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。

A two-step Floating Catchment Area (2SFCA) Method for Measuring Spatial Accessibility to Primary Healthcare Searvice in China: A Case Study of Donghai County in Jiangsu Province

In the poor rural areas of China, the population far away from the hospitals, not having immediate access to primary care, is showing rising trend on a yearly basis. The measures to improve the spatial accessibility to primary care in the poor areas are important for achieving equality in the public healthcare system in rural regions. To accurately evaluate the variations of the accessibility to medical services is a prerequisite for rationally allocating medical resources. After reviewing the studies at home and abroad on spatial accessibility to medical services, by using the two step floating catchment area (2SFCA) method in the case study of Donghai County in Jiangsu province, and taking administrative villages and hospitals as study units, this paper analyzes the variations between the villages’levels of the accessibility to primary care based on the shortest travel time from a village to a hospital calculated by Dijkstra method. In order to investigate the spatial distribution of the areas lacking access to primary care, the authors further analyze the spatial variations of the accessibility by choosing two service time threshold values (catchment sizes). In comparison to traditional measures such as ratio of population to provider (demand to supply), distance/time to the nearest service provider and gravity model, the 2SFCA method reveals a good spatial pattern of the variations of the accessibility to primary care. When a bigger service time threshold value is used, the spatial variations tend to be smoother. When a smaller service time threshold value is used, the spatial variations become more striking and the area lacking the access to primary care expands. The spatial pattern of the variations of the accessibility to primary care in Donghai County has characteristics of a single core structure. The areas along major transportation networks have higher levels of spatial accessibility, while the remote villages and townships lack the access. Promoting the level of the hospitals of the administrative villages in the remote townships and improving the road conditions should help improve the spatial accessibility to primary care in the areas.