Does Better Spatial Access Lead to Better Use of Prenatal Care? A Population Study in Georgia

Understanding the effect of spatial accessibility on service utilization is essential to facilitate prenatal care delivery. Previous studies suggest that mothers with better spatial access are more likely to receive adequate prenatal care. Their conclusions, however, are limited by use of small samples and inappropriate spatial accessibility measurements. This article examines the role of spatial accessibility in explaining the variation of prenatal care utilization among 202,377 mothers in Georgia from 2009 to 2011. Specifically, we use geographic information systems and spatial analysis methods to explore the spatial pattern of inadequate prenatal care utilization. A two-transportation-mode, two-step floating catchment area method is used to measure the spatial access to prenatal care by census tract. The effects of spatial accessibility, combined with the influences of demographic, socioeconomic, behavioral, and medical factors, on the adequacy of prenatal care utilization are investigated with statistical models at the individual level. The results show that mothers with better spatial access are less likely to have adequate prenatal care. The inconsistency of this finding with other existing evidence suggests that the effects of spatial accessibility on health service utilization could be complicated and context specific.     

Geographical accessibility and Kentucky's heart-related hospital services

Cardiovascular diseases (CVDs) are a leading cause of mortality in the US. Rates of mortality vary spatially and demographically, influenced not only by individual patient characteristics but also by levels of accessibility to hospital services and facilities. In 2000, Kentucky ranked third in the nation for heart-related deaths. The purpose of this paper is to assess geographical accessibility and service utilization related to ambulatory care sensitive CVDs in Kentucky. This study utilizes the Kentucky Hospital Discharge Database to evaluate service utilization and the Compressed Mortality File to examine mortality related to CVDs. A spatial statistical comparison of the geographical distribution of service usage and travel time to hospitals assists in assessing the relationship between accessibility and health. Our findings suggest that the distribution of utilization and mortality is geographically variable. People living in rural areas travel further to services; populations residing more than 45 min from health facilities are more likely to be socially and economically marginalized. Spatial clustering of high rates of hospital utilization occurs in areas with lower accessibility.     

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。     

Operationalizing the new concept of sexual and reproductive health in Indonesia

The new politics of family planning in the 1990s has involved the articulation of a comprehensive concept of sexual and reproductive health (SRH). Following the ratification of the SRH concept and goals at recent international conferences, one major issue is how governments translate the broad statements into operational policies and programs. The authors consider the ways in which the process is occurring in Indonesia, defining SRH, and reviewing the levels of its attainment in 8 of its components in Indonesia. The policy process in Indonesia is explored with regard to pre-existing reassessments, setting important priorities and moralistic and pragmatic policy orientations. The following SRH components are discussed: family planning, infertility, maternal and child health, HIV/AIDS, sexually transmitted diseases, adolescents' needs, sexual health, and gender issues. In terms of SRH, Indonesia has achieved considerable success in addressing family planning and infant and child mortality, limited success in addressing maternal mortality and HIV/AIDS, and very little progress in addressing STDs, adolescent needs, and positive sexuality. There are few data on gender issues.     

基于潜能模型的医疗设施空间可达性评价方法

空间可达性是评价医疗设施布局合理与否的重要指标,传统的医疗设施空间可达性评价,或者从医疗服务供需状况着手,或者从供需双方之间距离因素着手,均无法全面评价居民实际所能获取的医疗资源。本文采用基于潜能模型的评价方法对江苏省如东县医疗设施空间可达性进行分析研究,该方法综合考虑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。研究表明,通过选取合适的出行摩擦系数,该方法能够较为全面准确地测度较小研究单元的医疗设施空间可达性,辅以GIS技术,可以很直观地揭示研究区域内医疗设施空间可达性差异,结合公共卫生管理部门制定的医疗资源配置标准,还可较为准确判定缺医地区,为政府相关部门规划决策提供依据。     

REGIONAL DIMENSIONS OF ABORTION-FACILITY SERVICES

The fragmentation of health care services evident in contemporary United States medical care may also be seen in the provision of abortion-facility service, despite recent moves toward comprehensive health care. Abortion facilities in northeastern and southern states appear more likely to provide comprehensive services than do central and western facilities, based upon a survey of facility characteristics for 1978. Abortion cost and number of facilities, a competition variable, aid in discriminating among groups of facilities with service-level differentials.     

