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。     

就医空间可达性分析的两步移动搜索法——以江苏省东海县为例

精确评价医疗设施可达性的空间分异样状况是合理配置医疗资源的前提。本文在回顾国内外关于医疗空间可达性研究的基础上, 采用两步移动搜索法, 以江苏省贫困县--东海县为案例, 以行政村和医院为分析单元, 基于迪卡斯特拉算法计算出各村到医院(卫生院)的最短通行时间, 进而分析各村医疗空间可达性分异情况。采用不用服务时间阈值范围进行空间敏感性分析, 综合研判缺医地区分布特点。与传统的医卫人员和人口比值的方法相比, 两步移动搜索法能有效显示县域范围内医疗可达性的空间分异情况。采用较大的时间阈值, 医疗空间可达性分异较为平滑, 采用较小服务阈值则空间分异显著, 缺医范围也较大。东海县医疗空间可达性整体呈单核结构, 并沿主要交通线延伸, 缺医地区多分布于边缘乡镇。提高边缘乡镇的行政村的甲级卫生院等级和乡村道路等级将会改善边缘乡镇的就医可达性。     

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。     

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。     

Inverted Two-Step Floating Catchment Area Method for Measuring Facility Crowdedness

The popular two-step floating catchment area (2SFCA) method has been widely used in the literature to measure spatial accessibility of residents for a service. The 2SFCA method accounts for the ratio between the supply capacity and demand amount of the service as well as the complex spatial interaction between them. This article introduces an inverted two-step floating catchment area (i2SFCA) method that is derived from an extension of the classic Huff model and used to capture the “crowdedness” (scarcity of resource or intensity of competition) for facilities. The method is illustrated and validated by a case study of evaluating hospital inpatient services in Florida. Several possible uses of the measure are also discussed.     

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.     

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。     

Residential perspectives: the value of Floodplain‐ buyout open space

This mixed‐methods case study identifies how floodplain property acquisition—a buyout—impacts an urban environment at the neighborhood scale while considering the role of individual residents in formal and informal land‐use decision making. In floodplain buyouts, the reopening of urban space is enabled by federal structural drivers, primarily Federal Emergency Management Agency (FEMA), but it is repurposed as a cultural landscape constructed and produced by individuals. This research explores how residents perceive and ascribe values to the buyout landscape in Lexington, Kentucky. Enabled by federal funds, but left largely to their own devices, residents in Lexington adopted uses, ascribed values, and produced their own land‐use norms in each buyout neighborhood.     

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.     

基于高斯两步移动搜索法的沈阳市绿地可达性评价

基于高斯两步移动搜索法,进行沈阳市绿地可达性分析。在揭示研究区内绿地可达性空间格局的同时,探索这一新方法的实际应用价值。结果显示：① 沈阳市绿地可达性整体上具有北高南低、东高西低的空间分布特征,4 个高值区与3 个低值区可清晰识别;高值区域主要分布在核心城区的近外围,低值区域主要分布于核心城区与城市的西部及南部远郊。② 沈阳市绿地可达性空间格局十分不平衡,具有较强的空间极化特征,70%以上的街道绿地可达性低于全市平均水平,只有少数街道呈现较高的可达性,人口与绿地的空间不匹配是造成不平衡的主要因素。③ 根据可达性评价结果,提出了实施空间优化策略,促进绿地服务均等化的相关建议。该方法能够较好地揭示城市绿地系统与人口相互作用的规律,未来还应进一步与客观实际结合,使之更加具体化和实用化。     

广州市地铁对常规公交出行成本影响及其空间公平性研究

从时间与费用两个角度研究广州市地铁建设对公共交通可达性的影响及其影响的空间公平性。结果表明:① 加权时间与费用可达性均形成“核心-外围”的空间格局。通地铁后,南部郊区加权时间可达性变化率较大,花都区变化率最低;加权费用可达性高变率地区集中在地铁沿线及边缘地区。② 不乘地铁情境下,CBD等时圈呈同心圆状,80％的居民在50 min以及2元钱花费内能到达最近的商业综合体。乘地铁情境下等时圈沿着地铁网络延伸与扩散,80％的居民在30 min以及5元钱以内能到达最近的商业综合体。③ 无论是否乘坐地铁,出行时间的不公平程度都高于出行费用的不公平程度。番禺区的社区从地铁网络中时间可达性获益最多,最不公平的是白云区的社区,其绝对和相对变化较低;中心城区由于常规公交网络发达,地铁缩短的绝对出行时间较少,而变化率高。地铁对城市内中远距离出行性价比的影响最明显。     

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.     

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.     

Estimating the effect of turn penalties and traffic congestion on measuring spatial accessibility to primary health care

Geographic variations in spatial accessibility to public resources, such as health care services, raise important questions about the efficiencies and inequities of the processes that determine where these services are located. Spatial accessibility can be measured many different ways, but many of methods in use today involve some measure of travel cost (in time or distance). In this study we explore a simple methodological question: how much are models of spatial accessibility influenced by the precise metric of travel cost? We address this question by comparing spatial accessibility to primary care physicians for two different methods of calculating travel cost (in time) on a street network: free-flow travel time and congested with turn penalties travel time—which augments free-flow travel times with the burden of traffic congestion and traffic intersection controls. We consider the effect of these two metrics of travel cost on a gravity-based measure of spatial accessibility to primary health care services in Edmonton, Alberta, Canada. Our results suggest that while travel times between locations of demand and locations of primary care providers greatly differ based on how travel cost is calculated, the gravity-based measure of spatial accessibility provides similar information for both travel cost metrics. Using congested with turn penalties travel time can be an onerous addition to the analysis of spatial accessibility, and is more useful for measuring absolute travel time rather than modeling relative spatial accessibility.     

