Planning toward Equal Accessibility to Services: A Quadratic Programming Approach

Evaluating the spatial accessibility and spatial layout optimization of HIV/AIDS healthcare services in Shandong Province, China

Improving access to HIV/AIDS healthcare services is of great concern to government and policymakers striving to strengthen overall public health. How to reasonably allocate HIV/AIDS healthcare resources and maximize the equality of access to healthcare services across subdistrict areas has become an urgent problem to be solved. However, there is limited research on this topic in China. It is necessary to evaluate spatial accessibility to improve the accessibility and equity of HIV/AIDS healthcare services. In this study, the improved multi-modal two-step floating catchment area (2SFCA) and inverted 2SFCA (i2SFCA) methods are used to measure the spatial accessibility of HIV/AIDS healthcare services and the crowdedness of the healthcare sites in Shandong Province, China. Then, the theoretical supply and the optimal spatial distribution of resources are calculated and visualized by minimizing the accessibility gaps between demand locations. This study showed that the spatial accessibility of HIV/AIDS service resources in Shandong Province was concentrated and unevenly distributed, and the accessibility scores in the marginal areas of prefecture-level cities were significantly lower than those in other areas. Regions with a large number of doctors had significantly higher levels of spatial accessibility. The ART accessibility scores in the southwest of Shandong Province were higher than those in other regions. As the travel friction coefficient increased, the accessibility scores formed an approximately circular cluster distribution centered on the healthcare sites in geographical distribution. More ART drugs needed to be supplied in marginal areas and more doctors were needed to work on HIV/AIDS in urban areas to address the spatial distribution imbalance of HIV/AIDS healthcare services. This study profoundly analyzed the spatial accessibility of HIV/AIDS healthcare services and provided essential references for decision-makers. In addition, it gives a significant exploration for achieving the goal of equal access to HIV/AIDS healthcare services in the future.

Location-allocation modelling for rational health planning: Applying a two-step optimization approach to evaluate the spatial accessibility improvement of newly added tertiary hospitals in a metropolitan city of China

The inequity of access to healthcare services is still one of the most long-lasting problems confronted by worldwide countries. Under such context where maldistributed healthcare resources have posed huge challenges in achieving cross-regional efficiency and equity of healthcare services, rational allocation of newly added healthcare resources has become rather critical to policy makers. To address this issue, we applied a two-step optimization approach to investigate the spatial allocation of newly added tertiary general healthcare resources in Chengdu, a metropolitan city of China. The case study of Chengdu was utilized as an example to illustrate the feasibility of such spatial optimization approach in practice in terms of supporting regional health planning related decision-making procedures in China, as well as evaluating the performance of healthcare resource allocation related strategies actually implemented. Using current and historical health planning data, we sought to optimize tertiary general hospitals' locations to maximize population coverage of healthcare services in the first step, and to achieve equitable access to healthcare services among different residential locations via assigning the capacity (beds) to each hospital in the second step. Results suggested that the spatial optimization of newly added healthcare resources would theoretically enhance both efficiency and equity substantially. Specifically, if implemented in practice, such optimized spatial allocation of healthcare resources would theoretically contribute to improved efficiency as reflected by a 5% increase and a 15% increase in population coverage and the weighted median value of spatial accessibility, respectively. In addition, this would contribute to achieve enhanced equity as reflected by a 27% decrease in the weighted standard deviation of spatial access. These findings are anticipated to offer valuable policy implications to inform the spatial allocation decisions of healthcare resources in China as well as other countries confronted with similar challenges, and the two-step optimization approach could be applied to facilitate future rational health plannings.

Optimal allocation of physicians improves accessibility and workload disparities in stroke care

BACKGROUND

Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload.

METHODS

This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists.

RESULTS

The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities.

CONCLUSIONS

The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.