中国医疗卫生资源供给水平的空间均衡状态及其时间演变

为正确认识医疗卫生资源空间分布的现状,以医疗卫生资源空间均衡状态及其时间演变趋势为研究内容,采用中国338个地级市为研究样本,运用核密度估计、基尼系数及其分解和LISA时间路径分析等方法,构建国家-区域-市域3个层次的空间均衡分析框架,定量刻画医疗卫生资源空间均衡状态及其时间演变特征。研究结果表明,医疗卫生资源的空间分布正在走向均衡;医疗卫生资源供给水平在三大区域之间的交错程度较高且呈现逐渐增高的趋势;在东部沿海到中部地区的过渡地带存在集中分布的低低集聚区,即医疗卫生资源供给水平同样存在“京汕低谷带”。     

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。     

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.     

中小城市基本公共服务水平区域均等化的动态分析

选取基础教育、社会保障、基本医疗、公共文化四大类指标,利用2008—2013年我国26个省份163个中小城市的统计数据,测度了其基本公共服务水平区域均等化程度的动态变化。结果表明:中小城市基本公共服务平均水平呈上升趋势;基础教育和基本医疗的区域均等化程度较好,社会保障和公共文化的区域差异较大;基本公共服务水平表现出空间集聚发展态势,东高西低的分布格局呈加剧之势。优化公共财政体制建设,加强省份间协同发展是促进基本公共服务均等化的重要途径。     

南京市新街口CBD服务业空间集聚及演变特征——基于微观企业数据

经典的CBD内部产业空间布局理论源于西方,在新时期背景下需对其在中国的适用性进行实证检验。本文使用机器学习分类的2000—2018年微观企业数据,通过分析产业结构、集聚程度、空间分布特征等,探寻中国典型城市中心CBD——南京新街口地区的服务业时空演变及空间集聚特征。研究发现：① 南京市新街口服务业产业结构演变表现为生产性服务业数量持续领跑,流通性服务业增速趋缓,与消费性服务业、信息服务业差距拉大,总体未出现专业化趋势;在与全市对比中,消费性服务业有更强的比较优势,且优势随时间推移而扩大。② 行业集聚程度分化,各行业集聚程度演变表现为消费性服务业、社会性服务业与信息服务业总体集聚,其中餐饮、娱乐与居民服务业的集聚程度最高;零售业呈分散趋势,与前者形成倒挂;生产性服务业两极分化,金融业偏集聚,而研发设计服务业偏分散。③ 空间分布上演变整体呈现双圈层收缩趋势,生产性服务业与消费性服务业高度耦合,社会性服务业集聚中心趋于内核,流通性服务业与信息服务业集聚在外圈层。     

生态系统服务权衡研究进展：从认知到决策

作为沟通自然生态系统与人类社会的重要桥梁,生态系统服务一直以来都是地理学、生态学等学科的研究前沿和热点。正确认知生态系统服务之间的关系,是开展多种生态系统服务可持续管理决策的前提,有助于人类福祉的全面提升。本文通过厘定生态系统服务权衡的概念内涵,梳理了生态系统服务权衡的空间、时间和可逆性特征,将多层次人类福祉的满足作为权衡的最终目标,视生态补偿为权衡决策的基本保障途径。生态系统服务权衡关系的识别依托于定量指标法和综合模型法,且权衡关系可能随时空尺度的推移发生改变;情景分析与多目标分析是生态系统服务权衡决策的有效手段。生态系统服务权衡多尺度关联、生态系统服务流与远程耦合、生态系统服务消费与生态补偿,成为当前生态系统服务权衡研究的重点方向。     

