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

Accessibility evaluation and multi-scenario optimization of medical services in underdeveloped city driven by multi-source data and latest policies for China

Equitable and high-quality medical services are more urgent in underdeveloped cities for the higher population ageing and demanding social justice. However, there is little attention paid to the multi-level medical services, particularly regarding the time indicators under the latest policies for underdeveloped cities. The improved efforts were hampered partly by single scenario of location optimization, ignoring the integrated optimization for both road infrastructure and institution location. Toward the healthy China 2030 and rural revitalization policy, this study systematically investigated medical services for underdeveloped cities by constructing a multi-level evaluation and multi-scenario optimization framework with Geographical Information System technology in a case study of Xuchang City in China. Following the time goals from the latest policies, the services of high-quality hospitals and primary health centers were multi-level evaluated by network analysis method and further optimized through multi-scenario involving different new multi-level medical facilities and roads. Driven by urban-rural inequalities, candidate facilities were first selected based on multi-source data and then determined by location‑allocation analysis method, while new roads were assumed by space syntax method. The improvement rose rapidly and finally slowly with the increasing number of candidates. Few new roads and facilities could be more suitable, and the priority was explored under the local economy and planning. The findings could provide valuable support for urban healthy development under the latest policies.

Spatiotemporal evolution and influencing factors of the allocation of social care resources for the older adults in China

BACKGROUND

The reasonable allocation of social care resources for the older adults is a key measure to actively respond to population aging. This study aims to evaluate the evolutionary trend, spatial differences and influencing factors of the social elderly care resources (SECR) allocation in China.

METHODS

This study constructed a comprehensive index system consisting of three dimensions: material resources, human resources and financial resources, to measure the level of SECR in mainland China. The Kernel density estimation was used to reveal the dynamic evolution trend, and Dagum Gini Coefficient and its decomposition method were used to investigate the equity of SECR allocation. Spatial panel regression models were used to analyze the influencing factors of the allocation of SECR.

RESULTS

The level of SECR is rising from 0.197 in 2013 to 0.208 in 2019. The middle-high- and high-level areas of SECR were mainly distributed in the eastern and western China. The Gini coefficient of SECR decreased from 0.262 in 2013 to 0.249 in 2019. Per capita GDP, the proportion of social welfare expenditure in GDP and the proportion of the tertiary industry in GDP have significant positive effects on the allocation of SECR. Population aging and the development of service industry exhibit significant negative spatial spillover effects on the allocation of SECR.

CONCLUSIONS

The fairness of the allocation of SECR in China has been improved, while the spatial distribution is imbalanced. Economic development, fiscal input and the development of service industry have significant positive effects while population aging has significant negative effects on the SECR allocation.

Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China

Accessibility of health services signifies the quality and equitability of universal health provision. The hierarchical medical system recently implemented in China offers the policy instruments to improve medical services to the elderly in an aging society. As the critical primary care gateway, accessibility to community hospitals has significant impacts on people's health. However, current research has paid little attention to spatial accessibility within walking distance of community hospitals, especially for the elderly. This study selected four districts with different urbanization levels in the rapidly developing Beijing metropolis. The spatial interaction model was applied to measure the accessibility of community hospitals for the elderly at the community level. An attractiveness index was computed based on key hospital traits. The results showed that: (1) community hospitals could cover 82.66% of elderly residents, and 77.63% of the communities were within walking distance. The served elderly proportion was relatively high in central urban areas and low in the suburbs. (2) The attractiveness indices of hospitals varied notably between districts, with higher values in more urbanized areas. (3) The spatial accessibility for the elderly of hospitals differed significantly between the four districts, with a descending gradient from central to suburban and rural areas, as indicated by the Gini coefficients and Lorenz curves. (4) The accessibility index was strongly related to the served elderly population and the hospital-residence distance. The findings provide policy directions to the government, including providing more primary-care resources to suburban and rural areas, building new community hospitals in identified provision gaps, upgrading some clinics to hospitals in rural areas, and planning hospitals according to the projected trend of the elderly population in terms of quantity and distribution. The considerable provision disparity between core urban, suburban and rural areas can be addressed by refined spatial health planning informed by research.

