特大城市医疗公共服务可达性的空间格局及其影响因素分析——以上海市为例

Spatial Pattern of Medical Public Services Accessibility in Megacities and Its Influencing Factors:A Case Study of Shanghai

大城市通常是医疗资源最为丰富的地区,但普遍存在配置不均的问题。精准地衡量城市医疗公共服务的空间异质性、合理规划医疗公共空间,是实现城市稳定健康发展的重要保障。以上海市为例,运用改进两步移动搜索法,从乡镇(街道)尺度测算医疗服务设施的空间可达性,并结合基尼系数和空间自相关分析探究上海市医疗服务设施可达性的空间分异特征,探讨了影响上海市医疗服务资源可达性空间格局的主要因素。研究表明:上海市医疗公共服务可达性自中心城区向郊区逐渐递减;可达性高值区集中在外环线以内及其沿线地区,可达性低值区集中在远郊区。医疗资源呈现向心化集聚,满足了中心城区高密度的人口和体量庞大的老年人口就医需求;中心城区医疗服务资源配置相对均衡,可达性差异较小,而郊区医疗服务的可达性差异较大;上海市医疗服务可达性空间格局受人口密度和经济发展显著影响,上海市政府医疗财政支付对街道尺度的医疗服务设施空间可达性作用较小。在未来,在城市医疗卫生服务资源配置中注重人口集聚导向,建立医疗卫生人员双向流动的常态化机制是提升上海市医疗公共服务能力,优化城市医疗公共设施可达性的重要方向。

Megacities attract population clusters with high-quality and abundant medical public resources,however,with the rapid increase of population,they are not only facing the pressure of supplying medical service resources,but also the structural problems caused by the unbalanced and unequal spatial allocation of medical service resources.In order to plan the medical services rationally,accurately quantifying the spatial patterns of medical facilities will be helpful to the stable and sustainable development of the medical resource.Taking Shanghai as an example,this paper uses the Optimized Two-step Floating Catchment Area(O-2 SFCA) method to measure the spatial accessibility of medical facilities at the township(street) level.Moreover,we introduce the Gini coefficients and utilize spatial autocorrelation analysis to characterize the spatial differentiation of the accessibility of medical facilities in Shanghai.Finally,we discuss the main factors affecting the spatial differentiation of medical service resources in Shanghai.The accessibility of medical service facilities in Shanghai gradually decreases from the central area to the suburbs.The high accessibility areas are concentrated within the outer ring road,while the low accessibility areas are concentrated in the distant suburbs.In general,medical resources are distributed centripetally in Shanghai.The allocation of medical service resources in the central city is relatively balanced,with lower variation in accessibility,while the accessibility of medical services in the suburbs varies widely.The spatial pattern of medical services accessibility in Shanghai is significantly influenced by the demographic and economic situation,and the centripetal distribution of highquality medical resources meets the needs of the high-density population and the large elderly population in the central city.The medical financial payment of the Shanghai Municipal Government has limited effects on the spatial accessibility of medical service facilities at street-scale.Finally,we put forward relevant suggestions for optimizing the spatial allocation of medical public facilities in Shanghai and improving the capacity of urban medical public services.