗设施空间可达性进行研究。结果表明：杨浦区医疗设施空间可达性分布不均,大桥街道、定海路街道及殷行街道部分区域医疗设施空间可达性较高;中部区域一些街道存在同等级医院位置密集、医疗资源相对集中的情况;杨浦区三级医院的居民就医空间可达性整体优于二级、一级医院。改进的潜能模型综合考虑了居民点人口数量、医疗设施与居民点之间的出行阻抗、以及医疗设施的等级规模对居民就医选择的影响,能更合理地评价医疗设施的可达性。研究结果可为城市医疗设施科学规划与决策提供依据。     

北京市核心区医疗设施可达性研究

基于空间化的人口数据及改进的两步移动搜寻法,分析北京市核心区医疗设施的可达性和分布公平性。结果表明:北京核心区医疗设施的可达性空间分异特征显著,总体上呈现从中心向外围递减的圈层结构,且东北部高于西南部,其影响因素主要包括医疗设施的空间分布及服务能力、居住需求点的人口密度以及二者之间的交通状况;核心区高就医可达性街道相比于低就医可达性街道常住人口和老年人口占比更小,总体居住环境更差,医疗资源供给与需求的空间匹配程度较低。据此提出改善核心区医疗设施可达性分布的均衡性和公平性的政策建议。     

基于最优供需分配的公共设施空间可达性分析

空间可达性是衡量公共服务设施公平性的重要指标,在医疗、教育、休闲等公共服务的布局规划中得到广泛应用。然而已有设施服务可达性模型难以充分反映服务供需关系,计算指标也缺乏物理意义。本文提出新的最优供需分配的公共设施空间可达性计算方法（OSD）取代现有方法。该方法基于最优供需分配模型,将设施服务分配给需求者,根据分配结果计算空间可达性指标。给定服务设施与需求的空间分布,以最小化旅行成本为目标,顾及设施服务能力,采用经典的运输问题模型确定最优的服务供需分配方案,进而度量服务的空间可达性。以郑州市金水区社区卫生服务为例,求解25个中心与1333个居住小区的最优服务配置。使用最优配置结果确定每个设施的服务范围、每个居住小区使用服务的旅行时间,以及特定时间阈值的服务覆盖比率。与流行的两步移动搜索法相比,新方法的计算指标具有明确的物理意义。本文提出的可达性评价方法无需参数,计算高效,结果易于解释,在公共服务评价及设施布局规划方面具有应用潜力。     

Measuring spatial accessibility to primary care in rural areas: Improving the effectiveness of the two-step floating catchment area method

Quantifying spatial accessibility in relation to the provision of rural health services has proven difficult. This article critically appraises the two-step floating catchment area (2SFCA) method, a recent solution for measuring primary care service accessibility across rural areas of Victoria, Australia. The 2SFCA method is demonstrated to have two fundamental shortcomings – specifically the use of only one catchment size for all populations, and secondly the assumption that proximity is undifferentiated within a catchment (especially problematic when the catchment is large). Despite its advantages over simple population-to-provider ratios, the 2SFCA method needs to be used with caution.     

A three-step floating catchment area method for analyzing spatial access to health services

Gravity-based spatial access models have been widely used to estimate spatial access to healthcare services in an attempt to capture the interaction of various factors. However, these models are inadequate in informing health resource allocation work due to their inappropriate assumption of healthcare demand. For the purpose of effective healthcare resource planning, this article proposes a three-step floating catchment area (3SFCA) method to minimize the healthcare-demand overestimation problem. Specifically, a spatial impedance-based competition scheme is incorporated into the enhanced two-step floating catchment area (E2SFCA) method to account for a reasonable model of healthcare supply and demand. A case study of spatial access to primary care physicians along the Austin–San Antonio corridor area in central Texas showed that the proposed method effectively minimizes the overestimation of healthcare demand and reflects a more balanced geographic pattern of spatial access than E2SFCA. In addition, by using an adjusted spatial access index, the 3SFCA method indicates strong potential for identifying health professional shortage areas. The study concludes that 3SFCA is a promising method to provide health professionals and decision makers with useful healthcare accessibility information.     

基于改进3SFCA的乡村地区公共医疗设施空间可达性与公平性评价——以海口市为例

公共医疗设施配置合理与否影响城乡居民健康和福祉,科学客观测算乡村地区公共医疗设施公平可达性具有重要意义。乡村地区人口规模较小且分散居住,居民就医行为有别于城市居民,2SFCA或3SFCA方法难以客观揭示乡村地区人口分布规律和就医出行特征,导致评估乡村地区医疗设施可达性时效果不佳。论文根据海口市乡村居民就医出行规律选择距离衰减函数,格网化研究区形成人口需求点,考虑不同等级医疗机构对居民就医的吸引,改进了3SFCA算法,建立乡村地区公共医疗设施可达性与空间公平性评估方法体系,并以海口市为案例进行实证分析。结果表明：① 基于改进3SFCA法建立的可达性评价模型可以获得更精准客观的评价结果;② 海口市乡村地区公共医疗设施可达性整体较差且空间分异明显,高值区分布在东部的三江、云龙及甲子镇,低值区主要集中在研究区西部;③ 海口市乡村地区公共医疗设施配置的公平性不佳,少量的高和较高公平等级区域均位于中低人口密度区,而低和极低公平等级区域覆盖了广大的高人口密度区,医疗资源配置的公平性亟需改善。     

A comparative analysis of accessibility measures by the two-step floating catchment area (2SFCA) method

The recent decade has witnessed a new wave of development in the place-based accessibility theory, revolving around the two-step floating catchment area (2SFCA) method. The 2SFCA method, initially serving to evaluate the spatial inequity of health care services, has been further applied to other urban planning and facility access issues. Among these applications, different distance decay functions have been incorporated in the thread of model development, but their applicability and limitations have not been thoroughly examined. To this end, the paper has employed a place-based accessibility framework to compare the performance of twenty-four 2SFCA models in a comprehensive manner. Two important conclusions are drawn from this analysis: on a small analysis scale (e.g., community level), the catchment size is the most critical model component; on a large analysis scale (e.g., statewide), the distance decay function is of elevated importance. In sum, this comparative analysis provides the theoretical support necessary to the choice of the catchment size and the distance decay function in the 2SFCA method. Justification of model parameters through empirical evidence (e.g., field surveys about local travel activities) and model validation through sensitivity analysis are needed in future 2SFCA applications for various urban planning, service delivery, and spatial equity scenarios.     