An SCM-G2SFCA Model for Studying Spatial Accessibility of Urban Parks

The urban park is the main leisure and entertainment place in residents' daily lives. The accessibility of parks is closely related to the physical and mental health of the residents. Although many scholars have conducted a great deal of research on the spatial accessibility of urban parks, they have rarely considered the supply competition among different parks and the impact of multiple travel modes on the spatial accessibility of parks. Therefore, based on Baidu map navigation data, in this paper, the park Baidu score is used to represent the competitive relationship among different parks, and the impact of multiple travel modes on the spatial accessibility of parks is considered. A supply competition and multiple travel modes Gaussian two-step floating catchment area (SCM-G2SFCA) model is established to evaluate the spatial accessibility of the parks in the Wuhou District, Chengdu, China. The results show that (1) compared with traditional methods, the SCM-G2SFCA model can obtain more accurate results using Baidu map navigation data. (2) There are obvious spatial differences in the accessibility distribution of the parks in the Wuhou District, Chengdu, with high accessibility in the south and low accessibility in the north. The Jinyang and Huaxing sub-districts in the southern suburbs have the highest park accessibility and can obtain more adequate park services. The Fangcaojie and Cujin sub-districts in the northern urban areas have the lowest park accessibility and are relatively lacking in park services. The research results of this study have important reference value for the rational planning of urban parks and the improvement of the spatial accessibility of urban parks in the Wuhou District of Chengdu and similar urban areas.

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

How Can the Layout of Public Service Facilities Be Optimized to Reduce Travel-Related Carbon Emissions? Evidence from Changxing County, China

With the developments in urbanization and motorization, travel-related carbon emissions are increasing rapidly. The layout of public service facilities (LPSF) has a direct impact on travel-related carbon emissions. However, existing public service facility planning methods focus on population, economy, and other aspects, ignoring the environmental impact. So, how do we optimize the LPSF to reduce carbon emissions? This paper proposed a method to optimize the LPSF under the constraint of travel carbon emissions. We selected medical facilities in Changxing County, China, and applied the method we proposed. We found that (1) the carbon reduction effect was significant—the total monthly emissions in Changxing were reduced by 26.10%, and the area covered by high emissions was reduced; (2) the medical facilities in Changxing under a low-carbon goal should be distributed in the county center and surrounding urban areas in a multi-center form; and (3) improving the accessibility of facilities can help to form a low-carbon facilities layout. This paper provides a spatial planning method to guide the specific locations of facilities under low-carbon goals. It also provides scientific suggestions for low-carbon land-use policies at the county level in China.

Role of Built Environments on Physical Activity and Health Promotion: A Review and Policy Insights

As urbanization and motorization continue worldwide, various health issues have emerged as a burden between individuals, families and governments at all levels. Under the prevalence of chronic disease, this review synthesizes research on the impact of the various built environments on the multiple health outcomes from a methodological and mechanistic perspective. Besides, it attempts to provide useful planning and policy implications to promote physical activity and health benefits. The finds show that: (1) Current literature has used a variety of dataset, methods, and models to examine the built environment-health benefit connections from the perspective of physical activity; (2) The prevalence of chronic diseases is inextricably linked to the built environment, and policy interventions related to physical activity and physical and mental wellbeing of urban residents should be emphasized; (3) The impact of the built environment on health is manifested in the way various elements of the physical environment guide the lifestyle of residents, thereby influencing physical activity and travel; (4) Given the changes that have occurred in the built environment during the current urban expansion, the link between urban planning and the public health sector should be strengthened in the future, and the relevant authorities should actively pursue policies that promote urban public health in order to improve the health of residents. Finally, it proposes potential policy insights for urban planning and development toward a healthier city and society.

Modeling of emergency support capacity and optimization of delivery service system for urban living materials under uncertain situations: a case study of Xi'an City during COVID-19 epidemic

