National Medical System Research Articles

Creating online personal medical accounts: Recent experience in two developed countries

BackgroundOnline personal medical accounts are increasingly viewed as a useful mechanism to both inform and educate patients and citizens about their individual health condition. A number of countries have announced major national projects to put this type of information system in place. MethodsThis article adopts a comparative health systems approach to examine the experience of two smaller developed countries – Taiwan and Estonia – that now have universal national medical account systems in current service. The comparison focuses on the structural similarities and differences of both core characteristics of these two health systems and of their specific personal medical account arrangements. ResultsWhile Taiwan has multiple separated systems with voluntary options for patients, Estonia has a single integrated one which is mandatory for all citizens. Further, the Estonian system is more advanced in providing the ability to book or cancel medical appointments. Both systems directly control patients for system management purposes, allow patients access to prior medical records, and reorient the focus of health management from curative toward preventive care. A centralized and technically competent government agency and the political willingness of citizens to grant information-gathering powers to it appear to be essential elements in the successful implementation of these systems. Concerns about individual privacy protection and citizens' ability to decide whether to participate are also discussed. ConclusionA number of core issues regarding the technical introduction and political acceptability of personal medical accounts remain unresolved and will require considerable attention in the future.

EYE ON CHINA

Organ donations to be computerised in China. Traditional Chinese cold medicine has international standard now. Your eyes don’t deceive you, your brain does. Over one tenth of Chinese people have mental health problems. China to establish four-level national and regional medical system by 2020. Nanogenerator for cancer drug delivery system. Researchers develop new material to repair bone defects. Study revealed suppression of inhibitory neurons in fruit flies. AI system can diagnose childhood diseases like doctors.

Discipline construction of critical care medicine under the guideline of "excellence, high-quality and sustainability" in the First Affiliated Hospital of Zhengzhou University

Critical care medicine plays an important role in public health emergencies, major disasters and treatments of critically ill patients as an emerging clinical discipline. Our hospital put critical care medicine in an important position and apply multiple measures under the guidance of the spirit of graded diagnosis and national medical system reform combined with our concept of "more detailed, more excellent, high quality and sustainable development". Our hospital promote rapid, high-quality sustainable development of critical care by increasing discipline construction, scientific research, professional training, talent introduction, academic exchange, information construction, and precision medical treatment, etc.

Évolutions du nombre de tentatives de suicide dans le Nord-PasdeCalais depuis l’implantation de VigilanS : premières estimations

BackgroundThe implementation of a surveillance program after a suicide attempt (SA) is a very innovative step in the evolution of our system of care. It was interesting to know if we observe a decline in suicide attempts in the region, in particular of recurrences of SA. MethodWe measured the evolution of the number of suicide attempts before and after implantation of VigilanS, using two types of analysis: a first from the national medical information systems in Medicine-Surgery-Obstetrics (PMSI-MCO) and a second from the collection of the ER stays for SA in the hospitals involved in the VigilanS program. ResultsIn 2014 (year before start of VigilanS), a total of 10 119 ER stays for SA was observed (5626 women and4463 men); in 2017, the total was 9.230 stays for SA (5047 women and 3 839 men), representing a decrease of 13.5%. The reduction was balanced between men (−14%) and women (−10%). Based on the figures of PMSI, we see an acceleration of the reduction of stay for SA in the Nord-Pas-de-Calais after 2014 (−16% instead of −6%), instead of the two Picardy departments the most comparable which show a degradation of the phenomenon (+13%), and opposed to the Department of the Oise which shows a stable maintenance of the current decline (−12%). ConclusionThese two indicators are imperfect, but evolution over three years since the implementation of VigilanS goes in the same direction. We find a uncoupling of a hospital stay in connection with a SA. The intensity of this decline seems correlated to the penetrance of the program.

