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

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。

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.