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has brought a heavy burden and severe challenges to the global economy and society, forcing different countries and regions to take various preventive and control measures ranging from normal operations to partial or complete lockdowns. Taking Xi'an city as an example, based on multisource POI data for the government's vegetable storage delivery points, logistics terminal outlets, designated medical institutions, communities, etc., this paper uses the Gaussian two-step floating catchment area method (2SFCA) and other spatial analysis methods to analyze the spatial pattern of emergency support points (ESPs) and express logistics terminals in different situations. It then discusses construction and optimization strategies for urban emergency support and delivery service systems. The conclusions are as follows. (1) The ESPs are supported by large-scale chain supermarkets and fresh supermarkets, which are positively related to the population distribution.The spatial distribution of express logistics terminals is imbalanced, dense in the middle while sparse at the edges. 90% of express terminals are located within a 500 m distance of communities, however, some terminals are shared, which restrict their ability to provide emergency support to surrounding residents. (2) In general, accessibility increases as the number of ESPs increases; under normal traffic, as the distance threshold increases, the available ESPs increase but accessibility slightly decreases; with a traffic lockdown, the travel distance of residents is limited, and as ESPs increase, accessibility and the number of POIs covered significantly increase. (3) The spatial accessibility of the ESPs has a "dumbbell-shaped" distribution, with highest accessibility in the north and south, higher around the second ring road, slightly lower in the center, and lowest near the third ring road at east and west. (4) With the goal of "opening up the logistics artery and unblocking the distribution microcirculation", based on "ESPs + couriers + express logistics terminals + residents", this paper proposes to build and optimize the urban emergency support and delivery service system to improve the comprehensive ability of the city to cope with uncertain risks.

Assessing Spatial Accessibility to Primary Health Care Services in Beijing, China

Primary health care has been emphasized as a pillar of China’s current round of health reforms throughout the previous decade. The purpose of this study is to analyze the accessibility of primary health care services in Beijing and to identify locations with a relative scarcity of health personnel. Seven ecological conservation districts, which are relatively underdeveloped, were selected in the study. The Gini coefficient and Lorenz curve, as well as the shortest trip time and modified two-step floating catchment area (M2SFCA) approach, are used to quantify inequalities in primary health care resources and spatial accessibility. The Gini coefficient of primary medical services was calculated as high as 0.705, showing a significant disparity in primary care services. A total of 81.22% of communities reached the nearest primary care institution within 15 min. The average accessibility of primary healthcare services, as measured by the number of health professionals per 1000 population, was 2.34 in the 1715 communities of seven ecological conservation districts. Three hundred and ninety-one communities (22.80%) were identified with relatively low accessibility. More primary health professionals should be allocated to Miyun, Mentougou, and Changping Districts. Overall, the primary healthcare resources were distributed unevenly in most districts. According to our study, expanding primary healthcare institutions, increasing the number of competent health professionals, and enhancing road networks will all be effective ways to increase spatial accessibility and reduce primary healthcare service disparity in Beijing.

Spatial Accessibility Assessment of Prehospital EMS with a Focus on the Elderly Population: A Case Study in Ningbo, China

The spatial accessibility of prehospital EMS is particularly important for the elderly population’s physiological functions. Due to the recent expansion of aging populations all over the globe, elderly people’s spatial accessibility to prehospital EMS presents a serious challenge. An efficient strategy to address this issue involves using geographic information systems (GIS)-based tools to evaluate the spatial accessibility in conjunction with the spatial distribution of aging people, available road networks, and prehospital EMS facilities. This study employed gravity model and empirical Bayesian Kriging (EBK) interpolation analysis to evaluate the elderly’s spatial access to prehospital EMS in Ningbo, China. In our study, we aimed to solve the following specific research questions: In the study area, “what are the characteristics of the prehospital EMS demand of the elderly?” “Do the elderly have equal and convenient spatial access to prehospital EMS?” and “How can we satisfy the prehospital EMS demand of an aging population, improve their spatial access to prehospital EMS, and then ensure their quality of life?” The results showed that 37.44% of patients admitted to prehospital EMS in 2020 were 65 years and older. The rate of utilization of ambulance services by the elderly was 27.39 per 1000 elderly residents. Ambulance use by the elderly was the highest in the winter months and the lowest in the spring months (25.90% vs. 22.38%). As for the disease spectrum, the main disease was found to be trauma and intoxication (23.70%). The mean accessibility score was only 1.43 and nearly 70% of demand points had scored lower than 1. The elderly’s spatial accessibility to prehospital EMS had a central-outward gradient decreasing trend from the central region to the southeast and southwest of the study area. Our proposed methodology and its spatial equilibrium results could be taken as a benchmark of prehospital care capacity and help inform authorities’ efforts to develop efficient, aging-focused spatial accessibility plans.

