Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China.

Xiuli Wang,Jay Pan

doi:10.1186/s12913-016-1643-8

Abstract

BackgroundThere is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future.MethodsSichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment.ResultsIn Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region.ConclusionsThe combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

Highlights

There is a great disparity in spatial accessibility to hospital care between ethnic minority and nonminority regions in China
The percentage of residents living within 10 min of a hospital in the non-minority region (6.92 %) is four times that of ethnic minority region (1.71 %), while the percentage of residents living more than 120 min away from the nearest hospital is about half (5.73 % versus 11.55 %)
We identified the following problems in the supply of healthcare in ethnic minority region: 1) Doctors, health professionals, and beds are insufficient, and heavily clustered in a few sites; 2) the market mostly relies on government investment with only a small role for private investment; and 3) more primary and tertiary hospitals are needed in this region

Summary

Introduction

Among the 56 ethnic groups in China, the Han is the ethnic majority, accounting for more than 90 % of China’s population. They live in almost every region in China and own most property, technology, and resources [1,2,3,4,5]. To promote equality between ethnic groups, the Chinese government has implemented many policies to support ethnic minorities. The Chinese government has set up minority regions (including minority autonomous regions, minority counties, and minority villages) based on proportion of minority population, historical factors, local customs and culture, to offer efficient financial and political supports. In minority autonomous regions, ethnic minority constitute the majority of local government, and has many self-governance rights

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Conclusion