医疗设施可达性空间差异及其影响因素——基于上海市户籍与流动人口的对比

doi:10.18306/dlkxjz.2018.08.007

Abstract

Abstract:

Since the central government proposed "balancing basic public services" in 2006 and the 2009 World Bank Development Report advocated "equal coverage of residents' access to public services," improving facility accessibility and spatial distribution have increasingly become one of the development goals for regional governments and hot topics for academic research. In Shanghai Municipality, accessibility of medical facilities in different regions within the city needs to be examined urgently because it is closely related to people's livelihood, health, and social justice. Based on the accessibility of tertiary, secondary, and community hospitals in Shanghai, this study analyzed the accessibility of medical facilities in different areas of the city, and the variation between the registered and floating populations. Improved potential model and multivariate linear regression model are used accordingly. The study further explored the influencing mechanism of individual accessibility of medical treatment. The results are as follows. First, the inner city is characterized by the highest regional accessibility of medical facilities, and accessibility is gradually reduced from the inner city to the suburbs. The fluctuation of hospital accessibility is relatively clear in the suburban area. Anting Town, Huaxin Town, and some other towns in the west of Shanghai still lack of medical facilities. Second, registered population's accessibility of medical treatment is better than that of floating population, and the most obvious difference between the two groups is found in the fringe of the central urban area and the inner suburban areas. Compared to the Pudong area, floating population in the Puxi area is facing more difficulties in seeking medical care. Third, residential location significantly affects accessibility of medical treatment. For the registered population, community hospitals are more accessible in outer suburbs, and secondary hospitals are more accessible in the fringe of the central urban area compared with the inner suburbs. For the floating population, the above variation is not significant. No matter which regions they live, they are generally facing severe medical accessibility problems. Finally, socioeconomic and institutional factors also have impacts on accessibility to medical facilities. Middle-aged and elderly residents with higher education have better access to medical facilities. Housing property rights and medical insurance are much related to registered population's medical accessibility, while economic factors matter more for floating population. This study provides some suggestions for the relevant government departments to identify areas lacking medical facilities and improve the spatial distributions of medical and public transport facilities, thus helping to achieve the goal of equal access of health care. Future studies need to consider the integrated impact of spatial and institutional factors on residents' medical preferences and behaviors.

Key words: medical facility, medical accessibility, social equity, improved potential model, Shanghai

Yinhua TAO, Yue SHEN. Spatial difference of medical facility accessibility and influencing factors: A comparative study of registered and floating populations in Shanghai[J].PROGRESS IN GEOGRAPHY, 2018, 37(8): 1075-1085.

Figures/Tables 10

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References 28

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		户籍人口		流动人口
		人数	比例/%	人数	比例/%
性别	男	734	38.4	395	43.3
性别	女	1175	61.6	517	56.7
年龄	30岁以下	216	11.3	275	30.2
	30~45岁	460	24.1	491	53.8
	46~60岁	1200	62.9	145	15.9
	60岁以上	33	1.7	1	0.1
教育程度	小学及以下	98	5.1	163	17.9
	初中	594	31.1	440	48.2
	高中(中专)	723	37.9	152	16.7
	大学专科	244	12.8	66	7.2
	本科及以上	250	13.1	91	10.0
个人月收入	1500元以下	522	27.3	192	21.1
	1500~2500元	576	30.2	188	20.6
	2500~3500元	447	23.4	243	26.6
	3500元以上	364	19.1	289	31.7
房屋产权	不拥有	726	38.0	800	87.7
房屋产权	拥有	1183	62.0	112	12.3
医疗参保	未参加	175	9.2	526	57.7
医疗参保	参加	1734	90.8	386	43.3
居住区位	内城区	504	26.4	43	4.7
	中心城边缘区	665	34.8	106	11.6
	近郊区	460	24.1	576	63.2
	远郊区	280	14.7	187	20.5
	浦东	573	30.0	385	42.2
	浦西	1336	70.0	527	57.8

医疗设施类型		衰减系数
社区医院		-2.0
二级医院		-1.5
三级医院	其他区	-1.0
三级医院	崇明区	-1.2

变量	变量类型	备注
因变量
到最近社区医院路网距离	连续变量
到最近二级医院路网距离	连续变量
到最近三级医院路网距离	连续变量
自变量
1. 居住空间属性
居住区位(市郊)	分类变量	1=内城区,2=中心城边缘区,3=近郊区,4=远郊区(以近郊区为参考类别)
居住区位(浦东,浦西)	虚拟变量	1=浦西,0=浦东
2. 个体社会经济属性
性别	虚拟变量	1=男,0=女
年龄	连续变量
教育程度	等级变量	1~8分别表示教育程度由低到高
个人月收入	等级变量	收入的四分位数
房屋产权	虚拟变量	1=拥有房屋产权,0=无房屋产权
3. 制度性因素
医疗参保情况	虚拟变量	1=有医保,0=无医保

	平均值	标准差	最小值	最大值
内城区	0.074	0.012	0.041	0.094
中心城边缘区	0.049	0.013	0.024	0.082
近郊区	0.043	0.049	0.016	0.367
远郊区	0.035	0.027	0.000	0.126
浦东	0.038	0.016	0.002	0.088
浦西	0.052	0.036	0.000	0.367

	模型1：到社区医院路网距离					模型2：到二级医院路网距离					模型3：到三级医院路网距离
	户籍人口		流动人口			户籍人口		流动人口			户籍人口		流动人口
	标准化系数	T值	标准化系数	T值	标准化系数		T值	标准化系数	T值	标准化系数	T值		标准化系数	T值
内城区	-0.536^***	-22.045	-0.184^***	-5.576		-0.330^***	-14.595	-0.091^***	-2.896		-0.441^***	-20.364	-0.157^***	-5.548
中心城边缘区	-0.453^***	-18.372	-0.132^***	-3.876		-0.264^***	-11.510	-0.025	-0.782		-0.426^***	-19.440	-0.301^***	-10.349
远郊区	-0.175^***	-7.568	0.038	1.118		0.202^***	9.388	0.272^***	8.361		0.200^***	9.712	0.098^***	3.334
浦西	-0.178^***	-8.618	0.000	0.014		-0.260^***	-13.549	-0.127^***	-3.972		-0.146^***	-7.957	-0.332^***	-11.469
男性	-0.029	-1.526	0.024	0.688		0.028	1.583	0.081^**	2.429		-0.008	-0.485	0.054^*	1.793
年龄	-0.084^***	-3.867	0.017	0.474		-0.043^**	-2.148	-0.028	-0.843		-0.032^*	-1.644	-0.074^**	-2.441
教育程度	-0.106^***	-4.348	-0.026	-0.622		-0.072^***	-3.169	-0.091^**	-2.272		-0.047^**	-2.180	-0.158^***	-4.351
个人月收入	0.006	0.256	-1.376^*	-1.776		-0.010	-0.515	-0.078^**	-2.163		-0.020	-1.037	-0.060^*	-1.830
拥有房屋产权	-0.063^***	-3.156	-0.017	-1.296		-0.103^***	-5.515	-0.028	-0.783		-0.054^***	-3.056	0.004	0.137
有医保	0.046^**	2.355	0.046	1.296		0.011	0.625	-0.017	-0.507		0.004	0.256	-0.017	-0.564
调整后的R²	0.325		0.051			0.416		0.150			0.468		0.303

Spatial difference of medical facility accessibility and influencing factors: A comparative study of registered and floating populations in Shanghai

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