Site Selection of Fire Stations in Large Cities Based on Actual Spatiotemporal Demands: A Case Study of Nanjing City

The rapid expansion of cities brings in new challenges for the urban firefighting security, while the increasing fire frequency poses serious threats to the life, property, and safety of individuals living in cities. Firefighting in cities is a challenging task, and the optimal spatial arrangement of fire stations is critical to firefighting security. However, existing researches lack any consideration of the negative effects of the spatial randomness of fire outbreaks and delayed response time due to traffic jams upon the site selection. Based on the set cover location model integrated with the spatiotemporal big data, this paper combines the fire outbreak point with the traffic situation. The presented site selection strategy manages to ensure the arrival of the firefighting task force at random simulated fire outbreak points within the required time, under the constraints of the actual city planning and traffic situation. Taking Nanjing city as an example, this paper collects multi-source big data for the comprehensive analysis, including the full data of the fire outbreak history from June 2014 to June 2018, the traffic jam data based on the Amap, and the investigation data of the firefighting facilities in Nanjing. The regularity behind fire outbreaks is analyzed, the factors related to fire risks are identified, and the risk score is calculated. The previous fire outbreak points are put through the clustering analysis, the spatial distribution probability at points in each cluster is calculated according to the clustering score, and the random fire outbreak points are generated via the Monte Carlo simulation. Meanwhile, the objective emergency response time is set as five minutes. The average vehicle speed for each road in the urban area is calculated, and the actual traffic network model is built to compute the travel time from massive randomly-distributed simulated fire points. The problem is solved by making the travel time for all simulated demand points below five minutes. At last, the site selection result based on our model is adjusted and validated, according to the planned land use. The presented method incorporates the view of the spatiotemporal big data and provides a new idea and technical method for the modification and efficiency improvement of the fire station site selection model, contributing to a service cover ratio increase from 58% to 90%.

An Improved Accessibility-Based Model to Evaluate Educational Equity: A Case Study in the City of Wuhan

Limited studies focus on educational equity from the spatial accessibility perspective. This study combines survey data and big data and proposes a multi-mode Huff two-step floating catchment area (MMH2SFCA) method to calculate accessibility while considering multiple travel modes and school attractiveness. This method can also calculate education quality by extending the accessibility in each community. Results show that our proposed method can reliably identify the accessibility differences of schools across communities. The case study indicates an inequitable distribution of educational accessibility and quality. The communities with high accessibility are concentrated in the urban center and exurban zones surrounding schools, whereas high-quality areas are mainly concentrated in the urban center. Correlation analysis suggests that the educational quality of communities with high accessibility is not always high. The findings of this study can provide improvement for accessibility measurements and help explore a new research perspective for educational equity research.

Integrating Socioeconomic Status and Spatial Factors to Improve the Accessibility of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation

Health promotion empowers people, communities, and societies to take charge of their own health and quality of life. To strengthen community-based support, increase resource accessibility, and achieve the ideal of aging, this study targets the question of maximum equity with minimum values, taking distances and spatial and non-spatial factors into consideration. To compare disparities in the accessibility of community care resources and the optimization of allocation, methods for community care resource capacity were examined. This study also investigates units based on basic statistical area (BSA) to improve the limitation of larger reference locations (administrative districts) that cannot reflect the exact locations of people. The results show the capacity redistribution of each service point within the same total capacity, and the proposed method brings the population distribution of each demand to the best accessibility. Finally, the grading system of assessing accessibility scarcity allows the government to effectively categorize the prior improvement areas to achieve maximum equity under the same amount of care resources. There are 2046 (47.26%) and 396 (9.15%) BSAs that should be improved before and after optimization, respectively. Therefore, integrating socioeconomic status and spatial factors to assess accessibility of community-based care resources could provide comprehensive consideration for equal allocation.

A SBM-DEA based performance evaluation and optimization for social organizations participating in community and home-based elderly care services

The community and home-based elderly care service system has been proved an effective pattern to mitigate the elderly care dilemma under the background of accelerating aging in China. In particular, the participation of social organizations in community and home-based elderly care service has powerfully fueled the multi-supply of elderly care. As the industry of the elderly care service is in the ascendant, the management lags behind, resulting in the waste of significant social resources. Therefore, performance evaluation is proposed to resolve this problem. However, a systematic framework for evaluating performance of community and home-based elderly care service centers (CECSCs) is absent. To overcome this limitation, the SBM-DEA model is introduced in this paper to evaluate the performance of CECSCs. 186 social organizations in Nanjing were employed as an empirical study to develop the systematic framework for performance evaluation. Through holistic analysis of previous studies and interviews with experts, a systematic framework with 33 indicators of six dimensions (i.e., financial management, hardware facilities, team building, service management, service object and organization construction) was developed. Then, Sensitivity Analysis is used to screen the direction of performance optimization and specific suggestions were put forward for government, industrial associations and CECSCs to implement. The empirical study shows the proposed framework using SBM-DEA and sensitivity analysis is viable for conducting performance evaluation and improvement of CECSCs, which is conducive to the sustainable development of CECSCs.

