层级性公共服务设施空间可达性研究——以北京市综合性医疗设施为例

分层诊疗制度有利于充分利用已有的医疗资源,是医疗卫生体制改革的重要内容。但是目前关于医疗设施可达性的研究普遍存在两个问题：没有考虑医疗机构的层级性;没有考察城市的多模态道路设施对医疗机构空间可达性的影响。通过构建两阶段的两步移动搜寻法,同时利用多模态网络数据集的网络分析法,研究在不同转诊率条件下北京城六区医疗设施的空间可达性。研究发现：① 医疗设施的总体空间可达性随转诊率的提高呈现倒U型走势;60%左右的转诊率情况下医疗设施总体空间可达性最高。② 在60%的转诊率条件下,考虑地下交通时的医疗设施总体空间可达性比不考虑地下交通时提高约9.81%,街道医疗设施空间可达性方差下降8.58%。这说明地铁建设不仅可以提升医疗设施总体的空间可达性,还可以降低街道之间空间可达性的不均衡性。③ 医疗资源“倒金字塔”型分布是制约分层就诊体系建立的关键,建立分层就诊体系需要同时调整医疗资源在不同等级医院之间的分布。

The accessibility measurement of hierarchy public service facilities based on multi-mode network dataset and the two-step 2SFCA:A case study of Beijing's medical facilities

Hierarchical diagnosis and treatment system is a key part of medical and health system reform which can take full use of medical resources. But most of current research about accessibility of medical facilities has two drawbacks: Firstly, they did not consider the level of medical institutions and the stratification treatment of patients; secondly, the influence of multi-modal road facilities on spatial accessibility of medical institutions is not investigated. Here we conduct research on the spatial accessibility of medical institutions at different levels of medical institutions and different referral rates by using the two-step floating catchment area method and multi-modal network dataset. The conclusions are as follows: Firstly, the overall spatial accessibility of medical facilities shows the trend of the inverted U with the increase of referral rate, and when the referral rate was 60% the spatial accessibility of medical institutions comes to a head; Secondly, when the referral rate was 60%, the spatial accessibility of medical institutions considering the ground transportation and underground transportation is 9.81% higher than that considering the ground transportation only, and the variance of accessibility of medical institutions in the streets decreased by 8.58%; in other words, the subway can not only improve the overall spatial accessibility of medical facilities, but also reduce the imbalance of spatial accessibility of the streets; Thirdly, the "Inverted Pyramid" distribution of medical resources is the foundation of hierarchical diagnosis and treatment system.