新建三级医院选址时空变化特征及指标体系评价——京津冀地区的实证研究

Temporal and spatial characteristics and evaluation of index system for new tertiaryhospital site selection:An empirical study in the Jing-jin-ji Metropolitan Region

我国医疗资源整体呈现城乡分布不均,优质资源过度集中的特点。随着医疗资源布局的优化调整,许多位于城市中心的三级医院于市郊进行新建项目建设,选址成为首要面对的问题。通过元分析法从研究对象、方法及指标三方面进行文献计量研究,提出医院选址流程与方法。其后以京津冀地区的北京、天津、石家庄三市为例,分析2005年至今新建三级医院选址时空变化特征,进而构建医院选址指标体系,应用GWR模型进行统计检验。研究发现:第一,我国医院选址指标体系可归纳为六类一级指标,涵盖人口分布、交通可达性、现有医疗资源分布、场地条件及十六项二级指标;第二,三市三级医院总体呈现溢出效应,变迁特点可按选址区域不同归纳为“三级跃迁模式”,评价体系对于中心城区以外区域选址医院解释度更高;第三,以交通设施便捷性与现有医疗资源布局为代表的基础设施完备程度以及土地成本的合理性对于三级医院选址有重要影响。研究以期为未来更多医院选址和区域内医疗资源布局提供参考。

Background:With the acceleration of urbanization in China,the urban population is surging,leading to the increased demand for medical services.The overall distribution of medical resources in China shows an imbalance between urban and rural areas,with an over-concentration of high-quality resources.Along with the Strategy of Healthy China,it is urgent to optimize the layout of medical resources.Many tertiary hospitals,traditionally located in the city downtown areas,are undertaking new construction or relocation projects in suburban areas,making site selection the primary problem to face.Method:Firstly,the meta-analysis and bibliometric analysis are applied.Using“hospital”and“site selection”as the keywords for literature retrieval on CNKI,a total of 21 empirical studies related to the optimization of hospital site selection and layout published in recent 15 years(2008-2023)are identified.The current states of hospital site selection studies are analyzed,and quantitative statistical indicators affecting hospital site selection are selected to construct the evaluation index system.The hospital site selection process and method selection guidance is summarized.Then,taking three cities of Beijing,Tianjin,and Shijiazhuang from the Jing-Jin-Ji Metropolitan Region as examples,the study analyzes the spatial and temporal characteristics of site selection of new tertiary hospitals(also including the different forms such as relocation,return relocation,and listed cooperation)from 2005 to the present.Finally,the Geographically Weighted Regression model is used to verify the evaluation index system and analyze the key indicators for hospital site selection.Results:(1)Studies on hospital site selections were mostly concentrated in Beijing and the southern regions with well-developed economics,while less focused on small and medium-sized cities.Most studies focused on hospitals above the first level,employing a variety of qualitative and quantitative methods,often aiming for the maximum utility,and have not formed a dominant algorithm for the site selection.(2)The hospital site selection index system in China could be summarized into six first-level indicators,covering population distribution,traffic accessibility,distribution of existing medical resource,site conditions,and sixteen second-level indicators.(3)The overall trend of tertiary hospitals in the three cities of Jing-Jin-Ji metropolitan Region showed an overflow effect,and the characteristics of change could be described as a“three-level leapfrogging model”according to different site selection areas,showing a trend of expansion from the central urban areas to the peripheral parts.The new tertiary hospitals in Beijing mainly expanded to peripheral areas such as the district of Changping,Tongzhou,and Daxing,while those in Tianjin focused on the Binhai New Area,and those in Shijiazhuang were mostly concentrated in the eastern part of the central area.(4)The evaluation index had a higher explanatory power for site selection of hospitals outside the central urban areas.The completeness of infrastructure represented by the convenience of transportation facilities,the layout of existing medical resources,along with the rationality of land costs,played a significant impact on the site selection of tertiary hospitals,while the population size was not a significant factor.Conclusion:This study provides scientific indicator selection and decision support for the site selection of tertiary hospitals.Future study should be expanded to more cities across the country,applying big data to predict the distribution of healthcare demand,and introducing more qualitative and quantitative indicators to improve the equity and effectiveness of medical resources.This study provides a significant reference for future hospital site selection,the allocation of medical resources,and the establishment of healthy cities.