An integrated analysis of spatial access to the three-tier healthcare delivery system in China: a case study of Hainan Island

BACKGROUND

Access to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs).

METHODS

Hainan Island was taken as an example to explore the utilization of modern spatial access techniques under China's specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution's tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated.

RESULTS

On Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions.

CONCLUSION

Spatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.

Accessibility Assessment of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation

Equity in accessible healthcare is crucial for measuring health equity in community care policy. The most important objective of such a policy in Taiwan is empowering people and communities by improving health literacy and increasing access to healthcare resources. Using the nearest-neighbor two-step floating catchment area method, this study performed an accessibility assessment for community care resources before and after supply capacity optimization. For the target of maximum equity when allocating community care resources, taking maximum values, mean values and minimum values of the distances into consideration, three analytical allocation solutions for supply capability optimization were derived to further compare disparities in geographical accessibility. Three indicators, namely, the Gini coefficient, median minus mean and mean-squared error, were employed to assess the degree of optimization of geographical accessibility scores at the locations of the demand population and to determine the degree of geographic inequities in the allocation of community care resources. Our study proposed a method in which the minimum value of the distance is adopted as the approximate representation of distances between the service point and the locations of demand to determine the minimum value for supply capacity optimization. The study found that the method can effectively assess inequities in care resource allocation among urban and rural communities.

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.

Measuring Spatial Accessibility of Urban Fire Services Using Historical Fire Incidents in Nanjing, China

The measurement of spatial accessibility of fire services is a key task in enhancing fire response efficiency and minimizing property losses and deaths. Recently, the two-step floating catchment area method and its modified versions have been widely applied. However, the circle catchment areas used in these methods are not suitable for measuring the accessibility of fire services because each fire station is often responsible for the fire incidents within its coverage. Meanwhile, most existing methods take the demographic data and their centroids of residential areas as the demands and locations, respectively, which makes it difficult to reflect the actual demands and locations of fire services. Thus, this paper proposes a fixed-coverage-based two-step floating catchment area (FC2SFCA) method that takes the fixed service coverage of fire stations as the catchment area and the locations and dispatched fire engines of historical fire incidents as the demand location and size, respectively, to measure the spatial accessibility of fire services. Using a case study area in Nanjing, China, the proposed FC2SFCA and enhanced two-step floating catchment area (E2SFCA) are employed to measure and compare the spatial accessibility of fire incidents and fire stations. The results show that (1) the spatial accessibility across Nanjing, China is unbalanced, with relatively high spatial accessibility in the areas around fire stations and the southwest and northeast at the city center area and relatively low spatial accessibility in the periphery and boundary of the service coverage areas and the core of the city center; (2) compared with E2SFCA, FC2SFCA is less influenced by other fire stations and provides greater actual fire service accessibility; (3) the spatial accessibility of fire services is more strongly affected by the number of fire incidents than firefighting capabilities, the area of service coverage, or the average number of crossroads (per kilometer). Suggestions are then made to improve the overall spatial access to fire services.

Spatial Equity with Census Population Data vs. Floating Population Data: The Distribution of Earthquake Evacuation Shelters in Daegu, South Korea

The spatial equity of outdoor evacuation sites designated for emergency evacuation must be secured. In particular, public administrators must ensure spatial equity in preparing for unpredictable evacuation demands, such as earthquakes. This study analyzed the spatial equity of earthquake evacuation shelters in Daegu, South Korea, by using population data at the local level by time- and date-based mobile phone location data (i.e., floating population data). We compared our analysis of the spatial equity and error rate in this case with census data. Ultimately, our results demonstrate that the use of census population data can cause significant error in evaluations of the equity of evacuation shelter accessibility when the floating population data acquired through mobile phone location data are assumed exact.

