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

Author(s):  
Shaoyao Zhang ◽  
Xueqian Song ◽  
Yongping Wei ◽  
Wei Deng

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.

2021 ◽  
Vol 10 (9) ◽  
pp. 615
Author(s):  
Zhuolin Tao ◽  
Wenchao Han

The hierarchical healthcare system is widely considered to be a desirable mode of the delivery of healthcare services. It is expected that the establishment of a hierarchical healthcare system can help provide better and more equal healthcare accessibility. However, limited evidence has been provided on the impacts of a hierarchical healthcare system on healthcare accessibility. This study develops an improved Hierarchical two-step floating catchment area (2SFCA) method, which incorporates variable catchment area sizes, distance friction effects and utilization efficiency for facilities at different levels. Leveraging the Hierarchical 2SFCA method, various scenarios are set up to assess the accessibility impacts of a hierarchical healthcare system. The methods are applied in a case study of Shenzhen. The results reveal significant disparity and inequality in healthcare accessibility and also differences between various facility levels in Shenzhen. The overall healthcare accessibility and its equality can be significantly improved by fully utilizing existing facilities. It is also demonstrated that allocating additional supply to lower-level facilities can generate larger accessibility gains. Furthermore, allocating new supply to primary facilities would mitigate the inequality in healthcare accessibility, whereas inequality tends to be aggravated with new supply allocated to tertiary facilities. These impacts cannot be captured by traditional accessibility measures. This study demonstrates the pivotal role of primary facilities in the hierarchical healthcare system. It can contribute to the literature by providing transferable methods and procedures for measuring hierarchical healthcare accessibility and assessing accessibility impacts of a hierarchical healthcare system in developing countries.


Author(s):  
Meihan Jin ◽  
Lu Liu ◽  
De Tong ◽  
Yongxi Gong ◽  
Yu Liu

Public medical service facilities are among the most basic needs of the public and are directly related to residents’ health. The balanced development of medical service facilities is of great significance. Public medical service facilities can be divided into different levels according to their medical equipment, service catchment, and medical quality, which is very important but has been ignored for a long time in accessibility evaluations. In this research, based on the hospital and population datasets of Shenzhen, we propose a hierarchical two-step floating catchment area (H2SFCA) method to evaluate the spatial accessibility of public medical resources considering the factors at different levels of medical resources. In the proposed method, the spatial accessibility of each level of public medical service facilities are evaluated using different distance attenuation functions according to the medical service’s scope. In addition, a measurement is proposed to evaluate the equity of medical service facilities based on accessibility and population density distributions. To synthesize the general spatial accessibility and the distribution balance of public medical service facilities, we standardize the spatial accessibility of public medical service facilities at each level and then calculate the weighted sums of the accessibility of each level. The general spatial equity of public medical service facilities is also evaluated. The results show that the accessibility and distribution balance of medical resources performs dissimilarly at the three levels and can be discriminated within different regions of the city. The accessibility of citywide medical facilities in Shenzhen decreases from the city center to the suburban area in a radial pattern and the accessibility and distribution balance in the suburban areas needs improvement.


2019 ◽  
Vol 11 (1) ◽  
pp. 229 ◽  
Author(s):  
Xuan Sun ◽  
Tao Sun ◽  
Yushan Jin ◽  
Ya Ping Wang

To address the low performance of health care service delivery in the half-market system, the Chinese government has begun to advocate the medical alliance (MA) recently. Instead of strict regulations on the procedure of diagnosis and treatment, flexible resource sharing among medical institutions of different grades inside each MA is encouraged. By now, many attempts have been made for MA establishment from different perspectives, but there is no effective model maturely developed. For the promotion of the spatial accessibility to medical services at different levels, it is important to organize the hierarchial medial services according to the distributions of different grades of health care facilities in a city. With the city proper of Tianjin as the study case, we explored the optimal establishment of MAs using the geographic information system (GIS). By means of the Voronoi Diagrams, the service regions of different medical institutions were precisely defined and the organizational structure of hierarchical medical services in MAs was determined. Through interpolation analysis, accessibility to different levels of medical services was measured, and on this basis, discussions were conducted on the service efficiency of the MAs. According to the results from Tianjin, (1) under the proposed organizational model for MAs, the fit of the service regions of the first grade and the other two higher grades of medical institutions was good. but the fit of the second and the third grade medical institutions was insufficient. (2) Although the overall service efficiency was excellent, there were still deficiencies in a number of the MAs. (3) Increasing the number of second and third grade medical institutions in specific regions near the city’s edge, as well as the number of first grade institutions, could further improve the performance of hierarchical medical services.