The trend and features of physician workforce supply in China: after national medical licensing system reform

BackgroundThe annual number of newly licensed physicians is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health care market over a period. In order to both regulate medical professions and improve the quality of health care services, China established its medical licensing system from the point of the implementation of ‘Law on Practising Doctors’ in 1999. The objective of this study is to depict the trend and structure of newly licensed physicians thereafter.MethodsThis study analyses a unique census data set that provides the headcount of newly licensed physicians from 2005 to 2015 in China. We also review a short history of medical licensing system reform in China since the 1990s.ResultsThe annual number of first-time licensed physicians in China increased from 159 489 in 2005 to 221 639 in 2015. Up to 2015, over half of newly licensed physicians had not received a medical education equivalent to a bachelor degree or higher. Around 51% of China’s newly licensed physicians were female in 2005, while the same ratio for females in 2015 was 56%.ConclusionThis article first provides an exploratory analysis of physician inflow into health care market in China using physician licensing data. The medical licensing system in China allows entering physicians with a broad range of educational levels. Moreover, the feminisation of the physician supply in China has become increasingly apparent and its impacts on health care provision still require more rigorous examination.

Contesting Remedies: The Debate on STD Treatment Therapies in the early PRC

During the early years of the People's Republic of China, sexually transmitted diseases (STD) were almost eliminated nationwide for a period. In the STDs eradication campaign, "political correctness" became a ruling policy. During the prevention and treatment of the STDs, the choice of therapy depended on the "political correctness" policy rather than medical effectiveness. With this political background, three competing treatments of STDs emerged (especially for syphilis): penicillin treatment, arsenic and bismuth mixed and intermittent treatment, and traditional Chinese medicine treatments. The argument between treatments was a vivid microcosm of the love-hate political relationship between China and the Union of Soviet Socialist Republics (USSR). The traditional Chinese medicine treatments for syphilis were used as a tool by the authorities to prevent the national medical system becoming more and more westernized. The penicillin treatment, the winner of this battle, won because it catered to the political themes of the time, the "Great Leap Forward" . Overwhelming state power had a strong influence and control over the medical system and medical practice, with the initiative and independence of doctors being limited in an unprecedented fashion.

The China Hot Springs. Introduction and remarks

As early as the records “the flowing hot spring, washes away the filth, drives away evil spirits, and returns to the right way” of Ode of Hot Spring by Zhang Heng in the Eastern Han Dynasty to the Commentary on the Waterways Classic by Li Daoyuan in the Northern Wei Dynasty, there have been 31 records of hot spring in China, among which Lushan Mountain Hot Spring and Taiyi Mountain (Zhongnan Mountain) Hot Spring have detailed description of curative effect. Because of the its health benefits, hot spring bathing went into the residence of the upper ruling class. Many hot spring areas became temporary residence of the royal family, while the public use of hot spring was rarely recorded in the official history. For example, the Tang Dynasty poet Bai Juyi wrote Everlasting Regret, saying that “granted shower in Huaqing Pool in cold spring, with slippery hot spring water washing her silky skin.” Although the beauty effect of the hot spring was clear, what impressed the world was the political marriage of Imperial Concubine Yang. In the 14th century, the Mongols established a vast empire across Eurasia, and the Chinese and Western civilizations had an unprecedented intersection. Western balneotherapy has entered China for the first time. According to archaeological discovery, the remaining Yude Hall in The Palace Museum in Beijing was built in the Yuan Dynasty, built by Byzantine craftsmen at that time. Its architectural form was influenced by the Roman spa, which became the historical witness of the introduction of balneotherapy from the West into China. However, the sinicization of this only combination of Chinese and western balneotherapy was only used by the imperial palace of the Yuan Dynasty and it was not popularized in Chinese society after all. When the empire that unites Eurasia is gone, Yude Hall is forgotten gradually in the humble corner of Palace Museum. Influenced by the revival of western balneotherapy in the 19th century, Chinese warlords and senior officials built a number of hot spring accommodations throughout the country during the Republican period, such as Tangshan in Nanjing, Tanggangzi in Liaoning and Conghua hot spring. Unlike in the west, balneotherapy in China attaches great importance to the theory of natural health and neglects the development of water quality, medical facilities and complementary therapies. For example, the Pearl River Nursing Home built in the Conghua hot spring in the Republican period was named as the place of heavenly medicine, with an inscription of “a disease cannot be cured by medicine, but only by heaven”, which means to restore health through the efficacy of the natural environment. From 1950s to 1970s, China began the construction trend of nursing homes. More than 1,500 nursing homes of all kinds were set up in the 1960s, many of which are hot spring sanatoriums. At this stage, Chinese hot spring sanatorium introduced relatively completed balneotherapy from the Soviet union and became an important part of the national medical system. However, as the institutional reform in the 1990s was gradually pushed forward, the state's financial support for nursing homes gradually decreased, and a large number of nursing homes closed down due to the lack of patients. The development of balneotherapy in China fell into a low ebb again. Reform and opening-up in 1980s drived the redevelopment of hot spring tourist destinations in China. According to the China Hot Spring Association, there were 2,538 hot spring enterprises in China (excluding Hong Kong, Macao and Taiwan) as of 2017. In 2017, the total number of hot spring tourists reached 770 million, and the total revenue of national hot spring enterprises reached 242.83 billion yuan. China's hot spring tourism has experienced rapid growth in the past 30 years. Many new hot spring projects include the hot spring pool, water park, restaurant and highend hotel, and balneotherapy has been preserved in many hot spring projects. However, what do China's vast tourist population think of balneotherapy, and what do they do with their consumption in modern hot springs, all of which are worthy of attention.

