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。

Spatial accessibility and equality of public medical facilities in rural areas based on the improved 3SFCA: A case of Haikou City

Allocation of public medical facilities affects the health and well-being of urban and rural residents, therefore a scientific and accurate estimation of equal accessibility of public medical facilities in rural areas is of great significance. In rural areas, the population is scattered and the scale of settlement is small, and the medical care demand of residents is different from that of urban residents. The 2-step floating catchment area (2SFCA) and 3-step floating catchment area (3SFCA) algorithms are unable to accurately reflect the pattern of population distribution in rural areas, the characteristics of medical care-related travels, and residents' preference for higher-level medical institutions. Therefore, the 3SFCA method is not effective in evaluating the accessibility of medical facilities in rural areas. This study improved the 3SFCA algorithm from three aspects—selecting the distance attenuation function according to the travel pattern of the rural residents in Haikou City, gridding the study area into population demand points, and considering the attraction of medical institutions of different levels to residents. Then the methodological framework for evaluating the accessibility and spatial equality of public medical facilities in rural areas was established, and an empirical analysis of Haikou City was conducted. The results show that: 1) The improved 3SFCA algorithm can accurately evaluate spatial accessibility at a finer grid, and the established rural medical facility accessibility and spatial equality evaluation model is more objective. 2) The accessibility of public medical facilities in the rural areas of Haikou City is poor, and the spatial differences are obvious. The high-value areas are distributed in the east of the study area, such as Sanjiang, Yunlong, and Jiazi towns, and the low-value areas are mainly concentrated in the west of the study area. 3) The spatial equality of the allocation of public medical facilities in the rural areas of Haikou City is also poor. A small number of areas of high and medium-high equality level are located in the low- and medium-density areas, while the areas of low and very low spatial equality level cover a large number of high-density areas, and the spatial equality of medical resource allocation urgently needs to be improved.