2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhuolin Tao ◽  
Yang Cheng ◽  
Jixiang Liu

Abstract Background Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies. Methods Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement. Results The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making. Conclusions The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
F Gao ◽  
S Deguen

Abstract Background The evaluation of geographical healthcare accessibility in residential areas provides crucial information to public policy. This work developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the smallest available infra-urban level, that is, the Îlot Regroupé pour des Indicateurs Statistiques. Methods This study was carried out in the department of Nord, France. Healthcare professionals are geolocalized using postal addresses available on the French state health insurance website. ISA is derived from Enhanced Two-Step Floating Catchment Area (E2FCA) algorithm. We have constructed a catchment for each healthcare provider, by taking into account residential building centroids, car travel time as calculated by Google Maps and the edge effect. Principal Component Analyses (PCA) were used to build a composite ISA to describe the global accessibility of different kinds of health professionals. Results We applied our method to studying geographical healthcare accessibility for pregnant women, by selecting three types of healthcare provider: general practitioners, gynecologists and midwives. A total of 3587 healthcare providers are potentially able to provide care for inhabitants of the department of Nord. On average there are 92 general practitioners, 22 midwives and 21 gynecologists per 100,000 residents. The composite ISA for the three types of healthcare provider is 39 per 100,000 residents. Conclusions ISA is a multidimensional and improved measure, which combines the volume of services relative to population size with the proximity of services relative to the population’s location, available at the smallest feasible geographical scale. It could guide policy makers towards highlighting critical areas in need of more healthcare providers, and these areas should be earmarked for further knowledge-based policy making. Key messages Indicator of healthcare access at fine spatial scale allows us to identify precisely critical areas where healthcare professionals need to be allocated. ISA is a multidimensional measure, which combines the volume of services relative to population size with the proximity of services relative to the population’s location.


Author(s):  
Timur A. Magsumov ◽  
Mariya O. Nigmatullina

The author analyzes the therapeutic service development of the young city of the era of “developed socialism”, which eventually becomes the basis for the creation of the urban healthcare system in the late Soviet industrial centers. Both problems and achievements of its development are identified along with specific features of the urban healthcare system that had been formed at the beginning of the “Perestroika”, which eventually sharply distinguished the new socialist industrial centers from the cities of the European part of the country. During the period under consideration, a lot of work was done to establish a therapeutic service in the city of Naberezhnye Chelny. At the time the construction of industrial enterprises began, there was only one therapeutic unit in the central district hospital in the city. Later, hospitals and out-patient clinics were opened, healthcare centers and workshop services operated to treat the workers. Therapy was the basis of all specialized medical services, therefore, building up this service largely met the needs of the city under construction. As a result, specialized units were established on the basis of the therapeutic service, which subsequently operated as independent services. In the context of rapid demographic growth, the city was constantly expanding the network of medical institutions, increasing the number of employees along with facilities and equipment potential of medical institutions. This became the basis for the main result of the city’s therapeutic service activities during this period, i.e. the transition from the territorial-production principle of its patient service towards the territorial-specialized one. These undoubtedly positive results made it possible to maintain positive dynamics in the development of the city’s healthcare system in the subsequent years of the “Perestroika” and the collapse of the USSR, when the state of the industry as a whole declined sharply throughout the country. Keywords: history of healthcare, therapeutic service, USSR, Naberezhnye Chelny, prevention and treatment institutions, developed socialism.


Complexity ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Qian Xie ◽  
Ming Lu

Access to urban green space (UGS) is associated with the enhancement of health and disparities in access generate issues of spatial equity and socioenvironmental justice. The aim of this study is to measure spatial accessibility and investigate access disparities to UGSs in urban areas of Harbin, China. A Gaussian-based two-step floating catchment area method and spatial autocorrelation analysis were used to measure the accessibility and evaluate its distribution patterns in residential tracts. Bivariate correlation was employed to examine the statistical relations between demographic characteristics of residential tracts and green space access. The results show that most residential tracts have minimal green space access within walking distance, while a few have limited access within cycling distance. Additionally, spatial disparities were found with low-accessibility tracts clustering in the center of the city, while high-accessibility tracts were located in northern and southern suburbs. Demographic disparities were also identified in the study: females have less access to UGS than males, areas with a high birth rate generally have more access, and population density is negatively associated with UGS access. The findings not only indicate that Harbin has an uneven distribution and disproportionate provision of UGS for urban residents but also identify which areas and population groups within the city are disadvantaged in access to UGS and thus provide suggestions for future construction and provision of UGS.


2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Gang Cheng ◽  
Simin Jiang ◽  
Tao Zhang

In small, underdeveloped Chinese cities, the travel needs of economically disadvantaged residents have not been satisfactorily met for a long time, and thus, the problem of travel inequality has become increasingly serious. This study developed and applied a fuzzy multidimensional assessment approach of travel deprivation to assess the travel deprivations that arise because of this travel inequity. The resulting model includes both monetary and nonmonetary indicators, and involves multiple measurement items, dimensions, and related weights. Then, this fuzzy multidimensional assessment approach of travel deprivation is used to measure the travel deprivation in the underdeveloped, small city of Lhasa, China. The results identified both differences and similarities between different parts of the city. Among all measured dimensions, the following four dimensions cause strong travel deprivation: disposable income, travel service quality, travel time, and available transportation. Differences in the travel deprivation were identified between different parts of Lhasa, indicating multidimensional travel deprivation. Furthermore, an early warning analysis on travel deprivation and an assessment of different levels of residents’ travel deprivation in underdeveloped cities are presented. These findings provide an effective evaluation of the current situation of travel inequity in underdeveloped small cities.


