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。     

基于改进潜能模型的城市医疗设施空间可达性——以上海市杨浦区为例

引入人口规模因子和医疗设施等级规模影响系数改进潜能模型,基于GIS空间分析技术,以上海杨浦区为例对其医疗设施空间可达性进行研究。结果表明：杨浦区医疗设施空间可达性分布不均,大桥街道、定海路街道及殷行街道部分区域医疗设施空间可达性较高;中部区域一些街道存在同等级医院位置密集、医疗资源相对集中的情况;杨浦区三级医院的居民就医空间可达性整体优于二级、一级医院。改进的潜能模型综合考虑了居民点人口数量、医疗设施与居民点之间的出行阻抗、以及医疗设施的等级规模对居民就医选择的影响,能更合理地评价医疗设施的可达性。研究结果可为城市医疗设施科学规划与决策提供依据。     

基于改进潜能模型的县域小学空间可达性研究——以湖北省仙桃市为例

空间可达性是评价教育设施布局合理性的重要指标,而潜能模型是度量教育设施空间可达性的重要方法。本文在引入学校服务能力因子的基础上,综合考虑学校服务能力等级影响和居民极限出行时间构建就学影响因子,对潜能模型加以改进。通过以湖北省仙桃市为典型县域单元的案例研究,结果表明：①村级居民点尺度,乡镇中心和高等级公路沿线居民点的小学空间可达性普遍较高,并按照一定的半径范围呈距离衰减过程,而乡镇毗邻地区居民点的小学空间可达性相对较差;②乡镇(街道)尺度,可达性较高的乡镇(街道)主要分布在沿G318的北部地区,且城乡间、主城区与城郊的小学空间可达性均存在一定差距;③改进潜能模型能合理地评价各农村居民聚落点和各乡镇的小学空间可达性,当摩擦系数β取值为2时,能更为准确地揭示农村居民所能获取的教育资源,为相关部门决策提供科学依据。     

新冠疫情下城市应急医疗设施空间配置评价研究——以武汉市为例

通过数据实证分析COVID-19期间武汉市应急医疗设施的空间配置特征,构建武汉市疫情暴发期间的应急医疗设施空间配置评价体系,运用两步移动搜寻法等方法对武汉市应急医疗资源配置进行评价,提出其空间配置中的不足。研究发现,COVID-19暴发期间武汉的应急医疗设施的空间分布以核心城区为主,开放床位多集中在传统城市中心地区,周边地区的应急医疗设施空间配置上仍有不足;应急医疗设施的配置存在较大的缺口,空间分布不均衡,且综合可达性较差,可服务的研究单元较为局限,应急设施的就医可达性由城市中心从内向外依次降低。     

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。     

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。     

医疗设施可达性空间差异及其影响因素——基于上海市户籍与流动人口的对比

医疗设施可达性关乎民生健康、生活质量和社会公平等重大社会议题,受到广泛关注。将空间视角和社会视角相结合,考虑流动人口和户籍人口在城市不同区域内可达性的差异,将有助于更加全面地反映当前城市医疗服务的资源配置及其社会公平问题。本文以上海市不同等级医疗设施的可达性为研究对象,利用改进潜能模型和多元线性回归模型,分析了城市中不同区域内医疗设施的可达性、户籍人口和流动人口就医可达性差异及其影响机理。研究发现：医疗设施可达性自内城区向郊区逐渐降低,郊区可达性的波动程度较大;户籍人口的就医可达性优于流动人口,2类人群的差异在中心城边缘区和近郊区最为明显;居住地区位显著影响居民的就医可达性,但对于户籍人口的影响更加显著。本文可为上海市医疗资源的空间配置优化和改善流动人口就医条件提供实证研究依据。     

基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例

针对贫困山区医疗资源短缺、分布不均衡、服务能力差等问题,以重庆市石柱县为例,基于自然村尺度,采用改进的两步移动搜索法,从供需角度分析研究区医疗服务空间可达性特征。设置不同的时间阻抗进行敏感性分析,探究可达性变化规律。通过对石柱县医疗资源空间布局的均衡性评价,为山区未来医疗布局的合理规划与医疗标准的配备提供决策依据。结果表明:1石柱县整体医疗服务可达性差,低于重庆市平均水平。2县域医疗资源布局不均衡,空间差异明显。高值区主要集中在方斗山中低山区和黄水镇,低值区主要集中在南部中山区,两极分异明显。3医院的规模、级别,道路的等级、疏密对可达性有一定的影响:靠近县城的乡镇、路网密集的地方可达性一般较好。4随着出行阻抗的增大,医疗服务的可达性随之变好,边缘乡镇的可达性随之变差,可达性值变化幅度减缓,医疗服务空间可达性分异变小;医疗资源配备充足的乡镇,随着时间阻抗增加,对周边乡镇可达性的影响增强。     

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。     

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。     

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.     

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.     

Accessibility in designing centralised warehousing: Case of health care logistics in Northern Finland

Long distances and sparse service networks set challenging conditions for material logistics in health care. Globally, health care organisations have been making structural changes towards centralised warehousing and deliveries. In Northern Finland, material logistics of the public health care system rely mainly on numerous separate order and delivery systems, although logistics needs, ordering and stock in different health care facilities correspond to each other. As centralised logistics in orders and deliveries may lead to remarkable savings, pressure for centralised management is high. This paper analyses how effectively a potential centralised warehousing system can be organised based on its spatial components. These include optimal location of one or more warehouses, delivery network coverage and efficiency of routes, as well as accessibility of health centres and hospitals. The geographic information systems (GIS) -based accessibility analytical framework described in this study applies vehicle routing and heuristic computations to location-allocation of warehouses to potential sites by optimising transport cost with a constraint to provide service to at least 90% of delivery demand. The spatial data include the road network, health care facility locations with rough estimates of freight demand nodes and potential locations of warehouse facilities. The main findings of the study show that majority of health centres and hospitals can be effectively reached by a delivery network based on one or two warehouses. Furthermore, the efficiency of the delivery network does not increase remarkably by increasing the number of warehouses, when measured as driving time.     

Network Topology and City Accessibility of the Commercial Internet

The rapid growth in this decade of World Wide Web access through the Internet is supported by a complex matrix of telecommunications infrastructure. This paper presents an overview of the history of the Internet and recent efforts to measure its structure and performance, and examines the spatial organization of the commercial Internet backbone. The research presented in this paper differs from previous Internet measurement work in that we apply network analysis methods to evaluate Internet connectivity. Transportation network analysis techniques are applied to measure 1) connectivity of individual service provider networks and 2) accessibility of cities to Internet service. The results reveal many different strategies implemented by service providers in network design as well as large differences in levels of accessibility of cities and regions in the United States. There is also an apparent disparity between population and city accessibility to the Internet.     

Network Topology and City Accessibility of the Commercial Internet

The rapid growth in this decade of World Wide Web access through the Internet is supported by a complex matrix of telecommunications infrastructure. This paper presents an overview of the history of the Internet and recent efforts to measure its structure and performance, and examines the spatial organization of the commercial Internet backbone. The research presented in this paper differs from previous Internet measurement work in that we apply network analysis methods to evaluate Internet connectivity. Transportation network analysis techniques are applied to measure 1) connectivity of individual service provider networks and 2) accessibility of cities to Internet service. The results reveal many different strategies implemented by service providers in network design as well as large differences in levels of accessibility of cities and regions in the United States. There is also an apparent disparity between population and city accessibility to the Internet.