Site Selection for Pre-Hospital Emergency Stations Based on the Actual Spatiotemporal Demand: A Case Study of Nanjing City, China

Rapid economic and social development has been accompanied by the occurrence of many major issues throughout the world. Specifically, there is an ever-increasing demand for emergent medical services among the public. In order to ensure timely responses to emergency demands, it is critical to reasonably configure the emergency stations. In general, emergency stations are mostly distributed according to the distribution of emergency demands and response time, which, however, fails to consider the negative impacts of randomly occurring emergency demands and traffic delays. In this study, first aid demands are combined with traffic states based on the spatiotemporal big data set covering model, which alleviates the negative impacts of randomly occurring first aid demands and traffic delay time on the planning of pre-hospital first aid stations. Moreover, the accuracy of the site selection model is improved, which meets the requirements that all randomly occurring simulated first aid demands can be approached within the target time under planning conditions and actual traffic constraints. Taking Nanjing City as an example, this study obtains multi-source big data, such as ambulance-carried GPS data from June 2018 to June 2019, Gaode Map-recorded traffic congestion data, and survey data of emergency rescue facilities. Basing on the processing and analysis of these data, it shows that first aid demands in Nanjing City are highly region-specific with high time delay. Various required factors are determined based on modeling and analysis, and the target time is agreed to be 8 min. The average vehicle speed on each road is calculated, accompanied by the establishment of an actual road network model. In this context, the transit time from the randomly distributed first aid stations to the hospital can be calculated, which are set to satisfy the model conditions so as to obtain the solution. Finally, such a solution is adjusted and verified according to the land-use situation. The results of this study, based on spatiotemporal big data, are expected to provide insights into improving the site selection model and enhancing efficiency while providing new technical methods.

Deconstructing laws of accessibility and facility distribution in cities

The era of the automobile has seriously degraded the quality of urban life through costly travel and visible environmental effects. A new urban planning paradigm must be at the heart of our road map for the years to come, the one where, within minutes, inhabitants can access their basic living needs by bike or by foot. In this work, we present novel insights of the interplay between the distributions of facilities and population that maximize accessibility over the existing road networks. Results in six cities reveal that travel costs could be reduced in half through redistributing facilities. In the optimal scenario, the average travel distance can be modeled as a functional form of the number of facilities and the population density. As an application of this finding, it is possible to estimate the number of facilities needed for reaching a desired average travel distance given the population distribution in a city.

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 Access to Medical Services in the Underdeveloped Region of Northwestern China: A Case Study in Lanzhou City

Research on the spatial access to medical services has become a hot topic in recent years. The representative provincial capital in the underdeveloped region of northwestern China, Lanzhou, was selected for the research area. In this paper, methods such as the two-step floating catchment area and ArcGIS network analysis are used to analyze the geographic spatial accessibility of medical services and differences of spatial access between urban and rural areas in Lanzhou city. The results show that 1. Areas in General and below grade of accessibility account for most of Lanzhou city. Therefore, the spatial accessibility of whole Lanzhou city is comparatively unsatisfactory. It shows a tendency of the north region to be worse than south region, and areas in parts of the main districts, parts of HG, and other tiny minority show Great grade of accessibility, and most of other areas distribute in poorer grade of accessibility, especially the surrounding mountainous region. 2. There are obvious differences in accessibility between urban and rural regions, mainly reflected in that residents and areas are basically districted in the Great and Good grade in the urban region, while almost 75% of the population and 35% of the areas are distributed in the Great and Good grade, and nearly 25% of the residents and 65% of the areas are still in the unsatisfactory accessibility grade in the rural region. According to the results, the researchers put forward corresponding suggestions to improve the current situation, which are roughly as follows: The construction of hospitals and primary health care should be strengthened in the rural region, especially the construction of township health centers and health stations. High-class hospitals are needed in Honggu district, Yongdeng county, Yuzhong county, and Gaolan county, while the medical capacity and facility grade of existing hospitals should be improved to satisfy the demand of local residents. Meanwhile, rural areas should strengthen the construction of road networks.

