Assessing the Impacts of Hierarchical Healthcare System on the Accessibility and Spatial Equality of Healthcare Services in Shenzhen, China

Abstract

The hierarchical healthcare system is widely considered to be a desirable mode of the delivery of healthcare services. It is expected that the establishment of a hierarchical healthcare system can help provide better and more equal healthcare accessibility. However, limited evidence has been provided on the impacts of a hierarchical healthcare system on healthcare accessibility. This study develops an improved Hierarchical two-step floating catchment area (2SFCA) method, which incorporates variable catchment area sizes, distance friction effects and utilization efficiency for facilities at different levels. Leveraging the Hierarchical 2SFCA method, various scenarios are set up to assess the accessibility impacts of a hierarchical healthcare system. The methods are applied in a case study of Shenzhen. The results reveal significant disparity and inequality in healthcare accessibility and also differences between various facility levels in Shenzhen. The overall healthcare accessibility and its equality can be significantly improved by fully utilizing existing facilities. It is also demonstrated that allocating additional supply to lower-level facilities can generate larger accessibility gains. Furthermore, allocating new supply to primary facilities would mitigate the inequality in healthcare accessibility, whereas inequality tends to be aggravated with new supply allocated to tertiary facilities. These impacts cannot be captured by traditional accessibility measures. This study demonstrates the pivotal role of primary facilities in the hierarchical healthcare system. It can contribute to the literature by providing transferable methods and procedures for measuring hierarchical healthcare accessibility and assessing accessibility impacts of a hierarchical healthcare system in developing countries.

Spatial accessibility of continuous maternal and perinatal healthcare services in Mozambique

“…Such remarkable achievements can be largely attributed to constant efforts made by the Chinese government on the promotion of primary health care (PHC), along with the implementation of other strategies towards the optimization of the hierarchical healthcare delivery system intended for maternal and child healthcare. For example, integrated service packages delivered via collaborative efforts of tertiary hospitals and primary maternal care institutions proved to be an effective solution to strengthening the capacity of local healthcare facilities as well as their corresponding referral systems, which resulted in increased in-hospital births and signi cantly reduced maternal mortality 39,41,42 . In addition to the provision of training programs to cultivate highly-skilled healthcare professionals among local healthcare facilities, strategies to address the accessibility and inequity issue should also consider the adoption of information technologies for those living in remote areas, such as mobile clinics, mobile emergency services or telemedicine applications for routine check-ups 43 .…”

Evaluation of the spatial equality of the medical service function from the perspective of the life circle：A case study of Chengdu City

“…(2) Number of beds and accessibility. This subsystem refers to the convenience, quantity and quality of specific service that the medical facility supplies to people in life circle, which relies on the spatial distribution and level of medical facility [7,16]. These two subsystems constitute the supply side of the medical service function.…”

“…The equality assessment of medical services involves the spatial matching of medical service providers and service demand objects [16]. In terms of the medical service providers, there are two main issues that need to be addressed: the service capacity of the medical resources and the convenience of the location of the medical facilities [17,18].…”

“…In recent years, the government has committed to establishing a three-level and nine-grade medical system, including primary (level I), secondary (level II), and tertiary levels (level III) 1 , each of which contains three grades, that is, A, B, and C. The service capacity of each level affects fundamentally the equality of medical resources. Studies have focused on the differences in the spatial equality of such graded medical facilities, such as the works of Tao who evaluated the spatial equality of tertiary medical facilities in Shenzhen [16], and Xu who evaluated the spatial equalization of tertiary medical facilities in Shanghai [18]. The superiority of the spatial location of medical facilities is usually expressed by accessibility (and/or convenience), which is the most commonly used indicator for measuring the convenience for people to have opportunities to access services in the region [21][22][23].…”

Analysis of Healthcare Seeking Behavior Among Patients Visiting Public Primary and Secondary Healthcare Facilities in an Urban Indian District

“…HSB is considered to be an outcome of the complex interaction between the patient’s illness condition and their socioeconomic and demographic characteristics as well as the quality, availability, and accessibility of healthcare services (Deolia et al 2020). Healthcare facilities are organized in a hierarchical manner across the globe, including in India, wherein lower level facilities provide treatment for common ailments of mild and moderate severity, while higher level facilities mainly focus on specialized care and illnesses of high severity to ensure equitable access to medical services (Tao & Han, 2021). In a hierarchical system, patients are typically assigned a nearby primary healthcare facility for initial visits, and then referred to higher level facilities as required.…”