北京市养老设施空间可达性评价

发展养老服务是当前中国社会建设中的重要部分。近年来,北京市养老设施发展迅速,但是由于快速的人口老龄化,北京市养老设施的供给仍难以满足老年人口对养老设施的需求。对北京市养老设施空间可达性进行科学评价是进行合理空间配置的基础,具有重要的现实意义。本文基于GIS技术,应用改进的两步移动搜索法,对北京市养老设施的空间可达性进行了测算,并重点对1小时单一有效服务半径和按养老设施规模划分的三级有效服务半径这两种情形进行了比较分析。结果表明,后者对北京市养老设施的空间可达性评价更具合理性。本文对空间可达性的测算结果识别出了北京市各区域养老设施的稀缺程度,为养老设施的空间布局提出了政策性建议。     

两步移动搜寻法及其扩展形式研究进展

两步移动搜寻法是公共服务设施空间可达性研究中的重要方法,在国内外公共服务设施布局研究中得到了广泛应用,且发展出了众多扩展形式。但国内研究中对两步移动搜寻法尤其是其扩展形式的应用还较为有限。本文对两步移动搜寻法的主要扩展形式进行系统梳理和总结,将国内外研究中提出的两步移动搜寻法扩展形式归纳为基于引入距离衰减函数的扩展、对搜寻半径的扩展、针对需求或供给竞争的扩展以及基于出行方式的扩展4类,并分析了各种扩展形式的优缺点、适用情景以及未来可能改进方向。旨在为相关研究的方法选择提供参考,促进两步移动搜寻法及其扩展形式在国内相关领域的应用和发展。     

A relative spatial access assessment approach for analyzing potential spatial access to colorectal cancer services in Texas

The usefulness of gravity-based spatial access models is limited because of the uncertainty introduced by the range of values of the impedance coefficient. To solve this problem, this paper proposes the concept of spatial access ratio (SPAR) derived from the enhanced 2-step floating catchment area (E2SFCA) method — a recent extension of the gravity model — to assess potential spatial access. First, a sensitivity assessment is conducted to verify the effectiveness of SPAR and its advantages in overcoming the uncertainty problem. Then, the E2SFCA method and the shortest travel time method are employed to measure potential spatial access to colorectal cancer (CRC) prevention and treatment services in Texas based on data at the census tract level. The socio-demographic and geographic distributions of potential spatial access to CRC services are also examined. The sensitivity assessment reveals substantial fluctuations in the values of the spatial access index calculated directly by the E2SFCA method under different values of the impedance coefficient. However, the values of SPAR remain stable under different values of the coefficient. A comparative analysis indicates that potential spatial access to primary care physicians (PCPs), CRC screening facilities, and oncologists varied among different racial/ethnic and socioeconomic population groups as well as in different geographic regions in Texas. Non-Hispanic blacks, Asians, and people in affluent areas had a geographical advantage in accessing CRC services than other groups. The urban/rural difference was more obvious and serious than those of different racial/ethnic groups and groups with different socio-economic statuses, as metropolitan residents had more than three times the potential spatial access than isolated rural residents.     

Disparities in Spatial Accessibility of Pharmacies in Baton Rouge,Louisiana

This study examines spatial accessibility of pharmacies in Baton Rouge, Louisiana. Two popular geographic information systems (GIS)—based methods are compared: the proximity method uses the distance (travel time) from the nearest pharmacy, and the two‐step floating catchment area (2SFCA) method considers the match ratio between providers and population as well as the complex spatial interaction between them. The study indicates that disproportionally higher percentages of African‐Americans are in areas with shorter travel time to the nearest pharmacies than whites, but suffer from poorer accessibility measured by the 2SFCA method—that is, fewer pharmacies per 10,000 residents. Seniors, particularly those of seventy‐five years or older, tend to be disproportionally concentrated in areas that not only are closer to pharmacies, but also have more pharmacies per 10,000 residents. The two methods used in the study capture different elements in spatial accessibility: one being physically close to a facility and another adding the crowdedness in service. Both properties can be valuable for residents. The two may not always coincide with each other in spatial variability, as it is the case for racial disparity in our study area. However, when they do, as in the case for seniors, it may imply a true (dis)advantage for a demographic group in terms of both properties of spatial accessibility.     

基于改进潜能模型的就医空间可达性度量和缺医地区判断——以江苏省如东县为例

潜能模型广泛应用于就医空间可达性评价,现有模型综合了医疗设施服务能力、居民点人口数量、医疗设施与居民点之间的出行阻抗。在此基础上通过考虑"医疗设施不同等级规模对居民就医选择行为的影响"对模型进行修正。结果表明,改进的潜能模型能够更为合理地评价就医空间可达性,准确揭示居民实际所能获取的医疗资源,结合医疗资源配置相关标准,则能有效判定缺医地区,为政府相关部门规划决策提供依据。