Multi-Mode Two-Step Floating Catchment Area (2SFCA) Method to Measure the Potential Spatial Accessibility of Healthcare Services

While great progress in the development of a methodological approach to measure the accessibility of healthcare services has been made, the exclusion of the complex multi-mode travel behavior of urban residents and a rough calculation of travel costs from the origin to the destination limit its potential for making a detailed assessment, especially in urban areas. In this paper, we aim to describe and implement an enhanced method that enables the integration of multiple transportation modes into a two-step floating catchment area (2SFCA) method to estimate accessibility. We used a travel-mode choice survey, based on distance sections, to determine the complex multi-mode travel behavior of urban residents. Taking Nanjing as a study area, we proposed complete door-to-door approaches to determine every aspect of basic transportation modes. Additionally, we processed open data to implement an accurate computing of the origin-destination (OD) time cost. We applied the enhanced method to estimate the accessibility of residents to hospitals and compared it with three single-mode 2SFCA methods. The results showed that the proposed method effectively identified more accessibility details and provided more realistic accessibility values.

Evaluating the Spatial Accessibility and Distribution Balance of Multi-Level Medical Service Facilities

Public medical service facilities are among the most basic needs of the public and are directly related to residents' health. The balanced development of medical service facilities is of great significance. Public medical service facilities can be divided into different levels according to their medical equipment, service catchment, and medical quality, which is very important but has been ignored for a long time in accessibility evaluations. In this research, based on the hospital and population datasets of Shenzhen, we propose a hierarchical two-step floating catchment area (H2SFCA) method to evaluate the spatial accessibility of public medical resources considering the factors at different levels of medical resources. In the proposed method, the spatial accessibility of each level of public medical service facilities are evaluated using different distance attenuation functions according to the medical service's scope. In addition, a measurement is proposed to evaluate the equity of medical service facilities based on accessibility and population density distributions. To synthesize the general spatial accessibility and the distribution balance of public medical service facilities, we standardize the spatial accessibility of public medical service facilities at each level and then calculate the weighted sums of the accessibility of each level. The general spatial equity of public medical service facilities is also evaluated. The results show that the accessibility and distribution balance of medical resources performs dissimilarly at the three levels and can be discriminated within different regions of the city. The accessibility of citywide medical facilities in Shenzhen decreases from the city center to the suburban area in a radial pattern and the accessibility and distribution balance in the suburban areas needs improvement.

A two-stage spatial allocation model for elderly healthcare facilities in large-scale affordable housing communities: a case study in Nanjing City

Background

As the proportion of elderly residents living in large-scale affordable housing communities (LAHCs) increases in China, serious problems have become apparent related to the spatial allocation of elderly healthcare facilities (EHFs), e.g., insufficient provision and inaccessibility. To address these issues, this study developed a location allocation model for EHFs to ensure equitable and efficient access to healthcare services for the elderly in LAHCs.

Methods

Based on discrete location theory, this paper develops a two-stage optimization model for the spatial allocation of EHFs in LAHCs. In the first stage, the candidate locations of EHFs are specified using geographic information system (GIS) techniques. In the second stage, the optimal location and size of each EHF are determined based on the greedy algorithm (GA). Finally, the proposed two-stage optimization model is tested using the Daishan LAHC in Nanjing, Eastern China.

Results

The demand of the elderly for accessibility to EHFs is in line with Nanjing’s planning standards. Deep insights into spatial data are revealed by GIS techniques that enable candidate locations of EHFs to be obtained. In addition, the model helps EHF planners achieve equity and efficiency simultaneously. Two optimal locations for EHFs in the Daishan LAHC are identified, which in turn verifies the validity of the model.

Conclusions

As a strategy for allocating EHFs, this two-stage model improves the equity and efficiency of access to healthcare services for the elderly by optimizing the potential sites for EHFs. It can also be used to assist policymakers in providing adequate healthcare services for the low-income elderly. Furthermore, the model can be extended to the allocation of other public-service facilities in different countries or regions.

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.

Equity and efficiency of medical service systems at the provincial level of China's mainland: a comparative study from 2009 to 2014

BACKGROUND

The astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery.

METHODS

A descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants.

RESULTS

The inputs and outputs of most provincial medical service systems increased gradually from 2009 to 2014. Overall, the eastern region allocated more human and capital resources than the other two regions, and produced more than 50% of the total outpatient and emergency room visits, whereas the western region produced more inpatient services (about 30% of the total volume of inpatient services) according to the distribution of the population. The average efficiency scores of the provincial medical systems in China's mainland were 0.895, 0.927, 0.929, 0.963, 0.977 and 0.968 from 2009 to 2014, with a slight average improvement of 1.60%. The efficiency score of each provincial medical service system varied greatly from one another: Tibet (1.475 ± 0.057) performed extremely well, whereas several others including Heilongjiang (0.579 ± 0.001) performed poorly. Furthermore, the proportion of high-class medical facilities was negatively associated with efficiency, whereas the proportion of the vulnerable population, the per capita Gross Domestic Product, the proportion of the illiterate population and the improvement of primary health care had positive effects on efficiency.

