Spatial Distribution Balance Analysis of Hospitals in Wuhan

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

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

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.

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.

Impact of the presence of private hospitals on the spatial equality of healthcare accessibility in Beijing, China

Providing equal geographical access to hospitals, either in the public or private healthcare sector, is vital and will benefit public health in general. Against the background of the partial privatization of the healthcare sector, the impact of private hospitals on equal healthcare access has been a highly neglected issue. We have applied an assessment methodology to study this situation by comparing the status quo scenario with one without private hospitals, based on accessibility analysis and spatial equality measurements. The case study of Beijing, China revealed a double-sided impact. With the presence of private hospitals, the Gini coefficient of spatial accessibility in urban districts was reduced from 0.03391 to 0.03211, while it increased from 0.1734 to 0.1914 in suburban districts. Thus, private hospitals improved spatial equality in urban districts in Beijing but jeopardized it in suburban districts. These research findings should enlighten policymakers to promote healthcare equality but would also need to be repeated in some other big cities.

Inequality of public facilities between urban and rural areas and its driving factors in ten cities of China

Urban development continues to face the dilemma of spatial inequality of public facilities, particularly educational and medical facilities. Identifying inequalities in various types of public facilities and their driving mechanisms is crucial in reducing social inequality. However, information on this topic is limited. This study took 10 typical cities in China as cases. We used the methods of the Gini coefficient and hedonic price model as bases in evaluating the equality of nine types of education and medical facilities, focusing on the differences between urban and rural areas. Moreover, we further analyzed the driving factors of facility equality. Results showed that equality of public facilities in urban areas was significantly higher than that in rural areas. Primary schools, middle schools, and health service centers were relatively equal, and kindergartens and pharmacies were unequal only in rural areas. However, the equality of facilities with large-size or commercial attributes was not optimistic. Furthermore, there remained a significant gap among counties (or districts), which was mainly driven by population, economy, and building density in the form of logarithm and logarithmic linear models. Our research contributes to an in-depth understanding of the inequality of public facilities and further supports decision-making to improve social equality.

Evaluation of Medical Carrying Capacity for Megacities from a Traffic Analysis Zone View: A Case Study in Shenzhen, China

Sustainable Development Goals propose to build inclusive, safe, resilient, and sustainable cities and human settlements, which requires us to scientifically evaluate the carrying capacity of current urban public service facilities, but there is still a lack of in-depth exploration of urban public medical service facilities. Therefore, this paper, within the mobile phone signaling data, improved the potential model and carrying capacity evaluation model of public medical facilities, explored the spatial pattern distribution of public medical resources in Shenzhen, and analyzed the current situation of carrying capacity of public medical resources. The study showed that: (1) the overall spatial distribution of public medical resources in Shenzhen is uneven, showing a pattern of multicenter aggregation and multilevel development; (2) the service potential of public medical facilities has obvious spatial variations, with Futian District, Dapeng New District, and Nanshan District showing more obvious high-gravitational-value aggregation centers; (3) medical facilities in Shenzhen are never empty, but the problems of medical underloading and overloading are severe, and spatial allocation and utilization efficiency need to be further optimized. The research results can provide a scientific basis for the research on the allocation and sustainable construction of medical resources in megacities.

An Equity Evaluation on Accessibility of Primary Healthcare Facilities by Using V2SFCA Method: Taking Fukuoka City, Japan, as a Case Study

The primary healthcare facilities are among the most basic needs of the residents, huge in quantity and widespread. Their distributions are directly related to people’s health, which affects the sustainable development of cities. The accessibility calculation of primary level healthcare facilities and the equity evaluation of accessibility from the perspective of medical service category and urban population is very important for the decision-making of layout and configuration but has been ignored for a long time. This study took the primary healthcare facilities of Fukuoka city in Japan as research objects; it first used the variable two-step floating catchment area (V2SFCA) method to calculate the healthcare catchment areas (HCAs) of medical service providers and the population catchment area (PCAs) of medical demand locations, and then obtained the accessibility to primary healthcare facilities. Finally, the spatial disparities of accessibility were evaluated from three aspects: overall space distribution by using Global and Local Moran’s I, service quality, and the population to be served. The results showed that HCAs were from 500 m to 6400 m, PCAs ranged from 500 m to 3000 m, the use of variable catchments can improve the accuracy of accessibility assessment results; the accessibility of primary healthcare facilities was clustered and had significant spatial differences, which were high in urban center and low in suburban area; the obvious differences in the accessibility distribution characteristics of clinics in differential diagnosis and treatment departments led to different degrees of unsaturation in the types of medical services obtained by residents; although the elderly’s demand for basic medical care was many times higher than that of other age groups, the accessibility in high-demand areas was generally low, and the situation in severely high-demand areas was more serious. This work puts forward a multi-dimensional realistic evaluation system for equality accessibility of primary healthcare facilities, providing the data support for the medical resources and facilities’ allocation and the intensive land use.