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。     

基于生活圈理论的合肥市城市养老服务设施空间配置合理性研究

基于生活圈理论,构建了城市养老服务设施空间配置合理性评价标准,运用GIS空间分析方法,从城市、行政区及街道等不同空间层面对合肥市城市养老服务设施空间分布特征及配置合理性进行分析。研究发现：1）合肥市城市养老供给以社区养老服务为主要类型,城市养老服务设施建设数量和体量在4个行政区间存有较大差异;2）合肥市城市养老服务设施空间分布、配置合理性均由城市中心向外围地区呈圈层式递减,城市新区是养老服务供给的薄弱地段;3）合肥市城市养老服务设施空间配置合理性在街道层面差异更显著,覆盖率相似街道呈现明显的空间聚集特征。     

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。     

京津冀生产性服务业空间分工特征及溢出效应

生产性服务业在京津冀地区的合理分工对于实现京津冀地区空间协调发展具有非常重要的推动作用。利用2003-2012年京津冀地区13个地级城市面板数据,测算了京津冀生产性服务业分工的空间特征与行业特征,并基于空间面板计量模型,实证检验了生产性服务业各行业在京津冀地区城市之间的空间外溢效应。主要结论：① 北京和天津在京津冀生产性服务业分工体系中都呈现出多样化的特征,而河北省11个城市则呈现出专业化特征,大多专注于金融服务业和交通运输业的发展;② 北京与天津之间的生产性服务业分工程度相对较低,并且从动态上两个城市的生产性服务业结构呈现趋同的趋势;③ 金融服务业、商务服务业、信服务业和交通运输业在京津冀地区的地方化程度较高,而科技服务业和房地产服务业的地方化程度则明显偏低。④ 地方化程度较低的科技服务业和房地产服务业在京津冀地区各城市间的空间外溢效应显著,但受交易成本和对“面对面”接触需求的影响,空间溢出效应随距离增加而衰减,在150 km范围内的空间溢出效应最强;而地方化程度相对较高的交通运输业、金融服务业和商务服务业的空间外溢效应则不显著。信息服务业在京津冀地区城市间的溢出仅体现在相邻城市之间。实证结果一定程度上反映生产性服务业各行业的地方化程度越低,城市之间的空间溢出越易实现。     

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.     

“15 分钟生活圈”视角下住宅小区与公共服务设施空间配置评价——以乌鲁木齐市为例

新型城镇化高质量发展更加注重提升人民群众的幸福感和获得感,加大“15分钟生活圈”公共服务建设力度能有效提升人民群众生活满意度。基于国家“15分钟生活圈”建设要求使用高德地图POI数据,采用核密度估计、缓冲区分析、栅格分析等方法,对乌鲁木齐市公共服务设施的空间覆盖特征进行判断,对住宅小区与各类设施的空间匹配状况进行综合评价。研究表明:(1)不同类型基础公共服务设施的空间布局特征有所差异,既与住宅小区的集聚分布有一定关联,又体现了不同设施的属性特点。(2)不同类型的基础公共服务设施在住宅小区“15分钟生活圈”的覆盖率有一定的差异,以公交站点为代表的公共交通出行的覆盖率最高,便民商业设施中超市、果蔬店、理发店等日常服务设施的覆盖率相对高于银行、电讯营业厅等设施,教育设施中幼儿园覆盖率最高,其次为小学,中学的覆盖率相对较低。医疗设施服务覆盖率在各类型中差别不显著,卫生服务中心、药店、诊所基本都能实现95%的覆盖率。(3)不同类型基本公共服务与住宅空间配置达标率存在较明显区域差异。在人口分布越密集的区域,便民商业、教育、医疗、交通4类公共服务设施均达标的住宅小区比例越高,而人口密度相对较低的外围区域和新建城区医疗和便民商业设施的达标率偏低。(4)乌鲁木齐市建设“15分钟活动圈”应注重加强新建城区的公共服务配套,尤其是便民商业和基层医疗设施,老城区应加强改造过程中公共服务的更新配套。