Assessment of the supply/demand balance of medical resources in Beijing from the perspective of hierarchical diagnosis and treatment

Considering the United Nations' Sustainable Development Goals (SDGs) and the need for a balanced spatial distribution of urban medical resources capable of perspective of hierarchical diagnosis and treatment, i.e. providing continuous and accessible medical services during potential public health emergencies, we assessed accessibility and service capacity of the three hospital levels in Beijing. Using geographical information systems (GIS) and the two-step floating catchment area method with the street as research unit, we found that there is an over-supply of medical resources in the centre of the city with weaker support in the peripheral areas as manifested by less supply in relation to popular demand of medical services. The spatial distribution of hospitals at all levels and their resources was found to be uneven: 82.4% of the residents can reach a tertiary hospital (a hospital offering advanced specialized medical and health services to multiple regions) within a 15-minute drive; 50.6% can reach a secondary hospital (a hospital offering comprehensive medical and health services to various communities) within a 10-minute drive; and 77.6% can reach a primary hospital (a hospital directly delivering prevention, medical treatment, healthcare, and rehabilitation services to the community of a certain population) within a 15- minute walk. It was noted that the supply/demand balance of medical resources in the tertiary hospitals decreases from the centre to the periphery, while the secondary hospitals show a dual-centre pattern and the primary hospitals a more uneven distribution, with oversupply in the East and the opposite in the Centre. The results of the study provide supplementary decision support for improving the hierarchical diagnosis and treatment system and accelerate the overall deployment of medical resources.

Spatial Accessibility Evaluation and Location Optimization of Primary Healthcare in China: A Case Study of Shenzhen

The unbalanced allocation of healthcare resources is a major challenge that hinders access to healthcare. Taking Shenzhen as an example, this study aimed to enhance equity in obtaining healthcare services, through measuring and visualizing the spatial accessibility of community healthcare centers (CHC), and optimizing CHC geospatial allocation. We used the number of health technicians per 10,000 to represent the CHC's service capacity, combined with resident points and census data to calculate the population the CHC needs to carry, and then analyzed the accessibility based on the Gaussian two-step floating catchment area method. In 2020, five regions in Shenzhen had better spatial accessibility scores: Nanshan (0.250), Luohu (0.246), Futian (0.244), Dapeng (0.226), and Yantian (0.196). The spatial accessibility of CHCs shows a gradual decrease from the city center to the edge, which is affected by economic and topographic factors. With the support of the maximal covering location problem model, we selected up to 567 candidate locations for the new CHC, which could improve Shenzhen's accessibility score from 0.189 to 0.361 and increase the coverage population by 63.46% within a 15-min impedance. By introducing spatial techniques and maps, this study provides (a) new evidence for promoting equitable access to primary healthcare services in Shenzhen and (b) a foundation for improving the accessibility of public service facilities in other areas.

Supply-demand balance and spatial distribution optimization of primary care facilities in highland cities from a resilience perspective: A study of Lhasa, China

Introduction

The development of urban resilience, which is fundamentally a balance between the supply capacity of primary care resources and the demand from urban residents, includes an appropriate architecture of primary care facilities. Resilient city construction in highland areas is hampered by the physical environment and transportation constraints and frequently encounters issues like poor accessibility and unequal distribution of primary care facilities.

Methods

To optimize the supply and demand of primary care resources in highland cities and effectively improve the resilience of urban public health, this paper assesses the distribution of primary care facilities within the built-up area of Lhasa (China) through a spatial network analysis method based on GIS, combined with population distribution data, and employs a location-allocation model to optimize the distribution.

Results

Firstly, the overall supply of primary care exceeds the overall demand, but the facilities' service area can only accommodate 59% of the residences. Secondly, there is a clear spatial variation in the accessibility of primary care facilities, and the time cost of healthcare is too high in some residences. Thirdly, the supply-demand relationship of primary care facilities is unbalanced, with both over-saturated and over-deficient areas.

Discussion

After distribution optimization, the coverage and accessibility of primary care facilities have increased significantly, and the spatial imbalance of supply and demand has been alleviated. This paper proposes a research method to evaluate and optimize the spatial distribution of primary care facilities from multiple perspectives based on the resilience theory. The results of the study and visualization analysis methods can be used as an invaluable reference for planning the distribution of urban healthcare facilities and urban resilience construction in highland areas and other underdeveloped areas.