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。     

时空约束下的地铁可达性研究：以北京为例

以北京市为例,基于340个站点的时刻表构建地铁组织网络,采用网络分析法和累积机会法,对比在“工作日”和“双休日”“高峰期”和“非高峰期”等时空约束下的可达性动态。研究发现：① 由于起始地空间区位特征及沿线土地利用功能结构的多样性,不同线路的时刻组织模式各异。② 基于运营组织网络的地铁可达性存在时刻上的动态变化,一日内早晚高峰可达性最优,双休日可达性略低于平时。③ 基于运营组织网络的地铁可达性与基于设施网络的可达性存在明显空间差异,且距市中心15~20 km处的站点工作日和双休日的可达性差异最大,与地铁网络结构特征有关。综上,基于时刻组织时空约束下的可达性分析有利于了解地铁系统的精细化管理,并有助于进一步剖析居民出行规律和城市空间结构。     

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。     

基于学籍地址和地理编码的乡村小学教育资源空间可达性分析

基于“学籍信息中的家庭地址承载了学生空间位置”这一假设,通过学籍信息收集了湖南省株洲县小学生的家庭地址,借助高德开放平台提供的地理编码和POI搜索服务,获得到了株洲县小学生的空间位置和分布,并基于最短路径分析和高斯型两步移动搜索法分析了株洲县小学教育资源的空间可达性及其特征,尝试为区域教育资源的空间均衡性分析与规划配置提供新的数据源和方法借鉴。结果表明：① 基于学籍地址和地理编码技术能够较准确地获取株洲县小学生的空间分布。② 株洲县小学生就近入学距离的最大值、平均值和中位数分别为11.83 km、2.10 km和1.81 km,就近入学距离小于2.0 km的学生仅占55.46%,为株洲县兼顾公平和效率的教育资源配置工作带来了挑战。③ 株洲县北部城镇地区因学校数量较多,平均就近入学距离较小,教育资源的空间可达性普遍较高,且空间差异小,均衡性好;而东南部的乡村地区,平均就近入学距离较大,教育资源的空间可达性普遍较低,且空间差异大。④ 基于情景分析,在不造成局地生源稳定性问题的前提下,新增3所学校后,东南部地区的平均就近入学距离和教育资源的空间可达性有很大的改善,龙潭镇和龙门镇的平均入学距离由3784 m和3520 m降低到3116 m和2636 m,教育资源的空间可达性分别由0.0492和0.0982提高到0.0762和0.1496。     

暴雨内涝情景下城市消防服务可达性的精细化评估

为了揭示城市暴雨内涝灾害对应急响应服务功能的影响,论文基于高精度城市洪涝模型(FloodMap)和增强型两步移动搜寻法(E2SFCA),对暴雨内涝灾害影响下上海市中心城区消防服务可达性进行精细化评估。研究结果表明：① 百年一遇暴雨内涝情景下,内涝最严重时积水深度超过50 cm的淹没范围整体呈现“西高东低”分布态势,淹没总面积约1.5 km²,可导致471条路段(约占路网全长5.11%)通行受阻。② 上海市中心城区消防服务可达性的空间差异比较显著,大体呈现出由黄浦江两岸向西北和东南方向递减态势,但在一天中的不同时段,可达性空间格局变化并不明显。③ 与正常天气条件相比,暴雨内涝情景下不可达单元(250 m×250 m)数量显著增多,夜间低峰、早高峰、白天平峰和晚高峰时段分别增加36.32%、35.89%、39.07%和32.01%;从暴雨内涝的过程(全程120 min)上看,在雨峰后半段((30, 45] min)不可达单元数量最多,消防服务可达性的空间差异程度最大。④ 消防服务可达性表现出一定程度的空间集聚特征,其中高值聚集区(“高—高”型)主要位于黄浦江两岸以及浦西边缘地区,低值聚集区(“低—低”型)主要位于西北和西南区域,这2类聚集区呈“团块状”分布,而“高—低”型和“低—高”型集聚均不显著。⑤ 研究区内消防服务可达性与需求的空间失配现象(“低需求—高可达”或“高需求—低可达”)较为明显,而暴雨内涝会加剧空间失配问题。研究结果可为提升城市洪涝灾害管理与应急响应服务的精细化水平提供科学依据。     

Modeling Spatial Accessibility of Immigrants to Culturally Diverse Family Physicians

This article uses accessibility as an analytical tool to examine health care access among immigrants in a multicultural urban setting. It applies and improves on two widely used accessibility models—the gravity model and the two-step floating catchment area model—in measuring spatial accessibility by Mainland Chinese immigrants in the Toronto Census Metropolitan Area. Empirical data on physician-seeking behaviors are collected through two rounds of questionnaire surveys. Attention is focused on journey to physician location and utilization of linguistically matched family physicians. Based on the survey data, a two-zone accessibility model is developed by relaxing the travel threshold and distance impedance parameters that are traditionally treated as a constant in the accessibility models. General linear models are used to identify relationships among spatial accessibility, geography, and socioeconomic characteristics of Mainland Chinese immigrants. The results suggest a spatial mismatch in the supply of and demand for culturally sensitive care, and residential location is the primary factor that determines spatial accessibility to family physicians. The article yields important policy implications.