Two-step Floating Catchment Area Research Articles

Spatial Disparities in Access to Dialysis Facilities in Texas: An Analysis of End-Stage Renal Data in 1974–2020

Background/Objectives: This study investigates the spatial disparities in access to dialysis facilities across Texas. The objective is to analyze how urbanization and socio-economic/demographic factors influence these disparities, with a focus on differences between urban and rural areas. Methods: The enhanced two-step floating catchment area method is employed to calculate accessibility scores to dialysis facilities across the state. Additionally, Moran eigenvector spatial filtering is utilized to analyze the influence of urbanization and socio-economic/demographic factors on accessibility disparities. Results: The Moran eigenvector spatial filtering analysis revealed a significant level of spatial autocorrelation in accessibility scores, particularly highlighting disparities between urban and rural areas. Urban regions, especially major metropolitan areas, achieved higher accessibility scores due to the dense concentration of dialysis facilities. In contrast, rural areas, notably in western and northern Texas, exhibited lower accessibility, underscoring the challenges faced by residents in these regions. The model further identified urbanization and the percentage of the elderly population as critical covariates affecting accessibility, with urban counties showing higher accessibility and elderly populations in rural areas facing significant challenges. Conclusions: These findings emphasize the importance of considering spatial dependencies in healthcare accessibility studies. They suggest the need for targeted policy interventions to address the identified disparities, particularly in underserved rural regions, to improve access to dialysis facilities for vulnerable populations.

Developing a Novel Surgical Care Access Score for Osteoarthritis Patients Considering Total Knee Replacement.

Access to specialized orthopedic care is an important determinant of the decision to undergo total knee replacement (TKR); however, most studies have mainly utilized distance to the nearest high-volume hospital as the primary proxy for access. We applied the two-step floating catchment area (2SFCA) method to develop a more comprehensive TKR access score that accounts for other potential factors, i.e., supply of and demand for this procedure, that also affect access. To apply the 2SFCA method, we first estimated TKR demand using the CDC estimates of prevalence of osteoarthritis, which was multiplied by estimates of patients who would potentially benefit from TKR. We then estimated TKR supply using the number of TKRs performed in each hospital, extracted from the CMS MedPAR database. For the nationwide analysis, we estimated the access score for a radius of 55 km around each census tract in the contiguous US. For a subset of the census tracts, we employed a more realistic but more computationally intensive 42-minute driving distance to determine the robustness of the 55 km assumption, and calculated the Spearman rank correlation between the two access scores. Across the US, the access score was categorized low for 51%, medium for 24%, and high for 25% of census tracts. The Spearman correlation coefficient between these national scores and those with 42-minute driving time was 0.75. We developed a novel TKR care access score that may enhance quality measures available to patients, providers, payors and researchers.

Impact of Green Space on Older Adults’ Quality of Life Based on Spatial and Non-Spatial Analyses

Outdoor green space is an important public resource supporting older adults’ active lifestyle and improving their quality of life (QoL). However, the impact of green space on older adults’ QoL has seldom been comprehensibly investigated in Asia. Therefore, this study aimed to predict the impact of green space on older adults’ QoL in China by conducting both spatial analysis and questionnaire surveys. A two-step floating catchment area method was applied to measure the spatial accessibility of green space to older adults at the subdistrict level. To investigate older adults’ actual opinions and verify spatial analysis results, a large-scale questionnaire survey was also conducted. Both ANOVA and logistic regression were adopted to analyze questionnaire survey data. The results indicated that (1) green space was not equally distributed; (2) the possibility of a good QoL for older adults was significantly influenced by accessibility, size, and facilities of green space; (3) the possibility of older adults’ satisfactory QoL would decrease with the increase in walking distances to green space and increase with their good self-care ability. These findings could provide insights for future planning to enhance the spatial distribution of green space and improve QoL for older adults.