Extending floating catchment area methods to estimate future hospital bed capacity requirements

A new hospital in north-west Sydney, Australia is to start construction in the year 2023. However, the number of emergency department beds/treatment spaces (EDBs) that it will contain is yet to be determined, as this region is expected to have relatively high population growth from year 2021 to year 2036. In this paper, floating catchment area (FCA) methods were employed to estimate the required number of EDBs for this new hospital. Metrics including spatial accessibility index and spatial equity were calculated based on the predicted populations for 2021 and 2036 using government sourced data. Specifically, potential spatial accessibility and horizontal spatial equity were employed for this paper. Mathematical optimisation was used to determine the most efficient distribution of EDBs throughout different hospitals in this region in 2036. The best allocation of capacity across the study area that simultaneously improved average spatial accessibility and improved spatial equity relative to the metrics of 2021 was found. Traditional methods of healthcare planning seldom consider the spatial location of populations or the travel cost to hospitals. This paper presents a novel method to how capacity of future services are determined due to population growth. These results can be compared to traditional methods to access the validity of the methods outlined in this paper.

Measuring spatial accessibility and supply-demand deviation of urban green space: A mobile phone signaling data perspective

The reasonable distribution of urban green space (UGS) is a topic that urban researchers have been exploring for a long time. Solving the imbalance between the supply and demand of UGS plays an important role in improving the health level of a city. This study examines the central urban area of Hefei as an example. We developed a modified Gaussian two-step floating catchment area method and used the path planning model of Gaode Map to evaluate the accessibility of UGS under different transportation modes and different time thresholds while integrating mobile phone signaling data. Additionally, a fine-scale analysis of the actual supply and demand relationship of UGS was conducted by integrating the accessibility evaluation results with the recreational situation of UGS to analyze the deviation of supply and demand to further discuss the spatial distribution equilibrium of UGS. The main conclusions are as follows. (1) The spatial distribution of UGSs in the central urban area of Hefei is uneven. Different time thresholds and different transportation modes have a significant impact on the UGS accessibility evaluation results. (2) With the increase in the time threshold or travel distance, the number of grids above the moderate accessibility level generally increases. The spatial distribution of the grids with moderate, high and highest accessibility level present different patterns of contiguous, clusters, and spots distribution. (3) After combining these results with the actual recreational situation of UGS, we found that the overall demand in the central urban area exceeds the supply at the 15-min threshold, while the overall supply exceeds the demand at the 30-min threshold. The grids with balanced supply and demand or more supply than demand have comprehensive parks with a moderate population density and strong road connectivity in the neighborhood. This study strengthens the data granularity and improves the accuracy of accessibility evaluation by integrating mobile phone signaling data with the path planning model of Gaode Map. Also, we evaluate the accessibility with multi-transport modes and different time thresholds, which can bring more practical guidance for optimizing the distribution of UGS.

Supply-demand matching of medical services at a city level under the background of hierarchical diagnosis and treatment - based on Didi Chuxing Data in Haikou, China

BACKGROUND

Implementation of the Healthy China Strategy and the hierarchical diagnosis and treatment system has injected new vitality into medical services. Given the insufficient supply of medical services and increasing demand for medical treatment, exploring the supply-demand pattern of medical services has become an urgent theoretical and practical problem to be solved. The equity of healthcare facilities has received widespread attention, but due to limited data, there is little research on the supply-demand pattern of medical services. This study focuses on evaluating the supply-demand matching pattern of medical services at different levels in Haikou City with big geographic data and promoting the realization of a balance between medical supply and demand.

METHODS

This study utilizes spatial data of medical institutions, Didi Chuxing Data, and population density data. Firstly, use the two-step floating catchment area method and GIS spatial analysis to explore characteristics of the supply-demand patterns of medical services at different levels in Haikou. Secondly, we mine residents' demand for medical treatment based on Didi Chuxing Data. Then combined with population density data, divide supply-demand matching of medical institutions into four types. Finally, propose optimization strategies for the problems.

RESULTS

The accessibility pattern of high-level medical institutions in Haikou presents high in the north and low in the south. The accessibility pattern of low-level medical institutions is the opposite. High-level medical institutions have a strong demand for medical treatment, which is less hampered by distance. The healthcare demand of low-level medical institutions is small, and they mainly are medium- and short-distance medical travel. The types of medical services at different levels are mainly "low supply - low demand" and "high supply - low demand" types.