Siting of Healthcare Care Facilities Based on the Purpose of Their Operation, Demographic Changes, Environmental Characteristics, and the Impact on Public Health

A contemporary approach to the spatial design of healthcare care facilities faces numerous challenges at the crossroads of multidisciplinary topics of architecture and urbanism, healthcare, security, and organisational sciences. Due to the unique combination of uses, users and architectural expression, they are defined as urban nodes. With their inclusion, architects facilitate a better placing of healthcare facilities, indirectly improving human health. The purpose of the article is to seek guidelines for the siting of healthcare facilities to provide suitable and equal healthcare to different social structures, and for the optimal and fair spatial distribution of healthcare services. The descriptive method was used to review literature on the siting of healthcare facilities based on the purpose of their operation, demographic changes, environmental characteristics, and the impact on public health. This method was selected as it facilitates data acquisition from various sources and a comprehensive understanding of the topic discussed. The results of the research show how important the impact of the healthcare care facilities siting on human health and the wider social significance of the topic discussed is. The findings may provide guidelines and proposals for future spatial decisions.

An equity and efficiency integrated grid-to-level 2SFCA approach: spatial accessibility of multilevel healthcare

BACKGROUND

Equity of healthcare spatial access is essential for the health outcomes of medical investments and the welfare of populations, and efficiency of medical resource allocation is important for obtaining a supply-demand equilibrium with lower cost and higher outputs with limited inputs. However, the literature that involves both equity and efficiency in its analysis of healthcare spatial allocation is rare, and the spatial accessibility of multilevel healthcare is difficult to measure by traditional methods in a large region with diversified population distribution.

METHODS

To assist in solving these issues, this paper aims to build an equity and efficiency integrated analytical framework by proposing a new "GTL-2SFCA" approach to analyze the spatial accessibility of multilevel healthcare; maximum and minimum floating catchments of different levels of healthcare were assigned to ensure a combination of universal search coverage and efficient hospitalization behavior simulation.

RESULTS

The analytical framework was applied and tested in Hubei, China. Almost half of the residents (47.95%) and townships (44.98%) have access to both public general hospitals (PGHs) and primary healthcare centers (PHCs) services, 36.89% of the residents enjoy only one sufficient service, either PGHs or PHCs, and the remaining residents (15.16%) are faced with the risk of lacking access to both services. The results reveal that there are core-periphery effects of multilevel healthcare throughout Hubei and isolate clusters that have adequate access in the western region. The polarization effect of higher-level healthcare and the polycentric pattern of lower-level healthcare coexist. The multilevel healthcare shortage was identified in some areas in boundary and peripheral regions.

CONCLUSIONS

This study integrates equity and efficiency into the GTL-2SFCA framework, enriches the FCA series methodologies and provides a more operational solution for evaluating the access of residents in more sophisticated spatial units to each level of healthcare. By more significantly differing and quantifying the catchment area and distance decay effect, this methodology avoids overestimating or underestimating accessibility and discovers some imperceptible spatial inequities. This study has application value for researchers and decision-makers in other scenarios and regions with significant heterogeneity in medical resources and where the population has greater mobility.