Exploring the Spatial Patterns of Accessibility to Metro Services Considering the Locations of Station Entrances/Exits

Accessibility to metro services is often evaluated based on the locations of stations. However, compared to the location of station itself, focusing on its entrances/exits offers a more accurate approach to assessing station supply and demand levels. Despite this, research focusing on the supply of and demand for metro services concerning metro entrances and exits remains limited. This study employed multi-source geospatial data from Xiamen, China, to examine the supply and demand dynamics of metro stations with a particular emphasis on entrances/exits. In the first phase, we treated entrances/exits as supply facilities and used land plot boundaries as the fundamental spatial units for accessibility calculations. Taking into account the layout characteristics of entrances/exits, along with the traffic generation of various land-use types, we employed the Gaussian two-step floating catchment area (G2SFCA) method to gauge the supply and demand levels of plots. Subsequently, we computed the spatial supply-and-demand relationships of station entrances/exits for both station-level and shared usage level of entrances/exits. We found that the accessibility from plots to entrances/exits diverged from previously observed spatial distribution trends, being higher in city centers, regional boundaries, and terminal stations and lower in transitional areas. Moreover, “metro accessibility” and the “imbalance index of entrances/exits” are associated with the primary functions of stations and the surrounding urban development; yet they exhibit spatial heterogeneity. The stations with a high value for “imbalanced index of entrances/exits” were always near some business parks, and “metro accessibility” seemed to be more easily affected by location factors. Based on two metrics, stations were categorized into four types, each displaying unique characteristics regarding location distributions, entrance/exit configurations, and commuting passenger sources. This research aims to identify the phenomenon of unfair transport in metro service from the perspective of their entrances, inform the optimization of metro station designs, and tailor planning recommendations, ultimately enhancing transport equity and contributing to sustainable urban built environments.

Enhancing Urban Mobility with Aerial Ropeway Transit (ART): Future Accessibility Impacts of Multimodal Transit Expansion Scenarios

Aerial ropeway transit (ART) systems are emerging alternatives to augment existing transit systems in congested cities in the Global South, especially in urban areas with limited transit coverage because of road width constraints or topography. Integration of aerial cable car stations to an existing transit network can improve the overall accessibility of various population segments with significant positive benefits in relation to reducing transport-related social exclusion. This study evaluated the impact of introducing ART in the city of Varanasi (India) and assessed the spatial accessibility improvements to critical facility locations such as heritage sites, educational institutions, hospitals, and employment centers. Several multimodal transit expansion scenarios were considered in this study and the potential benefits of each case were quantified using the two-step floating catchment area (2SFCA) method. A multi-criteria decision-making (MCDM) approach was subsequently employed for identifying the optimal locations of ART stops. Microlevel analysis findings suggest that the mean accessibility values could increase up to 10.92% in the first phase of the ART implementation, which could subsequently increase to 24.7% and 49.8% for the subsequent transit expansion scenarios. The study also investigated the Varanasi ART DPR prepared by Varanasi Development Authority (VDA) and showed that a significant increase of 16% in accessibility levels could be achieved if optimal stop locations identified in this study were implemented. The proposed two-step (2SFCA+MCDM) method for identifying the optimal locations of ART stations in a multimodal transit network is expected to be an effective tool for transit system redesign using place-based accessibility measures.