CONCLUSIONS

Medical services at different levels in Haikou are mainly in supply-demand imbalance. Therefore, we put forward optimization strategies to promote the equity of primary medical services, such as propelling the establishment and improvement of the hierarchical diagnosis and treatment system, building a new model of medical and health service supply, and strengthening balanced coverage of primary medical institutions. The mining of big geographic data is beneficial to alleviate the mismatch between medical supply and demand, although the data and methods need to be improved.

Examining the Spatial Coordination between Metrorail Accessibility and Urban Spatial Form in the Context of Big Data

Metrorail accessibility is an important indicator that influences urban spatial form. For this article, we created a 3SFCA method to analyze the Metrorail accessibility of Shanghai covering four levels: traffic analysis zones (TAZs), stations, metrorail network, and regions. The floor area ratio (FAR) was used to reflect the urban form, and spatial coordination model was introduced to examine the spatial balance between metrorail accessibility and urban forms. Results revealed that the spatial distribution of metrorail accessibility and urban form are characterized by a monocentric spatial structure, while the values of both variables decrease gradually from urban center to suburban regions, with the regional difference being significantly greater than the other three levels. The results also indicated that the development of metrorail stations has a time lag effect on the urban spatial form, and the catchment area of a metro station shows characteristics of gradually expanding and then shrinking from city center to suburban regions. Finally, the results showed that there is a strong coordination between accessibility and urban form around metro stations, but the coordinate degree varies by regions. Thus, we concluded that station density should be increased within the fourth ring, FAR should be increased between the second and third rings, and rail transit capacity in the urban center area should be increased.

An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China

Spatial accessibility to medical services (SAMS) is one of the most important indicators to examine the convenience for people to get access to medical services. In China, the difficulty in getting access to medical services is a commonly appreciated social problem. To mitigate this problem, Chinese government established the hierarchical diagnosis and treatment system (HDTS) in 2005. However, there is no existing study to examine the HDTS from the perspective of SAMS. This paper therefore introduces an integrative method to analyze SAMS in adopting HDTS. The introduced integrative method is developed by referring to the existing 2SFCA method, a commonly applied method for analyzing SAMS, and the characteristics of HDTS are taken into consideration. The application of the integrative method is demonstrated with reference to a Chongqing case. The research findings suggest that: 1) A new method to evaluate SAMS in the context of HDTS is needed; 2) The integrative method developed in this study is proven effective for analyzing SAMS in the context of HDTS through the case study; 3) The case results reveal that the implementation of HDTS can significantly improve the overall SAMS performance in Chongqing; 4) The desirable referral rate of HDTS is 1.24% in the case study by comparing the SAMS performance between different referral rates.

Spatial Optimization of Residential Care Facility Configuration Based on the Integration of Modified Immune Algorithm and GIS: A Case Study of Jing'an District in Shanghai, China

As the population is aging rapidly, the irrationality of residential care facility (RCF) configuration has impacted the efficiency and quality of the aged care services so significantly that the optimization of RCF configuration is urgently required. A multi-objective spatial optimization model for the RCF configuration is developed by considering the demands of three stakeholders, including the government, the elderly, and the investor. A modified immune algorithm (MIA) is implemented to find the optimal solutions, and the geographic information system (GIS) is used to extract information on spatial relationships and visually display optimization results. Jing’an District, part of Shanghai, China, is analyzed as a case study to demonstrate the advantages of this integrated approach. The configuration rationality of existing residential care facilities (RCFs) is analyzed, and a detailed recommendation for optimization is proposed. The results indicate that the number of existing RCFs is deficient; the locations of some RCFs are unreasonable, and there is a large gap between the service supply of existing RCFs and the demands of the elderly. To fully meet the care demands of the elderly, 6 new facilities containing 1193 beds are needed to be added. In comparison with the optimization results of other algorithms, MIA is superior in terms of the calculation accuracy and convergence rate. Based on the integration of MIA and GIS, the quantity, locations, and scale of RCFs can be optimized simultaneously, effectively, and comprehensively. The optimization scheme has improved the equity and efficiency of RCF configuration, increased the profits of investors, and reduced the travel costs of the elderly. The proposed method and optimization results have reference value for policy-making and planning of RCFs as well as other public service facilities.

Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China

BACKGROUND

Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies.

METHODS

Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement.

RESULTS

The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making.

