1980—2019年湘鄂豫公共卫生服务均等性及其人地关系的时空差异

均衡的公共卫生服务是保障人民有效享受健康公平权的重要途径,医疗机构布局、人口分布以及建设用地与公共卫生服务均等性密切相关。本文运用空间统计分析、可能—满意度模型、“公共卫生服务均等性—建设用地—人口分布”耦合协调度模型等方法,分析1980—2019年湘鄂豫三省的公共卫生服务均等性时空演变规律,以及均等性和建设用地、人口分布耦合协调关系的变迁特征。结果表明：① 公共卫生服务均等性总体在中等水平（0.7~0.8）左右波动,呈现先上升后下降的趋势,湘鄂豫公共卫生服务均等性的平均增速分别为-7.68%、-0.96%、 -2.11%;② 湘鄂豫公共卫生服务空间上存在显著聚集特征,“高—高”集聚和“低—低”集聚的极化效应明显,且8个方位内公共卫生服务均等性差异明显,说明其发展不平衡不充分问题突出;③ 公共卫生服务与建设用地、人口分布的相互作用程度和同步发展程度较弱,三者协调发展程度处于失调向协调的转型期。在中国新发展阶段,为顺应复杂的“人—地”关系变迁规律,公共卫生服务均等性的时空发展格局以及其方位差异特征可为优质公共卫生服务资源的均衡配给和公平性提升提供决策依据。

The equality of public health services and the spatiotemporal heterogeneities of human-land relationships in Hunan,Hubei, and Henan from 1980 to 2019

It is an essential way to ensure that health and equity could be enjoyed effectively through a balanced system of public health services. The layout of medical facilities, population distribution, and construction land distribution are highly correlated to public health services equalization. The research in this paper is based on spatial statistical analysis, the possibility-satisfiability model, and the coupling coordination degree model between public health service equalization, construction land distribution, and population distribution. Based on these methods, the spatiotemporal evolution regularity analysis is carried out on the public health services equalization in provinces of Hunan, Hubei, and Henan during 1980-2019. Furthermore, we examine the variation of the coupling coordination relationships between the triad of public health services equalization, population distribution, and construction land. The results show that: (1) the degree of public health services equalization fluctuates around the middle level (0.7-0.8), and it shows a general tendency of rising first and then falling. The average growth rate of public health services equalization in Hunan, Hubei, and Henan was -7.68%, -0.96%, and -2.11%, respectively. (2) The distribution of public health services shows obvious spatial clusters in Hunan, Hubei, and Henan. The high-high and low-low categories of spatial agglomeration indicated that an obvious polarizability effect exists in public health services distribution. Besides, public health services equalization in eight azimuth regions of each province is obviously different. This implies that the unbalanced and inadequate problem is prominent with the development of public health services equalization in the three provinces. (3) The degree of interactions and synchronous development between public health services, construction land, and population distribution is small. In general, the coordinated development state between the three is in the transition period from maladjustment to coordination. In order to deal with the complex man-land relationship at the new stage of China, we explore the spatiotemporal development pattern and the historical evolution characteristics of the public health services equalization, which can provide a policy-making basis for the rational configuration of public health resources and the improvement of public health services equalization.