Spatial Difference and Equity Analysis for Accessibility to Three-Level Medical Services Based on Actual Medical Behavior in Shaanxi, China

Digital economy and the medical and health service supply in China

The impact of the digital economy on the healthcare sector is becoming increasingly profound. This article focuses on the relationship between the development of China's digital economy and medical and health services supply. Based on panel data from 30 provinces in China from 2012 to 2021, the CRITIC weight method was applied to measure the supply capacity of medical and health services and the level of digital economy development, and the kernel density estimation method and Dagum Gini coefficient method was used to characterize the evolutionary trends and regional differences. Additionally, a two-way fixed-effects model is adopted to investigate the impact of digital economy development on medical and health services supply. The results show that both the supply capacity of healthcare services and the level of digital economy development have been increasing continuously in terms of evolutionary trends. From the perspective of regional differences, compared to the supply level of healthcare services, the regional differences in digital economy development are more significant. The intra-regional differences in medical and health services supply are greater than the inter-regional differences, while the development of the digital economy exhibits the opposite trend. The findings of this paper provide supports for China to enhance the development level of digital economy and improve supply of medical and health service.

Assessing the spatial equity of the aged care institutions based on the improved potential model: a case study in Shanghai, China

With the spread of an aging society, the demand for aged care institutions among older adults is increasing. The inadequate supply and distribution of aged care institutions have led to an increasing concern about spatial equity in aged care institutions. Most studies have utilized accessibility to assess spatial equity from the supply perspective, while the demand perspective has received little attention. In addition, few studies have evaluated the spatial equity of aged care institutions at grid resolution. Therefore, this study takes Shanghai as an example to analyze aged care institutions from both the supply and demand perspectives. By proposing an improved potential model, at a network resolution of 500 × 500, the spatial equity of aged care institutions is more refined. The results show that aged care institutions and the older population in Shanghai are predominantly concentrated in the downtown area and surrounding regions. However, the results obtained from the Lorenz curve and Gini coefficient indicate the allocation of pension beds based on population size is proportional across different districts of Shanghai. When considering the quality indicators of aged care institutions and introducing the improved potential energy model to calculate spatial accessibility, an imbalance between regions in Shanghai still exists and needs further optimization.

Urban-sub-urban-rural variation in the supply and demand of emergency medical services

Background

Emergency medical services (EMSs) are a critical component of health systems, often serving as the first point of contact for patients. Understanding EMS supply and demand is necessary to meet growing demand and improve service quality. Nevertheless, it remains unclear whether the EMS supply matches the demand after the 2016 healthcare reform in China. Our objective was to comprehensively investigate EMS supply-demand matching, particularly among urban vs. sub-urban vs. rural areas.

Methods

Data were extracted from the Tianjin Medical Priority Dispatch System (2017-2021). From supply and demand perspectives, EMS resources and patient characteristics were analyzed. First, we performed a descriptive analysis of characteristics, used Moran's I to explore the spatial layout, and used the Gini coefficient to evaluate the equity of EMS supply and demand. Second, we analyzed urban-sub-urban-rural variation in the characteristics of EMS supply and demand by using the chi-square test. Finally, we examined the association between the EMS health resource density index and the number of patients by using the Spearman correlation and divided supply-demand matching types into four types.

Results

In 2021, the numbers of medical emergency stations and ambulances were 1.602 and 3.270 per 100,000 population in Tianjin, respectively. There were gradients in the health resource density index of the number of emergency stations (0.260 vs. 0.059 vs. 0.036; P = 0.000) in urban, sub-urban, and rural areas. There was no spatial autocorrelation among medical emergency stations, of which the G values by population, geographical distribution, and the health resource density index were 0.132, 0.649, and 0.473, respectively. EMS demand was the highest in urban areas, followed by sub-urban and rural areas (24.671 vs. 15.081 vs. 3.210 per 1,000 population and per year; P = 0.000). The EMS supply met the demand in most districts (r = 0.701, P = 0.003). The high supply-high demand types with stationary demand trends were distributed in urban areas; the low supply-high demand types with significant demand growth trends were distributed in sub-urban areas; and the low supply-low demand types with the highest speed of demand growth were distributed in rural areas.

Conclusion

EMS supply quantity and quality were promoted, and the supply met the demand after the 2016 healthcare reform in Tianjin. There was urban-sub-urban-rural variation in EMS supply and demand patterns.

Spatial distribution, regional differences, and dynamic evolution of the medical and health services supply in China

The imbalance of medical and health services supply (MHSS) is a significant public health concern as regional economic development disparities widen in China. Based on the provincial panel data of medical and health services, this paper constructed an evaluation index system and used the two-stage nested entropy method to measure the MHSS level of 31 provinces in China from 2005 to 2020. Then we used the standard deviation ellipse, Dagum Gini coefficient, β convergence model, kernel density estimation and Markov chain to investigate the spatial distribution, regional differences, and dynamic evolution of MHSS. According to the results of these analysis, the conclusions are drawn as follows: (1) In general, the MHSS level in China showed a significant up-ward trend from 2005 to 2020. However, the MHSS level among different provinces showed a non-equilibrium characteristic. (2) Regional comparison shows that the eastern region had the highest level, and the central region had the lowest level. The eastern and central regions presented polarization, while the western region showed unremarkable gradient effect. (3) During the period, the overall regional differences, intra-regional differences, and inter-regional differences of MHSS level all showed convergence. (4) The economic development, urbanization rate, fiscal self-sufficiency rate, and foreign direct investment had significant impacts on the convergence. (5) The provinces with high levels had the positive spillover effect. The findings of this paper provide theoretical supports for optimizing the allocation of health resources and improving the equity of MHSS.