CONCLUSIONS

The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

Measuring Accessibility of Healthcare Facilities for Populations with Multiple Transportation Modes Considering Residential Transportation Mode Choice

Accessibility research of healthcare facilities is developing towards multiple transportation modes (MTM), which are influenced by residential transportation choices and preferences. Due to differences in travel impact factors such as traffic conditions, origin location, distance to the destination, and economic cost, residents’ daily travel presents different residential transportation mode choices (RTMC). The purpose of our study was to measure the spatial accessibility of healthcare facilities based on MTM considering RTMC (MTM-RTMC). We selected the gravity two-step floating catchment area method (G2SFCA) as a fundamental model. Through the single transportation mode (STM), MTM, and MTM-RTMC, three aspects used to illustrate and redesign the G2SFCA, we obtained the MTM-RTMC G2SFCA model that integrates RTMC probabilities and the travel friction coefficient. We selected Nanjing as the experimental area, used route planning data of four modes (including driving, walking, public transportation, and bicycling) from a web mapping platform, and applied the three models to pediatric clinic services to measure accessibility. The results show that the MTM-RTMC mechanism is to make up for the traditional estimation of accessibility, which loses sight of the influence of residential transportation choices. The MTM-RTMC mechanism that provides a more realistic and reliable way can generalize to major accessibility models and offers preferable guidance for policymakers.

Why Public Health Needs GIS: A Methodological Overview

The short paper provides an overview on how geographic issues have become increasingly relevant to public health research and policy, particularly through the lens of geographic information systems (GIS). It covers six themes with an emphasis on methodological issues. (1) Our health-related behavior varies across geographic settings, so should public health policy. (2) Facilities (supply) and patients (demand) in a health care market interact with each other across geopolitical borders, and measures of health care accessibility need to capture that. (3) Our health outcome is the result of joint effects of individual attributes and neighborhood characteristics, and an adequate definition of neighborhood is critical for assessing neighborhood effect. (4) Disease rates in areas of small population are unreliable, and one effective way to mitigate the problem is to construct a larger, internally-homogenous and comparable area unit. (5) Defining a scientific geographic unit for health care market is critical for researchers, practitioners, and policy makers to evaluate health care delivery, and GIS enables us to define the unit (e.g., primary care service areas, hospital service areas, and cancer service areas) automatically, efficiently and optimally. (6) Aside from various optimization objectives around "efficiency", it is as important to plan the location and allocation of health care resources toward maximum equality in health care access. Case studies are cited to illustrate each theme.

Spatial Accessibility and Social Inclusion: The Impact of Portugal's Last Health Reform

Health policies seek to promote access to health care and should provide appropriate geographical accessibility to each demographical functional group. The dispersal demand of health-care services and the provision for such services at fixed locations contribute to the growth of inequality in their access. Therefore, the optimal distribution of health facilities over the space/area can lead to accessibility improvements and to the mitigation of the social exclusion of the groups considered most vulnerable. Requiring for such, the use of planning practices joined with accessibility measures. However, the capacities of Geographic Information Systems in determining and evaluating spatial accessibility in health system planning have not yet been fully exploited. This paper focuses on health-care services planning based on accessibility measures grounded on the network analysis. The case study hinges on mainland Portugal. Different scenarios were developed to measure and compare impact on the population's accessibility. It distinguishes itself from other studies of accessibility measures by integrating network data in a spatial accessibility measure: the enhanced two-step floating catchment area. The convenient location for health-care facilities can increase the accessibility standards of the population and consequently reduce the economic and social costs incurred. Recently, the Portuguese government implemented a reform that aimed to improve, namely, the access and equity in meeting with the most urgent patients. It envisaged, in terms of equity, the allocation of 89 emergency network points that ensured more than 90% of the population be within 30 min from any one point in the network. Consequently, several emergency services were closed, namely, in rural areas. This reform highlighted the need to improve the quality of the emergency care, accessibility to each care facility, and equity in their access. Hence, accessibility measures become an efficient decision-making tool, despite its absence in effective practice planning. According to an application of this type of measure, it was possible to verify which levels of accessibility were decreased, including the most disadvantaged people, with a larger time of dislocation of 12 min between 2001 and 2011.

