基于可达性的医共体空间组织研究——以西藏林芝市为例

Spatial Organization of Medical Alliances Based on Accessibility:A Case Study of Linzhi City,Tibet

医疗联合体建设是我国医疗卫生制度改革的重点,也是促进基本医疗服务均等化的重要举措。研究县域医疗共同体的空间组织并分析其服务效率对合理配置基层医疗资源具有重要意义。以西藏林芝市为例,考虑自然环境和道路特征,采用累计成本距离算法测算就医可达性,以此为依据将林芝市划分为7个医共体,并对其服务效率进行评价。结果表明:(1)一级医院可达性远高于二、三级医院,1 h圈覆盖村居点达81%。(2)7个医共体的规模差异较大,波密县医共体内的一级医院最多,有12家,米林县医共体仅有5家一级医院。(3)三级医院对各医共体的服务效率差异较大,察隅县和墨脱县的三级医疗服务稀缺;工布江达县一级医院的加权平均可达性较低,说明人均执业(助理)医师相对不足。(4)察隅县与墨脱县的综合加权可达性较低,总体医疗服务较为薄弱。

Taking Linzhi City as an example,an empirical analysis is carried out on the spatial organization of medical alliances based on the spatial accessibility considering the physical environment and transportation system.Linzhi is delineated into seven medical alliances,and the service efficiency within the medical alliances is evaluated and compared.The results show that:(1)The accessibility of primary hospitals is much higher than that of secondary and tertiary hospitals,covering about 81%of residential points within one hour.(2)The medical resources of the seven medical alliances varies greatly.The medical alliance of Bomi is consisted of 12 primary hospitals,while the medical alliance of Milin is consisted of 5 primary hospitals.(3)The efficiency of tertiary medical service varies greatly among the medical alliances,Chayu and Motuo are lack of accessibility to the tertiary hospital.The average weighted accessibility of primary hospitals in Gongbujiangda is low,indicating a relative shortage of licensed doctors per capita.(4)The overall weighted accessibility of Chayu and Motuo is low,and the medical services are inadequate.