Analyzing the Spatial Accessibility of Public Healthcare Services in Djibouti

Ensuring access to healthcare for all, regardless of demographic, geographic, or socio-economic status, is essential for achieving universal health coverage. In Sub-Saharan Africa, where populations are often dispersed and healthcare services are limited, reducing distances or travel time to healthcare facilities is crucial for ensuring equitable access. This study examines the geographical access to public health services in Djibouti, highlighting the inequality in the distribution of medical infrastructure, especially for rural populations. The primary objective is to analyze spatial disparities in accessibility to public health facilities, identifying the least-served districts and proposing solutions to reduce these inequalities. Using the enhanced two-step floating catchment area (E2SFCA) method, the research evaluates spatial access. Data collected from the Ministry of Health of Djibouti show a high concentration of health services in the city of Djibouti, where more than 50% of the population resides. In contrast, inland districts such as Galafi and Moussa Ali display limited access, with travel times often exceeding 60 minutes, indicating an inequitable distribution of tertiary care facilities. Strengthening healthcare infrastructure in inland districts and deploying innovative solutions like mobile clinics and telemedicine are essential to reducing access inequalities and ensuring more equitable universal health coverage in Djibouti. Future research should assess the effectiveness of these interventions in sustainably improving healthcare access in the most vulnerable areas.

An Approach for Measuring Spatial Accessibility to Services/Facilities by Urban Community Aged Population

Abstract. Population aging is a global trend and a world-wide challenge to many governments. The high-quality life of the elderly cannot be separated from the support of basic services and facilities. Therefore, it is necessary to conduct analysis and research on the accessibility of urban community services and facilities. It is worth noting that the research in this article is based on master thesis (Bai, 2013). Drawing on the data, methods, and conclusions from the master's thesis, in this paper, an approach is designed for measuring spatial accessibility to services/facilities by a spatially dispersed ageing population in urban areas. The local government area (LGA) of Monash in the Melbourne metropolitan area has been selected the case study area. This study combines GIS-based spatial analytical procedures and two-step floating catchment area (2SFCA) method, in conjunction with mesh block level 2011 population data, service/facility data and transportation network data, to measure and map spatial variations in potential accessibility to services and facilities deemed essential to the aged population. Service facilities considered in the study include bus stops, train stations, bank facilities, shopping centres, post offices, churches, parks, public libraries, community centres, pharmacies, GP clinics and hospitals in Monash LGA. The research results can be used to optimize the spatial planning and layout of public facilities for ageing population.

Access to bus services: an analysis of the influence of land use types

ABSTRACT During travel, commuters are naturally influenced by built environment factors, particularly land use types. However, the existing literature overlooks this impact and neglects the application of the adjusted Gaussian two-step floating catchment area method in studying accessibility to metro. To analyse the influence of land use types on accessibility to transit and the nature of such influence, we employed the adjusted Gaussian two-step floating catchment area method in measuring accessibility and the entropy index in gauging land use diversity. We also deduced the changes in accessibility scores to capture the effects of land use types. Additionally, we examined the differences in the bus and metro accessibility scores to clarify the influence of each mode. The accessibility scores in the study area were influenced by the land use types within it, and this influence was significant in the core administrative districts. These findings will support policymakers in land use and public transport planning.

National-scale 1-km maps of hospital travel time and hospital accessibility in China

Ensuring equitable access to health services is crucial for public welfare and social equity, and is a key objective of the United Nations’ Sustainable Development Goals (SDGs). However, existing datasets often define hospital accessibility using travel time to hospitals in geographic dimension only, without considering the supply (hospital capacity) and demand (population distribution) dynamics. To overcome this limitation, we developed and validated a national-scale 1 km map of both hospital travel time and hospital accessibility in China. We used the Gaussian two-step floating catchment area (Ga2SFCA) model to calculate hospital accessibility, incorporating hospital capacity and service population. Various file types and statistical indicators are provided, making the dataset highly accessible for non-specialists. The dataset fills the gap in publicly available nationwide hospital accessibility data for China and can serve as a critical tool in optimizing resource allocation and developing targeted strategies to improve healthcare equity.

