Abstract
The hierarchical healthcare system is widely considered to be a desirable mode of the delivery of healthcare services. It is expected that the establishment of a hierarchical healthcare system can help provide better and more equal healthcare accessibility. However, limited evidence has been provided on the impacts of a hierarchical healthcare system on healthcare accessibility. This study develops an improved Hierarchical two-step floating catchment area (2SFCA) method, which incorporates variable catchment area sizes, distance friction effects and utilization efficiency for facilities at different levels. Leveraging the Hierarchical 2SFCA method, various scenarios are set up to assess the accessibility impacts of a hierarchical healthcare system. The methods are applied in a case study of Shenzhen. The results reveal significant disparity and inequality in healthcare accessibility and also differences between various facility levels in Shenzhen. The overall healthcare accessibility and its equality can be significantly improved by fully utilizing existing facilities. It is also demonstrated that allocating additional supply to lower-level facilities can generate larger accessibility gains. Furthermore, allocating new supply to primary facilities would mitigate the inequality in healthcare accessibility, whereas inequality tends to be aggravated with new supply allocated to tertiary facilities. These impacts cannot be captured by traditional accessibility measures. This study demonstrates the pivotal role of primary facilities in the hierarchical healthcare system. It can contribute to the literature by providing transferable methods and procedures for measuring hierarchical healthcare accessibility and assessing accessibility impacts of a hierarchical healthcare system in developing countries.
Highlights
IntroductionIntroduction published maps and institutional affilHuman health is a key topic drawing great attention from global researchers from domains such as medicine, public health, urban planning and geography
Introduction published maps and institutional affilHuman health is a key topic drawing great attention from global researchers from domains such as medicine, public health, urban planning and geography
China 2030” strategy, which is expected to be helpful in promoting equality in healthcare accessibility
Summary
Introduction published maps and institutional affilHuman health is a key topic drawing great attention from global researchers from domains such as medicine, public health, urban planning and geography. With the increasing improvement in wealth and well-being, increasing attention is being paid to health. In China, the “Healthy China 2030” strategy emphasizes the promotion of the equalization of health services and the health status of residents [2]. The rational distribution of healthcare facilities is a critical influencing factor on the utilization and outcomes of healthcare services [3,4]. Inequality in accessing healthcare services is considered to be a major threat to the overall level of health [3,5]. Even in developed countries such as the U.S where the total supply of healthcare services is relatively sufficient, there is still a considerable proportion of the population lacking access to healthcare services due to the unequal distribution of resources [6].
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