分级诊疗能否促进空间平等?——基于上海市公共医疗服务可达性的情景分析

DOES HIERARCHICAL DIAGNOSIS AND TREATMENT SYSTEM FACILIATE THE SPATIAL EQUALITY? A SCENARIO ANALYSIS OF THE ACCESSABILITY OF PUBLIC MEDICAL FACILITIES IN SHANGHAI

转型期中国城市社会空间经历剧烈重塑,不平衡不充分发展也体现在城市内部空间。充分的实证研究有助于理解抽象的城市内部空间平等议题,为决策提供科学参考。本研究从空间平等视角出发,以上海市为案例,结合分级诊疗情景模式,在人口、医疗设施信息、POI等数据基础上,借助两步移动搜索法评估以医疗资源为代表的公共服务可达性状况;并采用多种不平等指数测算不同城市居民面临的可达性差异。研究表明,分级诊疗模式可显著提高上海市医疗资源在全域覆盖的程度,缓解了中心城区和郊区之间的空间不平等状况。然而,这种“政策的红利”往往被优势群体所吸纳,而以移民、低学历者、工人以及租房居民为代表的弱势群体,他们的可达性却无显著改善。

The social space of urban China has been experiencing dramatic reconstruction in the transitional period, this is also a microcosm of the unbalanced and inadequate development in urban space. Complete empirical research will be helpful to facilitate the understanding of an abstract issue regards to the intra-city spatial equality, which further provides scientific consulting for decision making. Based on population, POI,medical facilities information and other sources of data, this paper takes Shanghai as a case and brings the scene of the hierarchical diagnosis and treatment system together, to assess the accessibility of medical facilities by the two-step floating catchment area method, and calculates the disparities of accessibility among different groups. The results indicate that the hierarchical diagnosis and treatment system has improved the extent of medical service coverage of the whole Shanghai greatly, and alleviated the imbalanced status between the central city and the suburbs significantly. However, the so-called "policy dividend" is usually be helpful for the socially advantaged groups;as for the marginal groups, such as the migrants, low educated group,manufacturing workers, and renters, their unequal status has no significant changes.