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

Abstract

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

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.

Figures/Tables 9

Fig.1

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Tab.1

Implementation steps of the two-step floating catchment area method"

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。

Tab.1

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Tab.2

Fig.5

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Tab.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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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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