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China.

Background:China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis (DEA) model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development.Methods:We chose 12 country-level hospitals based on geographical distribution and the economic development level in Anhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions.Results:During 2010–2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was >1, and the rest are <1 between 2010 and 2015.Conclusions:In 2010–2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.

Medical education and health care in China and the USA: a follow-up study of a 4 year cardiovascular visiting programme between Peking University and the University of Minnesota

BackgroundChina has witnessed a fast-developing social system in the past decades; meanwhile, its medical education and health-care system still face many challenges. A growing number of exchange programmes are being established to promote mutual awareness of medical education and health-care systems. The cardiovascular visiting programme between Peking University and University of Minnesota was established in 2013. The aim of this study was to investigate participating Chinese students' opinion about differences in medical education and health care between China and the USA. MethodsWe interviewed Chinese visiting medical students about the difference in health education and medical system between China and the USA before and after their visit to the USA. The questionnaire was based on three parts: the major difference in medical education; the strongest differences in residency training; and major challenges of medical status in China. FindingsWe interviewed 17 Chinese medical students. When comparing various aspects of the Chinese and American health education and medical systems, most students (91%) thought that China's medical education system placed highest value on textbook learning, and all students (100%) believed self-learning to be most important in the USA. Many students (76%) also believed that clinical skill training drew more attention in the USA than in China. Compared with Chinese hospitals, most participants responded that American hospitals obtained the more advanced clinical equipment (76%) and paid more attention to evidence-based treatment (100%), disease prevention (94%), and the importance of a national informationised system (65%). Among the challenges China is facing, amendment of the national medical referral system, improvement in doctor income and freelance policy, and strengthened clinical skills and operations training during fellowships were considered more important and urgent than in the USA. InterpretationWe found various differences between China and the USA with respect to medical education, hospital management, medical insurance, and communication between the patients and doctors. China still faces challenges and gaps in its health education and hospital management system as compared to the USA. As a result, mutual exchange programmes for medical students between China and the USA are beneficial and a crucial way to achieve a global and prosperous medical development in the future. The biggest limitations of this observational study were its small sample size and that it included Chinese students only. More medical students from both China and the USA might be interviewed in the future so as to further explore the difference in the medical education system. FundingNone.

