低收入人群公共医疗服务设施空间公平性测度——以广州中心城区为例

Spatial Equity Measurement of Public Medical Service Facilities for Low-income Populations:A Case Study of the Central City Area in Guangzhou

公共医疗服务设施为城市居民的生活和发展提供必要的资源和服务,对保障低收入人群健康具有关键作用。通过百度慧眼人口画像数据和公共医疗服务设施数据,刻画广州中心城区低收入人群和公共医疗服务设施空间分布模式。在此基础上,创新采用到达不同等级的公共医疗服务设施的不同出行模式及其引发的出行时间作为衰减系数的重要考虑因素,借助格网化高斯两步移动搜索法,构建公平性模型进行量化研究。结果表明:(1)低收入人群集聚在劳动密集型产业区周边和租金低廉住房区域。(2)公立医院的空间分布呈现出分散多中心格局;政府办基层医疗机构空间分布呈现集聚多中心格局。(3)总体而言,广州中心城区低收入人群公立医院空间公平性较好,呈现圈层结构的空间分布模式,与公共交通线路的空间分布具有一定的耦合关系。(4)广州中心城区低收入人群政府办基层医疗机构空间公平性仍然有待提高,呈现一主多次的空间分布模式,与政府办基层医疗机构设施资源非均质的空间分布相关。建议:(1)优化政府办基层医疗机构及资源的空间布局以提高其公平性;(2)完善公共交通系统以提高公立医院空间公平性;(3)加强空间公平性视角的城市公共医疗服务设施地方配置研究。

Realizing the equalization of public medical service facilities,improving the accessibility of facilities,and meeting concerns for the basic medical service needs of disadvantaged groups(e.g.,low-income groups)are the inevitable requirements for planning to promote the fair allocation of medical resources and improve the quality of life of residents.Currently,in order to construct a health city,alleviate the mismatch of supply and demand in public medical services,and promote social equality,two actions must be performed:analysis of the degree of matching between urban public medical service facility supply,spatial layout,and demands of low-income groups,and discussing the fairness of public medical service facilities orienting to low-income groups.In this study,an equity model was constructed based on the raster Gaussian twostep floating catchment area method,and the equity index was calculated based on the supply capacity of public medical service facilities,degree of demands of low-income groups,commuting mode,travel time cost,accessibility,and so on.Results show that:(1)low-income groups have a significant positive autocorrelation in spatial distribution,indicating their spatial aggregation effect.Low-income groups are primarily distributed around labor-intensive industrial zones and low-rent housing areas.The spatial distribution mode of low-income groups may be related to employment needs and rental prices.(2)The spatial distribution of public hospitals showed a decentralized polycentric pattern,while the spatial distribution of government-run primary medical institutions presents an agglomerative polycentric spatial pattern,with significant spatial heterogeneity.(3)The spatial equity of public hospitals for low-income groups in the central city area of Guangzhou shows obvious spatial differentiation characteristics and forms a circular spatial distribution pattern.It has a certain coupling relationship with the spatial distribution of public transport lines.(4)The spatial equity of governmentrun primary medical institutions for low-income groups in the study area is characterized by a primary center and multiple sub-centers,mainly manifested as the mismatching between the heterogeneous spatial distribution of facilities resources and distribution of lowincome groups.The overall spatial equity needs to be improved.The spatial distribution modes of low-income groups,public hospitals,and government-run primary medical institutions in the study area were analyzed by spatial autocorrelation analysis,hotspot analysis,and kernel density analysis.Moreover,a quantitative analysis of the spatial equity of public medical service facilities was carried out using the grid-Gaussian twostep floating catchment area method.Compared with previous research,this study provides innovations in its quantitative analysis of the spatial equity of public medical service facilities.The commuting modes to public medical service facilities and the travel time were viewed as important factors of attenuation coefficients from the perspective of low-income groups.This study can help urban public health officials and relevant decision makers in allocating public health resources and formulating medical policies.It offsets the insufficient considerations made by previous studies with respect to the social equity of low-income groups.Some suggestions were proposed:(1)the spatial distribution of government-run primary medical institutions and resources should be optimized to improve equity;(2)the public transport system should be further developed to improve the spatial equity of public hospitals;and(3)research on the local allocation of urban public health service facilities from the perspective of spatial equity should be strengthened.