CONCLUSION

Inequity in health resources allocation and service provision existed across the regions, but not all the gaps have begun to narrow since 2009. The difference of efficiency was great among provincial medical service systems but minor across regions, and the score changed very little over time. More importantly, the central region held the lowest average efficiency score in the past 6 years, while the western region held the largest average efficiency score at the first 5 years, which should receive enough attention of the government and decision-makers. In practice, efficiency was related to many complicated factors, indicating that the improvement of efficiency is a complex and iterative process that requires the strong cooperation of many sectors.

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 the Allocation of Special Elderly Nursing Homes in Tokyo, Japan

Social welfare and public health departments require reliable assessments to enhance the rationality of phased construction of special elderly nursing homes (SENHs). This paper aims to assess the allocation of SENHs based on a beds-needed index for SENHs (BNIS). This may help departments determine the priority for approving locations of SENHs more accurately with a limited budget. Traditional assessments in Tokyo use the sphere of welfare, ward, and sphere of daily life as spatial units for estimating beds-to-elderly population ratios. We calculate the BNIS by introducing a parameter-improved floating catchment area method (PI-FCA) at a smaller spatial unit, the Chome. In the PI-FCA, the catchment area is generated according to the standard of average population served by SENHs and capacity, the population demand is the population of the elderly requiring care levels 3–5 and is further modified by a coefficient of potential demand via building a multivariate linear model. Improved results were obtained using the PI-FCA. Finally, this study maps the distribution of the degree of BNIS, to provide a basis for the allocation assessment of SENHs. This caters to the needs of departments and is easily applicable in other public healthcare facilities.

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.

Spatial Access to Primary Care Providers in Appalachia: Evaluating Current Methodology

PURPOSE

The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia.

METHODS

The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared.

RESULTS

Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina.

CONCLUSION

The different parameters of the 2SFCA method-distance decay weights and variable catchment sizes-have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation.

Evaluating and Comparing Methods for Measuring Spatial Access to Mammography Centers in Appalachia (Re-Revised)

PURPOSE

This study evaluated spatial access to mammography centers in Appalachia using both traditional access measures and the two-step floating catchment area (2SFCA) method.

METHODS

Ratios of county mammography centers to women age 45 and older, driving time to nearest mammography facility, and various 2SFCA approaches were compared throughout Pennsylvania, Ohio, Kentucky, and North Carolina.

RESULTS

Closest travel time measures favored urban areas. The 2SFCA method produced varied results depending on the parameters chosen. Appalachia areas had greater travel times to their closest mammography center. Appalachia areas in OH and NC had worse 2SFCA scores than non-Appalachia areas of the same states.

CONCLUSION

A relative 2SFCA approach, the spatial access ratio (SPAR) method, was recommended because it helped minimize the differences between various 2SFCA approaches.

An Enhanced Variable Two-Step Floating Catchment Area Method for Measuring Spatial Accessibility to Residential Care Facilities in Nanjing

Civil administration departments require reliable measures of accessibility so that residential care facility shortage areas can be accurately identified. Building on previous research, this paper proposes an enhanced variable two-step floating catchment area (EV2SFCA) method that determines facility catchment sizes by dynamically summing the population around the facility until the facility-to-population ratio (FPR) is less than the FPR threshold (FPRT). To minimize the errors from the supply and demand catchments being mismatched, this paper proposes that the facility and population catchment areas must both contain the other location in calculating accessibility. A case study evaluating spatial accessibility to residential care facilities in Nanjing demonstrates that the proposed method is effective in accurately determining catchment sizes and identifying details in the variation of spatial accessibility. The proposed method can be easily applied to assess other public healthcare facilities, and can provide guidance to government departments on issues of spatial planning and identification of shortage and excess areas.

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

BACKGROUND

The inequities in healthcare services between regions, urban and rural, age groups and diverse income groups have been growing rapidly in China. Equal access to basic medical and healthcare services has been recognized as "a basic right of the people" by Chinese government. 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.

METHODS

This 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.

RESULTS

50.03% 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.

CONCLUSIONS

The 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.