Evaluating Spatial Disparity of Access to Public Parks in Gated and Open Communities with an Improved G2SFCA Model

A major concern of social equity and environmental justice is whether urban green resources are equitably distributed across the compact megacities of China. Many previous studies have evaluated the disparities in park access among various social groups, but few researchers have considered the heterogeneity of the built environment in residential communities. This study revisits an increasingly popular Gaussian-two-step floating catchment area (G2SFCA) model and mainly improves its two core parameters, the comprehensive supply indicator and variable catchment, in order to realistically evaluate park accessibility under different travel modes. We choose Nanjing city, China, as the study case in which to evaluate differences in public park access with respect to gated and open communities using our improved model. Moreover, gated communities have been further divided into three categories, which represent differences in a community’s ability to provide daily physical activities, to more deeply explore disparities in public park services. The results show that (1) the spatial accessibility of parks in Nanjing city is not evenly distributed, with communities located north of the Yangtze River having inferior park accessibility; (2) residents who live in open communities are more restricted with regard to access to parks than those in gated communities, although they experience relatively small differences under the walking mode; (3) gated communities with no internal park (“club park”) enjoy better public park services; and (4) residents living in 105 open communities and 167 gated communities without a club park can be regarded as the most vulnerable groups based on the lack of park services. The results of this study can provide a scientific basis for policy makers to target specific communities of vulnerable groups for further urban park development.

The Spatial Equity of Nursing Homes in Changchun: A Multi-Trip Modes Analysis

Based on network analysis, different trip modes were integrated into an improved potential model, and the geography of the spatial equity of nursing homes in Changchun is explored in 5-min, 10-min and 15-min scenarios, respectively. Results show that: (1) trip modes have significant influence on spatial equity and that the geography of spatial equity varied with trip modes; (2) the spatial equity value in Changchun is overall kept to a very low level. Most areas in urban fringes and urban core areas belong to underserved areas, and the capacity of nursing home, travel cost and the number of seniors, are the main influencing factors; (3) the geography of spatial equity in different scenarios show a very similar ring structure; namely, the spatial equity value within the urban core and at the most urban periphery is lower than that in intermediate areas. The hot spot analysis showed that the southwest urban fringes and east of the urban core are hot spot areas, while the urban core itself has cold spot areas.

An Improved Healthcare Accessibility Measure Considering the Temporal Dimension and Population Demand of Different Ages

Healthcare accessibility has become an issue of social equity. An accurate estimation of existing healthcare accessibility is vital to plan and allocate health resources. Healthcare capacity, population demand, and geographic impedance are three essential factors to measure spatial accessibility. Additionally, geographic impedance is usually represented with a function of travel time. In this paper, the three-step floating catchment area (3SFCA) method is improved from the perspectives of the temporal dimension and population demand. Specifically, the travel time from the population location to the service site is precisely calculated by introducing real-time traffic conditions instead of utilizing empirical speed in previous studies. Additionally, with the utilization of real-time traffic, a dynamic result of healthcare accessibility is derived during different time periods. In addition, since the medical needs of the elderly are higher than that of the young, a demand weight index of demand is introduced to adjust the population demand. A case study of healthcare accessibility in Wuhan shows that the proposed method is effective to measure healthcare accessibility during different time periods. The spatial accessibility disparities of communities and crowdedness of hospitals are identified as an important reference for the balance between the supply and demand of medical resources.

Spatial accessibility to healthcare services in Shenzhen, China: improving the multi-modal two-step floating catchment area method by estimating travel time via online map APIs

BACKGROUND

Shenzhen has rapidly grown into a megacity in the recent decades. It is a challenging task for the Shenzhen government to provide sufficient healthcare services. The spatial configuration of healthcare services can influence the convenience for the consumers to obtain healthcare services. Spatial accessibility has been widely adopted as a scientific measurement for evaluating the rationality of the spatial configuration of healthcare services.

METHODS

The multi-modal two-step floating catchment area (2SFCA) method is an important advance in the field of healthcare accessibility modelling, which enables the simultaneous assessment of spatial accessibility via multiple transport modes. This study further develops the multi-modal 2SFCA method by introducing online map APIs to improve the estimation of travel time by public transit or by car respectively.

RESULTS

As the results show, the distribution of healthcare accessibility by multi-modal 2SFCA shows significant spatial disparity. Moreover, by dividing the multi-modal accessibility into car-mode and transit-mode accessibility, this study discovers that the transit-mode subgroup is disadvantaged in the competition for healthcare services with the car-mode subgroup. The disparity in transit-mode accessibility is the main reason of the uneven pattern of healthcare accessibility in Shenzhen.