The trend and features of the doctor workforce supply in China after the national medical licensing system reform from 2005–15: a longitudinal analysis

BackgroundThe annual number of newly licensed doctors is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health-care market during a time period. Since the implementation of the Law on Practicing Doctors in 1999, the Chinese Government has established its medical licensure system to both regulate medical professions and improve the quality of health-care services. We aimed to analyse the trend and structure of newly licensed doctors since the establishment of its medical licensure system. MethodsWe analysed a unique census dataset that provides the headcount of newly licensed doctors in China between 2005 and 2015. We also review a short history of medical licensing system reform in China since the 1990s. FindingsThe annual number of first-time licensed doctors in China increased from 159 489 in 2005 to 221 639 in 2015. Until 2015, more than 50% of newly licensed doctors had not received equivalent medical education of a bachelor degree or higher. In 2005, about 51% of China's newly licensed doctors were women, whereas in 2015, 56% newly licensed doctors were women. InterpretationOur findings could inform policy making in human resources for health in at least two aspects. First, the heterogeneity of medical education of entering doctors needs to draw more attention of policy makers. The second policy implication is, however, that the feminisation of physician in China is becoming more apparent, and the consequences still require more rigorous examinations. FundingNone.

Supporting Integrated Care through National Standardisation of Chemotherapy Protocols

Patients with cancer transition through the different stages of the cancer care continuum, and into and out of the cancer system, and will see many care providers in many settings (1). These will include General Practitioners (GPs), Community Pharmacists and Nurses as well as consultant led hospital multi-disciplinary teams. These patients require care that is integrated around the patient’s needs and seamlessly coordinated across different providers (2) to ensure patients receive the right care, in the right place, at the right time (3).Chemotherapy treatment can be complex and toxic with many potential side effects. It is initiated by specialist consultants in secondary care and is either hospital or home administered. It is described in chemotherapy treatment protocols which support safe, evidence-based and cost effective cancer treatment. These are key documents which inform all involved in the care of the patient regarding the correct drug, dose, route and appropriate adjustments required due to toxicity or side effects. Effective communication and transfer of this information across the interface between primary and secondary care is seen as vital in the integration of care (3, 4).In 2014, the NCCP recommended that each hospital providing cancer services had access to an agreed list of chemotherapy protocols. This followed from the finding of the Oncology Medication Safety Review Report (5) which found that only 8 out of 26 hospitals had specific chemotherapy protocols in place which were available only for use within the hospital.The NCCP proceeded to implement a systematic process for the development of nationally approved chemotherapy protocols to improve communication at transitions in care for patients as they move across settings and providers, particularly from the hospital back into the community in order to support safe, evidence-based, cost effective cancer treatment. This process involves a standardised development and approval process. The protocols are developed in a coordinated fashion under the guidance of Specialist Medical Consultants with input from nursing staff, pharmacists and other healthcare professionals (HCPs). Once approved they are published on the NCCP website (6) where they are available to clinicians, HCPs and the public. These protocols are reviewed every two years at a minimum or when any relevant updates are published.The benefits of national, standardised chemotherapy protocols in terms of integrated patient care are manifold. Primary care HCPs, patients, carers and their families may readily access these protocols from a trusted source irrespective of their location. This ensures that the relevant information is available if patients become unwell, have queries or need an OAM prescription dispensed.The implementation of nationally approved standardised chemotherapy protocols is a key step forward to ensure that care is person-centred, coordinated and continuous across all care settings.180 chemotherapy protocols covering up to 240 different indications have been launched on the NCCP website. Going forward, these protocols will form the chemotherapy protocol library to underpin the national Medical Oncology Clinical Information System, a core component of the eHealth strategy (7) which is in development and will be the next step in improving the integration of care for patients with cancer.

Inclusion of gaming disorder criteria in ICD-11: A clinical perspective in favor.

Data from a specialist treatment facility for Internet addiction (IA) in Japan showed that (a) the vast majority of treatment seekers are addicted to online games, (b) their symptoms are often quite severe, and (c) there is a significant demand for IA treatment. In addition, systemic obstacles to the delivery of medical services in Japan exist due to the exclusion of IA criteria from ICD-10. Consequently, the inclusion of GD criteria in ICD-11 will almost certainly increase the capacity and quality of treatment through advances in research and possible changes in national medical systems to meet treatment demand.

