公平与效率导向下农村公共医疗资源的空间优化研究——以湖北省仙桃市为例

公共服务资源的空间配置问题一直存在效率与公平价值导向的博弈,空间综合人文社科的兴起,使其演化成一个空间优化问题。医疗资源空间配置的规划注重决策连续性,据此提出改进空间可达性的两步优化法。在农村地区资源有限的情况下,以空间可达性为主要指标,建立公平与效率导向下的二次规划模型,通过重新选址和设定规模以保证居民获得就医机会的最大公平和效率,并以湖北省仙桃市为案例进行应用研究。结果表明,新选地址和规模优化结果能使仙桃市医疗资源空间配置的公平性和效率性得到显著提高,2个步骤相结合,使其成为真正的混合优化模型,达到效率和公平平衡的双重目标。

Rural Public Medical Resources Allocation Spatial Optimization Towards Equity and Efficiency Access: A Case Study on Xiantao City,Hubei Province

A game relationship has always been existed between equity and efficiency on the study of resource allocation of public services, and the rise of spatially integrated humanities and social science has made it a spatial optimization problem. Research on the optimization of public service allocation towards equity and efficiency is still weak. In terms of spatial allocation of medical resources, it is considered that planning problems need continuous decision-making, such as selecting the location of new facilities and then adjusting the capacities of facilities. Based on this, a two-step optimization for spatial accessibility improvement (2SO4SAI) is proposed. In view of the limited resources in rural areas, taking spatial accessibility as the main index, and the objective function towards equity and efficiency is established, which includes a quadratic programming model with the objective and constraint of minimizing variance of spatial accessibility, minimizing total travel distance, minimizing maximum medical distance and maximizing coverage. This article clarifies how to find the best locations to site new facilities and adjusts the capacities of facilities to ensure the equity and efficiency distribution of medical opportunities for rural residents under their free choice of medical treatment, and a case study of Xiantao City is carried out. The results show that in the first step of optimizing location allocation with emphasis on efficiency, the final option can reduce the average distance between settlements and the nearest hospital from 6.5 km to 6.1 km, and increase the coverage of settlements and population within different distances. In the second step of facility capacities optimization, the ratio of service capacity allocation of the three hospitals after optimization is 1.7:3.0:1.0. Combining the two steps, it becomes a real mixed optimization model and achieves the dual objectives of equity and efficiency balance. In fact, the health status of residents in areas where public service resources are scarce often lags behind other areas, thus the investment in resources in this area will improve their health status more effectively and get higher returns. Therefore, the slight improvement of equity and efficiency cannot be ignored, and the spatial allocation of public resources must be continuously optimized. However, 2SO4SAI method takes equity and efficiency into account and has certain operability and rationality, it also has some limitations. Patient seeking hospital care is more diverse and complex than we can imagine. For example, many residents tend to bypass the choice near their homes in order to obtain higher quality services, which largely depends on the income and education of them. It is necessary to collect and analyze patient flow data, economic and cultural data in order to better simulate such behavior. In addition, this study simulates the limited data of resources, yet it does not simulate the optimization scheme of the total amount of service capacity without setting a ceiling when the financial input can be increased. It has solved how to allocate and optimize resources to maximize efficiency and fairness under limited resources, but has not solved how much resources are needed to maximize the equity and efficiency of the whole region. Such problems need to be further explored.