2016 ◽  
pp. 15
Author(s):  
Mariana Giaretto ◽  
Victoria Naffa

ResumenEn este trabajo analizamos las relaciones entre tomas de tierras y Estado, en elAlto Valle de Río Negro en Argentina. En un contexto general de especulacióninmobiliaria, por la que se encarecen los precios de alquileres y terrenos, y depolíticas de vivienda selectivas y acotadas, los sectores populares acceden aun espacio en la ciudad mediante tomas de tierras. Frente a estos conflictos,el Estado, en sus diferentes niveles y poderes, despliega una forma deintervención basada en la criminalización de las luchas por tierra y vivienda.Al mismo tiempo, el poder ejecutivo nacional crea la Secretaría de Acceso alHábitat, para posibilitar la intervención política orientada a la regularizaciónde los asentamientos. Sin embargo, esta intervención tiende a reinscribir laproblemática habitacional en el campo político, para reducirla a un conflicto“entre partes”, eludiendo la responsabilidad estatal.Desde un enfoque metodológico cualitativo, seleccionamos como referenteempírico el caso del asentamiento de Villa Obrera en Fiske, Menuco (Gral.Roca), y las técnicas de recolección de datos se basan en fuentes secundarias,como expedientes judiciales y normativa, y en fuentes primarias como son losrelatos de los protagonistas mediante entrevistas individuales y colectivas.Palabras clave: tomas de tierras, Estado, criminalización de los conflictos.Conflicts caused by land occupation and modesof State intervention: analysis of an experience ofAlto Valle in Río Negro (Argentina)AbstractThis paper analyzes the relationship between State and land occupation,at Alto Valle in Río Negro, Argentina. In a general context of real estatespeculation, where rents and land prices are expensive, and a policy ofselective and limited housing, popular sectors can have access to a spacein the city through land occupation. In front of these conflicts, the Statein its different levels and powers, displays a form of intervention basedon the criminalization of struggles for land and housing. At the sametime, the national executive creates the Secretariat of Access to Habitat,oriented to allow political intervention for the regularization of settlements.However, this intervention tends to re-register the housing problems in thepolitical arena, reducing it to a conflict “between parties” and eluding theresponsibility of the State.From a qualitative methodological approach, we selected as empirical referencethe case of the settlement of Villa Obrera in Fiske, Menuco (GeneralRoca). The techniques of data collection are based on secondary sources, suchas policy and legal records, and primary sources as the stories of protagoniststhrough individual and collective interviews.Keywords: land occupation, State, criminalization of conflicts.Conflitos sobre ocupações de terras e modos deintervenção do estado: análise de uma experiênciado Alto Valle do Rio Preto (Argentina)ResumoEste trabalho analisa as relações entre a posse de terra e o Estado, no AltoValle do Rio Preto, na Argentina. Num contexto geral da especulaçãoimobiliária, por qual se encarecem os preços do aluguel e das terras, e depolíticas de habitação seletivas e limitadas, os setores populares acedem aum espaço na cidade através de ocupações de terras. Frente a estes conflitos,o Estado, em seus diferentes níveis e poderes, desenvolve uma forma deintervenção com base na criminalização das lutas pela terra e vivenda. Aomesmo tempo, o poder executivo nacional cria a Secretaria de Acesso àHabitat para possibilitar à intervenção política orientada a regularização dosassentamentos. No entanto, esta intervenção tende a registrar os problemasde habitação no campo político, para reduzi-la a um conflito “entre aspartes”, iludindo a responsabilidade do Estado.A partir de uma abordagem metodológica qualitativa, foi selecionado comoreferência empírica o caso do Assentamento de Villa Obrera em Fiske,Menuco (Gral. Roca), e as técnicas de recolecção de dados são baseados emfontes secundárias, como expedientes judiciais e normativos, e em fontes primárias como são as histórias dos protagonistas através de entrevistasindividuais e coletivas.Palavras-chave: tomada de terras, Estado, criminalização dos conflitos.


2020 ◽  
Vol 25 (1) ◽  
pp. 135-149
Author(s):  
Jan Siegemund

AbstractLibel played an important and extraordinary role in early modern conflict culture. The article discusses their functions and the way they were assessed in court. The case study illustrates argumentative spaces and different levels of normative references in libel trials in 16th century electoral Saxony. In 1569, Andreas Langener – in consequence of a long stagnating private conflict – posted several libels against the nobleman Tham Pflugk in different public places in the city of Dresden. Consequently, he was arrested and charged with ‘libelling’. Depending on the reference to conflicting social and legal norms, he had therefore been either threatened with corporal punishment including his execution, or rewarded with laudations. In this case, the act of libelling could be seen as slander, but also as a service to the community, which Langener had informed about potentially harmful transgression of norms. While the common good was the highest maxim, different and sometimes conflicting legally protected interests had to be discussed. The situational decision depended on whether the articulated charges where true and relevant for the public, on the invective language, and especially on the quality and size of the public sphere reached by the libel.


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