Lymphatic filariasis patient identification in a large urban area of Tanzania: An application of a community-led mHealth system.

BackgroundLymphatic filariasis (LF) is best known for the disabling and disfiguring clinical conditions that infected patients can develop; providing care for these individuals is a major goal of the Global Programme to Eliminate LF. Methods of locating these patients, knowing their true number and thus providing care for them, remains a challenge for national medical systems, particularly when the endemic zone is a large urban area.Methodology/Principle findingsA health community-led door-to-door survey approach using the SMS reporting tool MeasureSMS-Morbidity was used to rapidly collate and monitor data on LF patients in real-time (location, sex, age, clinical condition) in Dar es Salaam, Tanzania. Each stage of the phased study carried out in the three urban districts of city consisted of a training period, a patient identification and reporting period, and a data verification period, with refinements to the system being made after each phase. A total of 6889 patients were reported (133.6 per 100,000 population), of which 4169 were reported to have hydrocoele (80.9 per 100,000), 2251 lymphoedema-elephantiasis (LE) (43.7 per 100,000) and 469 with both conditions (9.1 per 100,000). Kinondoni had the highest number of reported patients in absolute terms (2846, 138.9 per 100,000), followed by Temeke (2550, 157.3 per 100,000) and Ilala (1493, 100.5 per 100,000). The number of hydrocoele patients was almost twice that of LE in all three districts. Severe LE patients accounted for approximately a quarter (26.9%) of those reported, with the number of acute attacks increasing with reported LE severity (1.34 in mild cases, 1.78 in moderate cases, 2.52 in severe). Verification checks supported these findings.Conclusions/SignificanceThis system of identifying, recording and mapping patients affected by LF greatly assists in planning, locating and prioritising, as well as initiating, appropriate morbidity management and disability prevention (MMDP) activities. The approach is a feasible framework that could be used in other large urban environments in the LF endemic areas.

Role of Polish Medical Air Rescue in national medical rescue system

Great technological progression, as well as the development of motorization in the past decades, has caused an intensification of danger to health and life for contemporary societies. The increasing amount of HEMS (Helicopter Emergency Medical Service) units interventions underline that the significance of the Polish Med­ical Air Rescue service within the structures of National Medical Rescue System is increasing. Polish Medical Air Rescue is the one and only organization in Poland which uses helicopters while performing emergency medical services and conducting the transport of patients. The history of medical aviation, and later the Polish Medical Air Rescue service shows the great work and effort that has been put into the development and functioning of this organization.

Under what circumstances should stress incontinence surgery be performed at the same time as prolapse surgery? ICI-RS 2015.

An International Consultation on Incontinence-Research Society (ICI-RS) Think Tank in 2015 discussed and evaluated the evidence of when stress incontinence surgery should be performed with prolapse surgery and highlighted evidence gaps, with the aim of recommending further clinical and research proposals. A review of the literature assessing randomized studies where women with vaginal prolapse have been randomized to vaginal prolapse surgery with or without continence surgery were evaluated. The different clinical presentations were also evaluated and their impact on outcome was critically reviewed. There are three symptomatic groups of women with vaginal prolapse who are treated. The first group is continent women with vaginal prolapse. The second group has stress urinary incontinence (SUI) and vaginal prolapse. The last group has vaginal prolapse and have been found through testing to have occult SUI. The studies have reported a range of outcomes for each of these groups. There are different outcomes based on the surgical method used to correct the prolapse and also the different continence surgical techniques. There are insufficient studies to allow firm conclusions to be drawn. The economic impact of the different management pathways is also discussed although costs vary according to different national medical funding systems. There is considerable uncertainty about the optimal method of managing women with vaginal prolapse and stress incontinence due to the different surgical techniques available. In particular the group of women with occult SUI are a challenge as the optimal diagnostic method has not yet been defined.