Measuring Spatial Accessibility of Urban Medical Facilities: A Case Study in Changning District of Shanghai in China

Medical facilities help to ensure a higher quality of life and improve social welfare. The spatial accessibility determines the allocation fairness and efficiency of medical facilities. It also provides information about medical services that residents can share. Although critical, scholars often overlooked the level of medical facilities, the composition of integrated transportation networks, and the size of service catchment in the literature on accessibility. This study aims to fill this research gap by considering the integrated transportation network, population scale, travel impedance between medical facilities and residential areas, and the impact of medical facilities' levels on residents' medical choices. An improved potential model was constructed to analyze the spatial accessibility of medical facilities in Changning District of Shanghai, China. Interpolation analysis was conducted to reveal the spatial accessibility pattern. Cluster and outlier analysis and Getis-Ord Gi* analysis were applied for the cluster analysis. Results show that the spatial accessibility of medical facilities is quite different in different residential areas of Changning District, Shanghai. Among them, the spatial accessibility of medical facilities is relatively high in Hongqiao subdistrict, Xinjing Town, and part of Xinhua Road subdistrict. In addition, residents have overall better access to secondary hospitals than to primary and tertiary hospitals in the study area. This study provides a spatial decision support system for urban planners and policymakers regarding improving the accessibility of healthcare facilities. It extends the literature on spatial planning of public facilities and could facilitate scientific decision making.

Assessing Health Resources Equipped with Hemodynamic Rooms in the Portuguese-Spanish Borderland: Cross-Border Cooperation Strategies as a Possible Solution

Portugal and Spain share one of the greatest European borderland areas. This fact has direct impacts on a large territory and consequently on the communities’ living in it. Still, even if the border areas represent an essential fraction of the territory, planning policies have not resulted in specific cooperation programs that could enable sharing general leisure and recreation assets and infrastructures and collaboration in critical domains—i.e., the case of the health sector. The present study aims to assess the territorial accessibility to the hemodynamic rooms by the potential population of the Spanish-Portuguese transition areas that may suffer an acute myocardial infarction. Contextually, this study employed a spatial interaction model based on the three-step floating catchment area method (method-3SFCA). By applying these methods, it was possible to develop a map of accessibility to health infrastructures equipped with hemodynamics rooms on both sides of the border that may answer the Spanish-Portuguese border populations’ needs. Besides, while granting valuable information for decision-makers regarding the need to develop new infrastructures to guarantee that even considering cross border cooperation, everyone gets access to a hemodynamics room within the critical intervention period.

On the Application of Clustering and Classification Techniques to Analyze Metabolic Syndrome Severity Distribution Area and Critical Factors

In recent years, metabolic syndrome has become one of the leading causes of death in Taiwan. This study proposes a classification and clustering method specific to the administrative regions of New Taipei City to explore the incidence and corresponding risk factors for metabolic syndrome in various geographic areas. We used integrated community health screening data and survey results obtained from people aged ≥40 years in each of the administrative regions of New Taipei City as study samples. Using a combination of Ward’s method, multivariate analysis of variance, and k-means, we identified administrative regions of New Taipei City with metabolic syndrome incidences of a similar nature. Classification and regression tree methods were used to discover the key causes of metabolic syndrome in each region based on lifestyles and dietary habits. The administrative regions were divided into four groups: high-risk, slightly high-risk, normal-risk, and low-risk. The results showed that the severity of metabolic syndrome varies by region and the risk factors for metabolic syndrome vary by region. It has also been found that regions with a higher incidence of metabolic syndrome have relatively fewer medical resources.

Spatial Equity of Multilevel Healthcare in the Metropolis of Chengdu, China: A New Assessment Approach

The spatial equity of the healthcare system is an important factor in assessing how the different medical service demands of residents are met by different levels of medical institutions. However, previous studies have not paid sufficient attention to multilevel healthcare accessibility based on both the divergence of hierarchical healthcare supplies and variations in residents’ behavioral preferences for different types of healthcare. This study aims to propose a demand-driven “2R grid-to-level” (2R-GTL) method of analyzing the spatial equity in access to a multilevel healthcare system in Chengdu. Gridded populations, real-time travel distances and residents’ spatial behavioral preferences were used to generate a dynamic and accurate healthcare accessibility assessment. The results indicate that significant differences exist in the spatial accessibility to different levels of healthcare. Approximately 90% of the total population living in 57% of the total area in the city can access all three levels of healthcare within an acceptable travel distance, whereas multilevel healthcare shortage zones cover 42% of the total area and 12% of the population. A lack of primary healthcare is the most serious problem in these healthcare shortage zones. These results support the systematic monitoring of multilevel healthcare accessibility by decision-makers. The method proposed in this research could be improved by introducing nonspatial factors, private healthcare providers and other cultural contexts and time periods.