基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例

doi:10.18306/dlkxjz.2015.06.007

地理科学进展 ›› 2015, Vol. 34 ›› Issue (6): 716-725.doi: 10.18306/dlkxjz.2015.06.007

基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例

邓丽¹, 邵景安^1,^2,^*(), 郭跃^1,², 徐新良³

1. 重庆师范大学地理与旅游学院, 重庆 400047
2. 三峡库区地表过程与环境遥感重庆市重点实验室,重庆 400047
3. 资源与环境信息系统国家重点实验室, 中国科学院地理科学与资源研究所,北京 100101

收稿日期:2014-10-01 修回日期:2015-02-01 出版日期:2015-06-15 发布日期:2015-06-15
通讯作者: 邵景安
作者简介:
作者简介：邓丽(1990-),女,湖北黄冈人,硕士生,主要从事资源环境与城乡规划研究,E-mail: 1013664311@qq.com。
基金资助:
国家自然科学基金重大国际合作项目(41161140352);教育部人文社科青年基金项目(10YJCZH122);高分辨率对地观测系统重大专项(No.00-Y30B15-9001-14/16)

Spatial accessibility of medical services in mountainous regions based on modified two-step floating catchment area method: a case study of Shizhu County, Chongqing

Li DENG¹, Jing'an SHAO^1,^2,^*(), Yue GUO^1,², Xinliang XU³

1. College of Geographical Science, Chongqing Normal University, Chongqing 400047, China
2. Key Laboratory of Surface Process and Environment Remote Sensing in the Three Gorges Reservoir Area, Chongqing 400047, China
3. State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, CAS, Beijing 100101, China

Received:2014-10-01 Revised:2015-02-01 Online:2015-06-15 Published:2015-06-15
Contact: Jing'an SHAO

摘要/Abstract

摘要：

针对贫困山区医疗资源短缺、分布不均衡、服务能力差等问题,以重庆市石柱县为例,基于自然村尺度,采用改进的两步移动搜索法,从供需角度分析研究区医疗服务空间可达性特征。设置不同的时间阻抗进行敏感性分析,探究可达性变化规律。通过对石柱县医疗资源空间布局的均衡性评价,为山区未来医疗布局的合理规划与医疗标准的配备提供决策依据。结果表明：①石柱县整体医疗服务可达性差,低于重庆市平均水平。②县域医疗资源布局不均衡,空间差异明显。高值区主要集中在方斗山中低山区和黄水镇,低值区主要集中在南部中山区,两极分异明显。③医院的规模、级别,道路的等级、疏密对可达性有一定的影响：靠近县城的乡镇、路网密集的地方可达性一般较好。④随着出行阻抗的增大,医疗服务的可达性随之变好,边缘乡镇的可达性随之变差,可达性值变化幅度减缓,医疗服务空间可达性分异变小;医疗资源配备充足的乡镇,随着时间阻抗增加,对周边乡镇可达性的影响增强。

关键词: 贫困山区, 医疗服务, 改进的两步移动搜索法, 空间可达性, 敏感性, 重庆

Abstract:

Poverty-stricken mountainous areas often experience a severe shortage of medical resources, with uneven distribution and poor service capacity. This study uses the modified two-step floating catchment area method to analyze the characteristics of spatial accessibility of medical services in Shizhu County, Chongqing Municipality, southwestern China. It explores factors affecting the spatial accessibility of medical services from a supply and demand perspective, aiming for providing decision support for the planning of medical resources space allocation of mountainous regions. The basic unit of analysis is natural villages. Results show that: (1) Overall, the spatial accessibility of medical services in Shizhu County is poor and below the average level in Chongqing Municipality. (2) Medical resources distribution is uneven and the spatial differentiation is very clear. High accessibility areas mainly concentrate in the low and middle mountain areas of Fangdou Mountain and Huangshui Town. Low accessibility areas mainly concentrate in the high mountainous areas of northern Qiyao Mountain and middle mountain areas of southern Qiyao Mountain. The difference in accessibility is significant. (3) Scale and grade of hospitals and grade and density of roads have certain effect on accessibility: Accessibility is generally good in places near the county seat and have a dense road network. (4) Accessibility is high in places of dense road network. (5) With the increase of the distance impedance, accessibility gets better within the county but deteriorates at the peripherals of the villages and towns. The range of accessibility is lower, differentiation of spatial accessibility of medical services shrink, and the influences of the villages and towns with sufficient medical resources on accessibility of surrounding villages and towns increase.