The preparation and usage of public rescue units cooperating with the national medical rescue system towards actions taken on the spot of a disaster — an analysis of the issue based on the example of Wroclaw and Lower Silesia

INTRODUCTION: A disaster is an occurrence requiring numerous emergency services being engaged in order to successfully bring help to the victims. PURPOSE: The thesis describes Lower Silesia’s public rescue units and the possibility of using them in the field of a disaster. METHODS: The thesis descriptively presents a historical view of disasters, the Polish legal system that regu­lates the principles of operation on the field of the disaster and the disposal of the volunteer units. It also presents the legal requirements concerning the equipment of the above-mentioned units. RESULTS: The volunteer rescue units present in Wroclaw and Lower Silesia are very well equipped while the rescuers are very highly trained. Their varied scope of operations enables the units’ disposal both to natural and mechanical disasters. Continual rescue exercises allowed such procedures to gain a uniform character which improves the efficiency of the actions on the spot of the disaster. CONCLUSIONS: The disposal of volunteer rescue units seems to be determined by long lasting actions due to the length of time needed to reach operational readiness.

Management decisions for sustainable development: medical software case study

Software is becoming increasingly important and pervasive in healthcare. Deads and injuries, recalls related to the medical software, defective medical device statistics justify the practical dimension of the issue and needs to search ways seeking reduce possibility to arise injuries and deaths. Decision to release medical software to the market is very important not only to the manufacturer (design and development organization), but also for direct and indirect users (doctors and patients) and for all society, which is using national medical system with integrity information technologies possibilities. Manufacturers of medical devices assume responsibility for the correct functioning of medical devices and medical software manufacturer should assume responsibility for medical decisions making and medical decision influence on patient. This responsibility is related not only to the legal and financial risk, but also to the socially responsible business commitments. Software developing companies does not have knowledges about the conditions, which can assure medical software confidence before the release to the market. Such situations stops entrepreneur involvement in the medical software creating area.

Face the challenge, create brilliance further: understanding of burn surgery confusion in our country

Burn surgery has a glorious history in our country, but it still faces enormous challenges at present: the incidence of burn declines year by year, basic research and clinical diagnosis are more or less disjointed, national medical care and education system need to be further perfected, fusion of new technology lags behind, and army system adjustment in military hospitals is in progress, etc. We need to adjust strategies in time of peace, and prepare for challenges so as to create new splendor.

Proposed model for a Romanian register of chronic diseases in children

Background and ObjectivesThe prevalence of chronic diseases at children is increasing due to the progress made in medicine, which radically changed the evolution and the prognostics. Disease registers became important tools to register and monitor the chronic patients in order to asses their needs and improve their care. Disease registers are also very important for adjusting to population needs the actions in the public health field.The main objective for this research is to develop a model for a chronic disease register of children in Romania, taking into account the current situation of chronic diseases’ registration and reporting, the specific requirements for such medical database and the particularities of the information systems in the Romanian healthcare system. MethodsOur study was based on interviews with specialists and Health Ministry representatives, field observations, and analysis of published and unpublished data). ResultsWe developed a platform for a chronic diseases register of children based on open EHR specifications and architecture, which respects the requirements for data security and the particularities of Romania's healthcare system. The model created is functioning on two levels. The first one is local and corresponds to a medical unit, while the second one represents the connection and the communication method within the entire national medical system. In order to achieve the highest level of interoperability at the semantic level, we used, for the communication module of a National Disease Register system, only EN 13606 or HL7 v3 and / or HL7 v3 CDA. ConclusionsThis model is functional and can be applied initially at a clinical level for medical and administrative purposes. Its design allows a future development, integrated with the current informational systems and implemented at regional and national level. This will significantly improve the knowledge that may support good medical practice in this field, will enhance the coherence of data collection and, as a consequence, will impact positevely on the health of children diagnosed with chronic diseases.

Spatial inequity in access to healthcare facilities at a county level in a developing country: a case study of Deqing County, Zhejiang, China

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.