中国医疗资源配置与服务利用协调发展的时空演化——基于机构分层分析框架

基于机构分层分析框架，运用统计与空间分析方法，剖析中国省域基层医疗卫生机构和医院医疗资源配置与服务利用协调发展的时空演化特征及其驱动因子。研究发现:2010—2018年2类机构的耦合协调类型由濒临失调衰退型变为勉强协调发展型；总体呈东部经济发达地区水平较高，中部地区居中，西北、东北、西南等经济欠发达沿边地区较低的空间分布格局和以长江中下游地区和青藏高原地区为核心的热、冷点区的空间聚集特征，同时在空间格局改善程度、局部空间集聚效应强度和冷热点区变化范围等方面存在差异；受人口分布与结构、经济发展水平和地理空间等因子驱动，同时存在明显时空异质性特征。

Spatio-temporal Evolution of the Coordinated Development of Healthcare Resources and Utilization in China: Based on a Hierarchical Analysis Framework

The coordinated development of healthcare resources allocation and service utilization is closely related to the happiness of residents, the future of the country and the social progress. In particular, the research on the spatial pattern of the coordinated relationship is of great significance to narrow the interregional gaps in development and ease the contradiction between supply and demand of healthcare resources. At present, Chinese scholars pay more attention to the single aspect of healthcare resources allocation and service utilization, but the research on the relationship between them is still relatively shallow, especially from the perspective of spatial geography. Based on the hierarchical analysis framework of institutions, this paper focuses on the community healthcare institutions and hospitals in China by analyzing their spatiotemporal evolution characteristics and driving factors of healthcare resources and utilization in methods of statistical and spatial analysis. This article found that the type of coupling coordination of the two types of institutions has changed from the type of on the verge of maladjustment and recession to the type of barely coordinated development from 2010 to 2018. The coupled and coordinated development generally shows the spatial distribution pattern that the level of eastern economically developed region is higher, that of the central region is in the middle, while the northwest, northeast, southwest and other economically underdeveloped border areas are lower. The spatial aggregation characteristics of the hot and cold spot areas centered on the middle and lower reaches of the Yangtze River and the Qinghai-Tibet Plateau,and there are differences in the degree of improvement of the spatial pattern, the intensity of the local spatial agglomeration effect, and the range of changes in the cold and hot spots. Besides, the coupled and coordinated development are driven by population distribution and structure, economic development level, and geographic and spatial factors, and it also has obvious characteristics of spatio-temporal heterogeneity.