Abstract
BackgroundThe inequities in healthcare services between regions, urban and rural, age groups and diverse income groups have been growing rapidly in China. Equal access to basic medical and healthcare services has been recognized as “a basic right of the people” by Chinese government. Spatial accessibility to healthcare facilities has received huge attention in Chinese case studies but been less studied particularly at a county level due to limited availability of high-resolution spatial data. This study is focused on measuring spatial accessibility to healthcare facilities in Deqing County. The spatial inequity between the urban (town) and rural is assessed and three scenarios are designed and built to examine which scenario is instrumental for better reducing the spatial inequity.MethodsThis study utilizes highway network data, Digital Elevation Model (DEM), location of hospitals and clinics, 2010 census data at the finest level – village committee, residential building footprint and building height. Areal weighting method is used to disaggregate population data from village committee level to residential building cell level. Least cost path analysis is applied to calculate the travel time from each building cell to its closest healthcare facility. Then an integral accessibility will be calculated through weighting the travel time to the closest facility between three levels. The spatial inequity in healthcare accessibility between the town and rural areas is examined based on the coverages of areas and populations. The same method is used to compare three scenarios aimed at reducing such spatial inequity – relocation of hospitals, updates of weighting values, and the combination of both.Results50.03 % of residents can reach a county hospital within 15 min by driving, 95.77 % and 100 % within 30 and 60 min respectively. 55.14 % of residents can reach a town hospital within 5 min, 98.04 % and 100 % within 15 and 30 min respectively. 57.86 % of residential building areas can reach a village clinic within 5 min, 92.65 % and 99.22 % within 10 and 15 min. After weighting the travel time between the three-level facilities, 30.87 % of residents can reach a facility within 5 min, 80.46 %% and 99.88 % within 15 and 30 min respectively.ConclusionsThe healthcare accessibility pattern of Deqing County has exhibited spatial inequity between the town and rural areas, with the best accessibility in the capital of the county and poorest in the West of the county. There is a high negative correlation between population ageing and healthcare accessibility. Allocation of more advanced medical and healthcare equipment and highly skillful doctors and nurses to village clinics will be an efficient means of reducing the spatial inequity and further consolidating the national medical security system. GIS (Geographical Information Systems) methods have proven successful method of providing quantitative evidence for policy analysis although the data sets and methods could be further improved.
Highlights
The inequities in healthcare services between regions, urban and rural, age groups and diverse income groups have been growing rapidly in China
Based on R1 (T0), the total number of residents being able to access the county hospitals within the varied threshold time T0. Ak (T0) are statistically summarized into a histogram (Appendix 1b), which shows that 50.03 % of residents can reach a county hospital within 15 min, 95.77 % and 100 % within 30 and 60 min respectively
Deqing County has a generally reasonable provision of healthcare services as 80.46 %% and 99.88 % of population can reach a facility within 15 min and 30 min respectively
Summary
The inequities in healthcare services between regions, urban and rural, age groups and diverse income groups have been growing rapidly in China. Equal access to basic medical and healthcare services has been recognized as “a basic right of the people” by Chinese government. Prior to the economic reform or even before the mid-1980s, China had been one of the most successful countries in providing equal healthcare services [2] as 85 % of the population was able to access to basic health care at a low and affordable cost [3]. The astonishing economic achievements have increased the quantity and quality of healthcare facilities in cities and advanced rural areas markedly [4]. The total expenditure of healthcare, including financial sources from government, social medical insurance, commercial health insurance and residents’ self-funding reached 2434.591 billion yuan RMB in 2011, which is 5.1 % of the country’s GDP [5]. The total numbers of diagnosed and hospitalized patients have increased from 2.15 billion and 59.91 million in 2002 to 6.27 billion and 150 million in 2011 [5]
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