Urban and rural disparities in general hospital accessibility within a Chinese metropolis

Accessibility is one of the crucial criteria for measuring the ease of access to public services in a region. Given China’s historical rural–urban dualism and rapid urbanization process, there exist significant disparities in public services within metropolises. This study selects Nanjing as a representative metropolis and employs the Gaussian two-step floating catchment area method and an improved potential model to calculate the accessibility of comprehensive hospitals. Spatial autocorrelation and urban–rural disparities are analyzed, confirming spatial variations in healthcare service equity. The results show that: ①The spatial variability of accessibility to comprehensive hospitals is significant. The Gaussian two-step floating catchment method overestimates overall accessibility, and for Nanjing, the improved potential model with β = 1.5 proves more suitable. ②Accessibility exhibits pronounced clustering characteristics. Healthcare conditions for residents in the northern part of Liuhe District, eastern part of Qixia District, western part of Pukou District, peripheral areas of Jiangning District, eastern part of Gaochun District, and residents in Lishui District need improvement. ③Comprehensive healthcare services are relatively lacking in nearly 60% of rural areas. Our research findings provide valuable insights for improving spatial justice in public infrastructure in metropolises of developing countries.

How Green Space Justice in urban built-up areas affects public mental health: a moderated chain mediation model.

Green and blue spaces, as crucial components of urban ecosystems, significantly impact the physical and mental health of residents. However, the mechanisms through which Green/Blue Space Justice influence residents' health remain unclear. This study aims to explore the impact of green spaces on public psychological responses, physical activity, and mental health from a justice perspective, and to examine the moderating role of blue spaces in this relationship. The research was conducted in selected communities within the Chang-Zhu-Tan urban agglomeration in Hunan Province, China. A total of 801 valid questionnaires were collected through field visits and online surveys. The study uses an improved Gaussian-based two-step floating catchment area (2SFCA) method to assess green space accessibility. Data were analyzed using structural equation modeling (SEM) and moderation effect analysis to reveal the relationships between variables. The findings indicate that Green Space Justice has a significant positive impact on psychological responses, physical activity, and mental health; psychological responses and physical activity play crucial mediating roles between Green Space Justice and mental health; and Green Space Justice significantly affects mental health through a chain mediation path involving psychological responses and physical activity. Moreover, Blue Space Justice significantly moderates the impact of Green Space Justice on psychological responses and physical activity, but does not have a significant direct impact on mental health. This study enriches the theory of Green Space Justice by revealing the mechanisms through which it influences mental health via psychological responses and physical activity. It provides a scientific basis for the development of healthy cities. Additionally, it recommends that urban planning should prioritize the equitable distribution and high accessibility of both green and blue spaces to comprehensively enhance residents' physical and mental well-being. Policymakers should consider prioritizing the accessibility of high-quality green spaces for vulnerable communities during urban renewal and expansion processes to reduce social health inequalities and promote broader public health outcomes.

Measuring and optimizing the spatial accessibility of primary health care in remote and rural areas: a case study of Liannan Yao Autonomous County in China

The need for equitable access to primary healthcare services in the current global context has attracted widespread attention, prompting nations to continuously enhance their grassroots medical service levels. In response, China launched the "Healthy China" initiative, which prioritizes the enhancement of national health as a core goal of the healthcare system and uses this opportunity to deepen reforms aimed at strengthening primary care. However, in remote and rural areas, the optimization of medical resource allocation and the achievement of balanced service development remain critical challenges owing to limited resources. This study selected Liannan Yao Autonomous County, which is situated in the northwestern corner of Guangdong Province, as a case study due to its remote mountainous location, underdeveloped economy, and minority region characteristics. Through field research and interviews, this study thoroughly explored the needs of both supply and demand, factoring in elements such as the service capability of healthcare facilities and residents' travel thresholds to enhance the two-step floating catchment area model, thus making it more applicable to remote villages. By integrating electric bikes and cars, which are the primary means of transportation in rural areas, this study conducted a thorough analysis and comparison of the accessibility of medical services in Liannan Yao Autonomous County (Liannan County) . The results reveal significant disparities in healthcare accessibility, an uneven distribution of medical resources, and varying impacts of transportation conditions and facility service capabilities on accessibility. Notably, the study revealed that improving transportation conditions alone has limited effects in rural areas; the key lies in balancing medical service capabilities and the rationality of overall layouts. From the perspectives of equity and efficiency, this study employs the equitable coverage model and the efficiency-driven model to construct two scenarios, comparing accessibility changes in Liannan County under both conditions and proposing strategies to improve the spatial layout of local healthcare facilities. This research not only deepens the understanding of healthcare service accessibility in rural areas but also provides a scientific basis for optimizing resource allocation and enhancing primary medical services, offering valuable guidance and reference for Liannan County and other similar rural regions.

