Abstract
BackgroundEquity of healthcare spatial access is essential for the health outcomes of medical investments and the welfare of populations, and efficiency of medical resource allocation is important for obtaining a supply-demand equilibrium with lower cost and higher outputs with limited inputs. However, the literature that involves both equity and efficiency in its analysis of healthcare spatial allocation is rare, and the spatial accessibility of multilevel healthcare is difficult to measure by traditional methods in a large region with diversified population distribution.MethodsTo assist in solving these issues, this paper aims to build an equity and efficiency integrated analytical framework by proposing a new “GTL-2SFCA” approach to analyze the spatial accessibility of multilevel healthcare; maximum and minimum floating catchments of different levels of healthcare were assigned to ensure a combination of universal search coverage and efficient hospitalization behavior simulation.ResultsThe analytical framework was applied and tested in Hubei, China. Almost half of the residents (47.95%) and townships (44.98%) have access to both public general hospitals (PGHs) and primary healthcare centers (PHCs) services, 36.89% of the residents enjoy only one sufficient service, either PGHs or PHCs, and the remaining residents (15.16%) are faced with the risk of lacking access to both services. The results reveal that there are core-periphery effects of multilevel healthcare throughout Hubei and isolate clusters that have adequate access in the western region. The polarization effect of higher-level healthcare and the polycentric pattern of lower-level healthcare coexist. The multilevel healthcare shortage was identified in some areas in boundary and peripheral regions.ConclusionsThis study integrates equity and efficiency into the GTL-2SFCA framework, enriches the FCA series methodologies and provides a more operational solution for evaluating the access of residents in more sophisticated spatial units to each level of healthcare. By more significantly differing and quantifying the catchment area and distance decay effect, this methodology avoids overestimating or underestimating accessibility and discovers some imperceptible spatial inequities. This study has application value for researchers and decision-makers in other scenarios and regions with significant heterogeneity in medical resources and where the population has greater mobility.
Highlights
The trade-off between equity and efficiency is the central issue of healthcare spatial distribution
Based on our former research on a “2R-GTL” method and the widely applied 2SFCA method [23], we presented a new “GTL-2SFCA” approach to analyze the spatial accessibility of multilevel healthcare in Hubei Province in China as a case study (Fig. 1)
Gridded population and multilevel healthcare capacity Gridded permanent residential population In the population distribution figure based on township statistical data in Hubei (Fig. 4), the population density significantly corresponds to the topography; that is, most of the population is concentrated in the Jianghan Urban Plain Agglomeration comprising Wuhan, with Jingmen, Xiangyang and Shiyan in the Hanjiang Basin as densely populated areas
Summary
The trade-off between equity and efficiency is the central issue of healthcare spatial distribution. The WHO initiated a strategy for universal coverage of healthcare To achieve this goal, the Hierarchical Diagnosis and Treatment (HTD) reform has been implemented in China. Healthcare allocation is always conducted under limited resource constraints; it is important to understand how to reconstruct the structure of the multilevel healthcare system and to optimize spatial distribution of medical resources to obtain a supply-demand equilibrium with lower cost and higher input-output efficiency. Spatial equity of healthcare is beneficial for enhancing health outcomes, especially for marginal and vulnerable people. Equity of healthcare spatial access is essential for the health outcomes of medical investments and the welfare of populations, and efficiency of medical resource allocation is important for obtaining a supply-demand equilibrium with lower cost and higher outputs with limited inputs. The literature that involves both equity and efficiency in its analysis of healthcare spatial allocation is rare, and the spatial accessibility of multilevel healthcare is difficult to measure by traditional methods in a large region with diversified population distribution
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