CONCLUSIONS

The findings suggest improving the public transit conditions for accessing healthcare services to reduce the disparity of healthcare accessibility. More healthcare services should be allocated in the eastern and western Shenzhen, especially sub-districts in Dapeng District and western Bao'an District. As these findings cannot be drawn by the traditional single-modal 2SFCA method, the advantage of the multi-modal 2SFCA method is significant to both healthcare studies and healthcare system planning.

Measuring spatial accessibility to healthcare services with constraint of administrative boundary: a case study of Yanqing District, Beijing, China

BACKGROUND

The two-step floating catchment area (2SFCA) method, which is one of the most widely used methods for measuring healthcare spatial accessibility, defines the catchment area of each facility as the area within a certain distance from the facility. However, in some cases, the service utilization behavior is constrained by administrative boundaries, therefore the definition of catchment area within a certain distance may be inappropriate.

METHODS

In this study, we aim to propose a modification of the 2SFCA method for measuring spatial accessibility to healthcare services in a system constrained by administrative boundaries. The proposed method defines the catchment areas of healthcare facilities within certain administrative units. The method is applied in a case study of the healthcare services in Yanqing District of Beijing, China. Three types of healthcare facilities, including general hospitals, community healthcare centers and stations, are included.

RESULTS

Based on the sensitivity analysis of the distance-decay parameter β, result of the β = 1 scenario is relatively appropriate and is utilized for further analysis. The difference between spatial accessibility with or without constraint of administrative boundary is relatively significant. The results of the proposed model show that the village-level spatial accessibility to healthcare services shows a significant disparity, and the uneven distribution of general hospitals is the main cause.

CONCLUSIONS

The constraint of administrative boundary has a significant impact on healthcare accessibility, which verifies the validity of the modification proposed by this study in empirical studies. The empirical results also lead to policy recommendations to improve healthcare equity in the study area. At the town-level, the improvement of equity in healthcare accessibility could be achieved in two ways. First, the sizes of community healthcare centers in towns with small accessibility scores should be expanded. Second, new general hospitals can be built in the eastern part of Yanqing District. Within each town, to improve the equity in healthcare accessibility, community healthcare stations should be expanded or newly built in the periphery villages.

Assessing Spatial Accessibility of Public and Private Residential Aged Care Facilities: A Case Study in Wuhan, Central China

In the increasingly serious aging China, aged service is the provision of one of the most urgent and important public services to citizens, and private facilities has become an important service force with the aged service market opening in China. This study aims to explore the spatial variation in the accessibility of residential aged care facilities (RACFs) and compared the service capacity of public RACFs and private RACFs. It facilitates RACFs to be allocated rationally in the future and achieve the equalization of aged services. A village-level analysis of spatial access to public and private RACFs by the multi-catchment sizes Gaussian two-step floating catchment area (MCSG2SFCA) method was conducted through a case study in Wuhan City in Central China. The major results are as follows: (1) the accessibility of RACFs in urban areas is better than that in rural areas; (2) the public RACFs still dominate aged care services but the role of private RACFs is important as well; (3) in developed urban areas, the accessibility to private RACFs surpasses that of public ones, and the situation is opposite in rural areas; (4) the capacity of aged care services in Wuhan is not high, meanwhile there is remarkable regional disparity. The accessibility of RACFs in Wuhan is not satisfactory, and there is a significant gap between urban and rural areas. The private RACFs have significantly improved the urban capacity of aged care services, but the role in rural areas is still very weak.

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China

A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed "two-step optimization for spatial accessibility improvement (2SO4SAI)." The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.