A Case Study on Children’s Accessibility in Urban Parks in Changsha City, China: Developing an Improved 2SFCA Method

As countries develop, the challenge of providing access to the outdoors and nature increases. Consequently, recent environmental justice research has focused on measuring children’s access to parks. The results of these analyses better reflect differences in accessibility, but there are discrepancies between different accessibility models. This study aims to explore child-friendly accessibility measures and proposes a supply–demand-improved two-step floating catchment area (2SFCA) method for estimating urban park accessibility based on children’s needs. The application of this improved 2SFCA method in Changsha City successfully identified areas with unequal park accessibility, offering valuable insights for urban planners, that can be used to promote equitable access to green spaces for all residents, especially children. The results demonstrate that park accessibility in Changsha City exhibits significant differences across various areas, with the lowest accessibility in the western part of Furong District, the northwestern part of Yuhua District, and the southern part of Tianxin District; while the highest accessibility is found in Yuelu District. The limited green space in the central business district of Changsha City, coupled with high population density, indicates a tension between green space planning and population density in the city’s central area. The study proposes that the primary challenge in current green space planning in Changsha is the rational allocation of green spaces to meet the needs of high-density populations within limited urban space. It provides a comprehensive and realistic perspective for understanding the accessibility and availability of green spaces for children, which can help urban planners develop effective policies to support children’s outdoor mobility, while considering equity.

Research on the Evaluation of an Age-Friendly Layout of Medical Service Facilities in Wuhan City Based on Accessibility

Accessibility is an important indicator for measuring the level of medical facility services in cities. Traditional studies on healthcare accessibility for the elderly have typically focused on the capabilities of emergency services while overlooking the daily independent healthcare needs of the elderly. Taking Wuhan City as an example, the Gaussian two-step floating catchment area method is used in this study to measure the accessibility of urban elderly residents with respect to general hospitals, specialized hospitals, and community health service centers. It also analyzes the appropriateness of the medical facility layout for the elderly in Wuhan City. The research findings indicate the following: (1) The accessibility evaluation method for urban medical facilities established with the Gaussian two-step floating catchment area model can accurately assess the supply–demand relationship between the elderly and various levels of medical facilities. (2) The overall coverage of medical service facilities in Wuhan City is relatively high, but there are significant differences in accessibility for elderly residents in different areas. (3) The appropriateness of daily healthcare access for elderly residents in the central urban areas of Wuhan City is mainly influenced by the layout of general hospitals, while, in the peripheral areas, it is mainly influenced by the layout of specialized hospitals and community health service centers. (4) Improving the appropriateness of urban medical facilities for elderly individuals requires differentiated improvement measures tailored to the characteristics of different zones.

A Spatial Accessibility Study of Public Hospitals: A Multi-Mode Gravity-Based Two-Step Floating Catchment Area Method