Key words: poverty-stricken mountainous area, medical services, modified two-step floating catchment area method, spatial accessibility, sensitivity, Chongqing

邓丽, 邵景安, 郭跃, 徐新良. 基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例[J]. 地理科学进展, 2015, 34(6): 716-725.

Li DENG, Jing'an SHAO, Yue GUO, Xinliang XU. Spatial accessibility of medical services in mountainous regions based on modified two-step floating catchment area method: a case study of Shizhu County, Chongqing[J]. PROGRESS IN GEOGRAPHY, 2015, 34(6): 716-725.

图/表 9

图1

图2

图3

表1

两步移动搜索法实现步骤"

步骤	使用公式	步骤的实现	参数含义	可达性意义
第一步：计算每个医疗点的服务能力 $R j$ ;	$R j = S j ∑ D k$	建立每个医疗点 $j$ 距离阻抗 $d 0$ 范围内的服务区,查找落入服务区内所有位置(k)的人口,并求这些位置的人口之和。医疗点j的医务人员数与这些位置的总人口之比,即为每个医疗点的服务能力R_j。	$S j$ 为j点的医务人员数(或床位数); $D k$ 为服务区内所有位置(k)的人口之和; $d kj$ 为自然村k和医疗点j之间的距离阻抗。
第二步：计算每个居民点的可达性 $A i F$ 。	$A i F = ∑ R j = ∑ R j = S j ∑ D k$	建立每个村级居民点 $i$ 距离阻抗d₀范围内的服务区,查找服务区内所有位置的医疗点j,将所有医疗点的提供的服务R_j相加,即为居民点i点的可达性 $A i F$ 。	$A i F$ 为居民点i的医疗服务空间可达性;R_j是居民点i服务区( $d kj ≤ d 0$ )内的服务能力, $d ij$ 是位置i, j之间的距离阻抗。	$A i F$ 越大表明该居民点i的可达性越好,服务区内居民去医疗点的时空障碍越低。

表1

图4

表2

图5

图6

表3

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地形分区	医疗点数/个	医务人员数/人	每千人均医疗点/个	每千人均医务人员/人	地均医疗点/(个/km²)	地均医务人员/(人/km²)
A	54	88	0.627	1.022	0.191	0.312
B	36	109	0.526	1.594	0.103	0.311
C	100	281	0.539	1.516	0.135	0.379
D	41	116	0.941	2.663	0.080	0.226
E	55	60	0.710	0.774	0.054	0.059

时间阻抗t₀	空间可达性	自然村数/个	所占比例/%	<3.94^*的村子所占比例/%	<2.84^**的村子所占比例/%
0.39 h	0~0.629	57	25.45	94.64	90.18
	0.652~1.535	114	50.89
	1.646~3.015	38	16.96
	3.294~7.815	14	6.25
	13.463	1	0.45
0.78 h	0~0.892	62	27.68	97.32	89.73
	0.933~1.736	93	41.52
	1.806~2.910	51	22.76
	2.967~7.171	17	7.59
	14.335	1	0.45
1.56 h	0~0.830	36	16.07	96.43	93.30
	0.861~1.396	78	34.82
	1.441~2.164	67	29.91
	2.186~4.653	40	17.86
	7.210~9.208	3	1.34

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基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例

Spatial accessibility of medical services in mountainous regions based on modified two-step floating catchment area method: a case study of Shizhu County, Chongqing

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