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。

Spatial Accessibilities of Medical Services at County Level Based on Optimized Two-step Floating Catchment Area Method

There is a big gap between urban and rural residents in China, as to their medical services and health conditions. Rural residents are facing many problems to get medical services with high quality, including severe lack of services, unreasonable locations of medical services, inefficient utilization of public services facilities, and so on. So it is crucial to locate medical services at the county level reasonably, which is the smallest administrative zone to coordinate the distribution and the providing of public services globally. Based on Optimized Two-step Floating Catchment Area (O-2SFCA) method, this study focuses on the evaluation of spatial accessibility for medical services at the county level, in order to support the spatial planning of medical services regionally. While taking Deqing County in Zhejiang Province as a case, this study takes all public hospitals and clinics in downtown, small towns and villages into account. Specially the O-2SFCA method is brought out, aiming to improve some deficiencies of traditional Two-step Floating Catchment Area (2SFCA) method, including the distance decay in the scope of threshold value, the inadequate exploitation of medical services, and different standards of services from hospitals of various levels. Firstly the O-2SFCA introduces the kernel density function to model distance decay, with the purpose of reveal the fact that the probability of people’s trip to get medical services declines as the distance between them increases, while more longer the distance become, more lower probability for people’s trip. Secondly the O-2SFCA proposesa ‘choice weight’ based on the Kernel function to represent competitions between different medical services considering travel cost and service capacity, accurately computes the people’s choice probability of each service facility in the scope of threshold value, and models the inefficient utilizing of medical services. Thirdly the O-2SFCA sets different searching boundary according to the service capacity and standards of medical facilities, for the sake of modeling different services standards of various hospitals and clinics. Spatial accessibility of all villages to get all the public medical service of Deqing County are calculated, separately based on the 2SFCA and O-2SFCA method. At last, two conclusions can be reached: 1) The spatial accessibility of medical services in Deqing County shows a special spatial pattern of circular distribution, and the downtown and neighboring regions hold the highest values of accessibility, while remote and mountain regions hold low accessibility because of the complex topography and the weak traffic conditions. 2) Obviously there are different features between those two computing results based on the 2SFCA and O-2SFCA, but the spatial accessibility calculated from O-2SFCA method is more reasonable, according to field investigations.