The multi-modal two-step floating catchment area (MM-2SFCA) method is an extension of the two-step floating catchment area (2SFCA) method that incorporates the impact of different transportation modes, thereby facilitating more accurate calculations of the spatial accessibility of public facilities in urban areas. However, the MM-2SFCA method does not account for the impact of distance within the search radius on supply–demand capacities, and it assumes an idealized supply–demand relationship. This paper introduces the gravity model into the MM-2SFCA method, proposing a multi-modal gravity-based 2SFCA (MM-G2SFCA) method to better account for distance decay and supply–demand relationships. Furthermore, a standardized gravity model is proposed based on the traditional gravity model. This model imposes constraints on upper and lower limits for distance decay weights without compromising the fundamental curve characteristics of the gravity model, thereby avoiding extreme weight scenarios. The accessibility of public hospitals in Shenzhen is evaluated through the integration of basic geographic information data, resident travel data, and official statistical data. The findings demonstrate that the standardized gravity model effectively addresses the issue of excessively high local distance weights in the traditional gravity model, making it more suitable as a distance decay function. The MM-G2SFCA method improves the consideration of distance and supply–demand relationships, thereby facilitating a more rational distribution of accessibility on a global scale. This study discovers differences in the spatial allocation of public hospital resources across the Shenzhen’s districts. Accessibility within the metropolitan core is significantly higher than that outside the core. Additionally, there is a notable difference in the level of accessibility among the districts. Accessibility is found to be better in district centers and along the main traffic arteries.

Spatial accessibility of home visiting nursing: An exploratory ecological study.

Japan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community-based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities. We estimated the population-weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two-step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables. The PWSAI was median 9.0 [interquartile range: 6.2-11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp(β) and 95% credible interval were 1.043 [1.015-1.076] and 1.021 [1.006-1.036], respectively. The PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.

Analysing the intra and interregional components of spatial accessibility gravity model to capture the level of equity in the distribution of hospital services in Italy: do they influence patient mobility?

BackgroundAn equal distribution of hospital structures represents an important factor to achieve Universal Health Coverage. Generally, the most diffused approach to measure the potential availability to healthcare is the provider-to-population ratio based on the number of beds or professionals. However, this approach considers only the availability of resources provided at regional or local level ignoring the spatial accessibility of interregional facilities that are particularly accessed by patients living at the borders. Aim of this study is to outline the distribution of the intra and interregional services in Italy to capture the level of equity across the country. Moreover, it explores the impact of the accessibility to these resources on interregional patient’s mobility to receive care.MethodsTo compute spatial accessibility, we propose an alternative approach that applies the enhanced two-step floating catchment area (ESFCA) to capture the level of attraction of intra and interregional hospitals to a given population. Moreover, the adoption of process and outcome indices captured to what extent the quality of structures influenced patients in choosing services located inside or outside their region of residence.ResultsThe study confirms that there is an unequal distribution of high-quality resources at regional and national level with a high level of inequality in the availability and accessibility of quality resources between the north and south part of Italy. This is particularly true considering the accessibility of intraregional resources in the southern part of the country that clearly influences patient choice and contribute to a significant cross border passive mobility to northern regions. This is confirmed by an econometric model that showed a significant effect of spatial accessibility with the propensity of patients of travel from the region of residence to receive care.ConclusionsThe analysis of intra and interregional components of spatial accessibility may contribute to identify to what extent patients are willing to travel outside their region of residence to access to care services. Moreover, it can contribute to gain a deeper understanding of the allocation of health resources providing input for policy makers on the basis of the principles of service accessibility in order to contain patient mobility.

Spatiotemporal trends and geographic disparities in spatial accessibility to maternal and child health services in Nanning, China: impact of two-child policies