Minimizing Spatial Variability of Healthcare Spatial Accessibility-The Case of a Dengue Fever Outbreak

Outbreaks of infectious diseases or multi-casualty incidents have the potential to generate a large number of patients. It is a challenge for the healthcare system when demand for care suddenly surges. Traditionally, valuation of heath care spatial accessibility was based on static supply and demand information. In this study, we proposed an optimal model with the three-step floating catchment area (3SFCA) to account for the supply to minimize variability in spatial accessibility. We used empirical dengue fever outbreak data in Tainan City, Taiwan in 2015 to demonstrate the dynamic change in spatial accessibility based on the epidemic trend. The x and y coordinates of dengue-infected patients with precision loss were provided publicly by the Tainan City government, and were used as our model's demand. The spatial accessibility of heath care during the dengue outbreak from August to October 2015 was analyzed spatially and temporally by producing accessibility maps, and conducting capacity change analysis. This study also utilized the particle swarm optimization (PSO) model to decrease the spatial variation in accessibility and shortage areas of healthcare resources as the epidemic went on. The proposed method in this study can help decision makers reallocate healthcare resources spatially when the ratios of demand and supply surge too quickly and form clusters in some locations.

Spatial decision on allocating automated external defibrillators (AED) in communities by multi-criterion two-step floating catchment area (MC2SFCA)

BACKGROUND

The occurrence of out-of-hospital cardiac arrest (OHCA) is a critical life-threatening event which frequently warrants early defibrillation with an automated external defibrillator (AED). The optimization of allocating a limited number of AEDs in various types of communities is challenging. We aimed to propose a two-stage modeling framework including spatial accessibility evaluation and priority ranking to identify the highest gaps between demand and supply for allocating AEDs.

METHODS

In this study, a total of 6135 OHCA patients were defined as demand, and the existing 476 publicly available AEDs locations and 51 emergency medical service (EMS) stations were defined as supply. To identify the demand for AEDs, Bayesian spatial analysis with the integrated nested Laplace approximation (INLA) method is applied to estimate the composite spatial risks from multiple factors. The population density, proportion of elderly people, and land use classifications are identified as risk factors. Then, the multi-criterion two-step floating catchment area (MC2SFCA) method is used to measure spatial accessibility of AEDs between the spatial risks and the supply of AEDs. Priority ranking is utilized for prioritizing deployment of AEDs among communities because of limited resources.

RESULTS

Among 6135 OHCA patients, 56.85 % were older than 65 years old, and 79.04 % were in a residential area. The spatial distribution of OHCA incidents was found to be concentrated in the metropolitan area of Kaohsiung City, Taiwan. According to the posterior mean estimated by INLA, the spatial effects including population density and proportion of elderly people, and land use classifications are positively associated with the OHCA incidence. Utilizing the MC2SFCA for spatial accessibility, we found that supply of AEDs is less than demand in most areas, especially in rural areas. Under limited resources, we identify priority places for deploying AEDs based on transportation time to the nearest hospital and population size of the communities.

CONCLUSION

The proposed method will be beneficial for optimizing resource allocation while considering multiple local risks. The optimized deployment of AEDs can broaden EMS coverage and minimize the problems of the disparity in urban areas and the deficiency in rural areas.

Spatial optimization of residential care facility locations in Beijing, China: maximum equity in accessibility

Background

The residential care system is rapidly developing and plays an increasingly important role in care for the elderly in Beijing. A noticeable disparity in the accessibility to existing residential care facilities, however, is demonstrated in existing studies. The spatial optimization of residential care facility (RCF) locations is urgently needed to promote equal access to residential care resources among the elderly population.

Methods

A two-step floating catchment area method with an additional distance-decay function is adopted to measure accessibility to residential care facilities. The spatial optimization model is developed to maximize equity in accessibility by minimizing the total square difference between the accessibility score of each demand location and the weighted average accessibility score. The Particle Swarm Optimization (PSO) method is implemented for the solution.

Results

The optimized RCF layouts improve equal spatial access to residential care resources with very low accessibility standard variation (0.0066). A relatively large number of beds (51% of the total beds) to be located in the suburban districts between the central and periphery districts of Beijing are optimized. A smaller number of beds to be located in the central and periphery districts (33% and 16% respectively) are optimized. The gaps between the existing and optimized layouts suggest that more RCF beds (5961 beds) are needed in suburban districts, while the RCF beds in some subdistricts located in the central and periphery districts are oversupplied (5253 and 1584 surplus beds respectively).

Conclusions

The optimized results correspond to the municipal special plan proposed by the Beijing government. The optimization objective of this study is different from traditional facility location optimization models, and the method is efficient in maximizing equal access to residential care facilities. This method can support knowledge-based policy-making and planning of residential care facilities.