Equilibrium of Tiered Healthcare Resources during the COVID-19 Pandemic in China: A Case Study of Taiyuan, Shanxi Province

COVID-19 has caused more than 500 million infections and 6 million deaths. Due to a continuous shortage of medical resources, COVID-19 has raised alarm about medical and health resource allocation in China. A balanced spatial distribution of medical and health resources is a key livelihood issue in promoting the equalization of health services. This paper explores the spatial allocation equilibrium of two-tier medical and health resources and its influencing factors in Taiyuan. Using extracted POIs of medical and health resources of AMAP, we evaluated the spatial quantitative characteristics through the Health Resources Density Index, researched the spatial distribution pattern by kernel density analysis, hot spot analysis, and service area analysis, and identified the influencing factors of the spatial distribution equilibrium by the Geodetector model. The findings are as follows. The overall allocation level of medical and health resources in Taiyuan is low. There are tiered and regional differences; the response degree of primary care facilities to external factors is greater than that of hospitals; and the comprehensive influence of economic and topographic systems is crucial compared with other factors. Therefore, in order to promote the rational spatial distribution of medical and health resources in Taiyuan and to improve the construction of basic medical services within a 15 min radius, it is important to continuously improve the tiered healthcare system, uniformly deploy municipal medical and health resources, and increase the resource allocation to surrounding counties and remote mountainous areas. Future research should focus on collecting complete data, refining the research scale, analyzing qualitative differences, and proposing more accurate resource allocation strategies.

Resource Allocation Equity in the China’s Rural Three-Tier Healthcare System

The rural three-tier healthcare system is an essential part of the Chinese healthcare service system. To ensure rural residents’ equal access to such healthcare services, it is necessary to examine the current status of the healthcare system in rural China and formulate corresponding improvement suggestions. This study therefore collects the data from the China Health Statistics Yearbook, the China Health Yearbook and the China Statistical Yearbook between the years 2004 and 2021 to calculate the Gini coefficient (G), health resource density index (HRDI) and Theil index (T) first, and then perform the Mann–Kendall test afterwards to evaluate the equity of healthcare resource allocation comprehensively. This series of analysis helps in drawing the following conclusions: (1) county and county-level city medical and health institutions (CMHIs) show a higher development trend in comparison with township hospitals (THs) and village clinics (VCs); (2) VCs have higher institutional fairness, while for beds and personnel, CMHIs and THs are more fairly positioned; (3) more specifically for CMHIs and THs, personnel allocation is more fair than beds and institution allocations; (4) the density of healthcare resources in the eastern and central regions is higher than that in the western part, while the intra-regional distribution of beds and personnel in the west and central regions is better than that in the eastern region; (5) intra-regional differences are more significant than inter-regional differences and the fairness according to population distribution is higher than that of geographical area allocation. The results of this study provide theoretical basis for further optimizing the allocation of healthcare resources and improving the fairness of healthcare resources allocation from a macro perspective.

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.

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.

Exploring Spatiotemporal Accessibility of Urban Fire Services Using Real-Time Travel Time

The accessibility of urban fire services is a critical indicator in evaluating fire services and optimizing fire resource allocation. However, previous studies have mainly concentrated on measuring the spatial accessibility of fire services, and little, if any, consideration has been paid to exploring the spatiotemporal dynamics of the accessibility of urban fire services. Therefore, we used real-time travel time to extend an existing spatial accessibility method to measure the spatiotemporal accessibility of fire services in a case study of Nanjing, China. The results show that (1) the overall accessibility of fire incidents and fire stations in Nanjing, China, is uneven, with relatively high accessibility in the southwest and northeast of the city center; (2) the number of fire incidents with low-level accessibility apparently increases in rush hours (i.e., 07:00–09:00 and 17:00–19:00 h) in the southeast and north of the city center, and the fire incidents with medium-level and high-level accessibility easily change to lower levels under the influence of traffic congestion, with fire incidents with medium-level accessibility being affected the most; (3) the accessibility of fire stations changes over time with an obvious W pattern, with lower accessibility during rush hours than at other times, and several fire stations in the city center present an asymmetric W pattern; (4) the accessibility decline ratio for fire stations in rush hours is greater in the city center than in urban suburbs, and the decline ratios are strongly related to the travel time increase and the percent increase in uncovered fire incidents during rush hours. The results and findings demonstrate that our method can be used to explore the spatiotemporal dynamics of the accessibility of fire services, and so can guide policymakers in improving fire services.