BackgroundChina’s family planning policies have experienced stages of one-child policy, partial two-child policy, and universal two-child policy. However, the impact of these policy shifts on the spatial accessibility to maternal and child health (MCH) services for women and children remains uncertain. This study aimed to evaluate the spatiotemporal trends and geographic disparities in spatial accessibility to MCH services in the context of two-child polices.MethodsThis study was conducted in Nanning prefecture, China, from 2013 to 2019. Data on the transportation networks, MCH institutes, the annual number of newborns, and the annual number of pregnant women in Nanning prefecture were collected. Gaussian two-step floating catchment area (Ga2SFCA) method was employed to measure the spatial accessibility to MCH services at county, township, and village levels. Temporal trends in spatial accessibility were analyzed using Joinpoint regression analysis. Geographic disparities in spatial accessibility were identified using geographic information system (GIS) mapping techniques.ResultsOverall, the spatial accessibility to MCH services showed an upward trend from 2013 to 2019 at county, town, and village levels, with the average annual percent change (AAPC) being 5.04, 4.73, and 5.39, respectively. Specifically, the spatial accessibility experienced a slight downward trend during the period of partial two-child policy for both parents only children (i.e., 2013–2014), a slight upward trend during the period of partial two-child policy for either parent only child (i.e., 2014–2016) and the early stages of universal two-child policy (i.e., 2016–2018), and a large upward trend in the later stages of universal two-child policy (i.e., 2018–2019). Spatial accessibility to MCH services gradually decreased from central urban areas to surrounding rural areas. Regions with low spatial accessibility were predominantly located in remote rural areas.ConclusionWith the gradual opening of the two-child policies, the spatial accessibility to MCH services for women and children has generally improved. However, significant geographic disparities have persisted throughout the stages of the two-child policies. Comprehensive measures should be considered to improve equity in MCH services for women and children.

An Equity Evaluation of Healthcare Accessibility across Age Strata Using the G2SFCA Method: A Case Study in Karamay District, China

Equitable access to healthcare services is essential for residents’ well-being and social equity, requiring the rational spatial distribution of healthcare facilities in urban planning. Compared with major studies on the spatial accessibility and equity of healthcare services in first-tier cities, second-tier cities, which form the foundational structure of the global urban system, have not be given sufficient attention. Therefore, this study takes Karamay District in Karamay as a case study to analyze the spatial equity of healthcare services using place-based accessibility measures. For accessibility calculations, we employ the Gaussian two-step floating catchment area method to separately analyze the accessibility to hospitals and primary healthcare (PHC) institutions, considering factors such as the number of facilities, population, distance, and transportation modes. Second, we utilize global and local Moran’s I for spatial analysis to identify areas with varying levels of accessibility. Furthermore, considering the spatial equity for different social groups, this study innovatively proposes an analytical framework for assessing healthcare accessibility and equity across age groups using residential-level data and an adjusted search radius in second-tier cities, typically those with small-scale urban areas. The results reveal significant spatial clustering in healthcare accessibility, similar to that observed in most first-tier cities, as well as notable differences in the spatial distribution between hospital accessibility and PHC accessibility. Regarding age strata, results show that the elderly have lower access to hospitals but higher access to PHC institutions, which is opposite to the situation observed for children. Overall, second-tier cities demonstrate better equity in healthcare accessibility compared to first-tier cities, particularly regarding hospital accessibility. However, there are minor inequities in PHC accessibility for children aged 0–12 years. Our findings may provide valuable insights and essential data support for healthcare resource allocation and land use planning in second-tier cities.

From space to service: Measuring the accessibility in a space-time heterogeneity perspective

Accessibility has been identified as the primary motivating factor for the use of daily service facilities. Existing methods for measuring the accessibility of service facilities primarily focus on location accessibility, while little research extends it to service accessibility, which includes both reaching the location and obtaining the services. This paper proposes a novel approach to measuring service accessibility, termed the Space-Time Heterogeneous Gaussian Two-Step Floating Catchment Area (STH-G2SFCA). Firstly, a fine-grain heterogeneity analysis of service accessibility is constructed based on the supply-demand relationship. Secondly, a space-time search strategy is proposed with a Gaussian distance attenuation function, optimized by the decay rate of service attraction. Lastly, we introduce a supply-demand score and the Global Moran's index to assess the space-time patterns of service accessibility. A case study is conducted in the central urban area of Wuhan, China, with catering facilities as an example. The experimental results show that the STH-G2SFCA method can more precisely assess service accessibility, which is often overestimated in classic methods, and capture the temporal dynamics process of service accessibility within a day. The proposed method promises to be replicated in other service facilities, providing urban planners with a valuable tool for digital planning.