Assessing the spatial accessibility of hospital care in Sichuan Province, China

Pan, Jay; Liu, Huiran; Wang, Xiuli; Xie, Hongfu; Delamater, Paul L.

doi:10.4081/gh.2015.384

Cited by 46 publications

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“…The socio-economic and demographic characteristics of the two regions in Table 1 suggest that minority area is larger, has a lower GDP per capita, less urbanisation rate, fewer highway per land and much sparsely populated than the non-minority area in 2014. The average travelling time to the nearest hospital (ATH) was calculated per a shortest-path analysis method [ 21 ]. The ATH of minority counties in 2012 with a mean at 84.5 min and standard deviation (SD) at 33.6 was significant disadvantages ( p < 0.001) than that of non-minority counties (mean = 42.6, SD = 18.5).…”

Section: Resultsmentioning

confidence: 99%

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

et al. 2017

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BackgroundThe maternal mortality rate (MMR) markedly decreased in China, but there has been a significant imbalance among different geographic regions (east, central and west regions), and the mortality in the western region remains high. This study aims to examine how much disparity in the health system and MMR between ethnic minority and non-minority counties exists in Sichuan province of western China and measures conceivable commitments of the health system determinants of the disparity in MMR.MethodsThe MMR and health system data of 67 minority and 116 non-minority counties were taken from Sichuan provincial official sources. The 2-level Poisson regression model was used to identify health system determinants. A series of nested models with different health system factors were fitted to decide contribution of each factor to the disparity in MMR.ResultsThe MMR decreased over the last decade, with the fastest declining rate from 2006 to 2010. The minority counties experienced higher raw MMR in 2002 than non-minority counties (94.4 VS. 58.2), which still remained higher in 2014 (35.7 VS. 14.3), but the disparity of raw MMR between minority and non-minority counties decreased from 36.2 to 21.4. The better socio-economic condition, more health human resources and higher maternal health care services rate were associated with lower MMR. Hospital delivery rate alone explained 74.5% of the difference in MMR between minority and non-minority counties. All health system indicators together explained 97.6% of the ethnic difference in MMR, 59.8% in the change trend, and 66.3% county level variation respectively.ConclusionsHospital delivery rate mainly determined disparity in MMR between minority and non-minority counties in Sichuan province. Increasing hospital birth rates among ethnic minority counties may narrow the disparity in MMR by more than two-thirds of the current level.Electronic supplementary materialThe online version of this article (10.1186/s12889-017-4765-y) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

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“…Other studies have shown that children and adolescents from non-agricultural families have regular oral hygiene habits compared with agricultural families. 24 30 The spatial accessibility in relation to the population distribution and transportation infrastructure affects access to healthcare. 22 44 …”

Section: Discussionmentioning

confidence: 99%

“… 23 The province suffers from inequalities in the level of economic development and distribution of healthcare resources. 24 The cross-sectional national survey was conducted from December 2015 to May 2016 by the Department of Preventive Dentistry, West China Hospital of Stomatology, Sichuan University. A four-stage stratified random-cluster survey sampling method was adopted to obtain a representative sample of the residents in Sichuan Province based on the number of permanent residents and non-agricultural population ratio obtained in the 2010 Sixth National Population Census.…”

Section: Methodsmentioning

confidence: 99%

Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: a cross-sectional study

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ObjectivesAs a vulnerable group, the elders’ oral health gained less attention, particularly the relationship between socioeconomic status (SES) and dental caries. This study aimed to assess the associations and to explore the effects of confounders on the associations in elderly people.DesignCross-sectional study.Settings3 neighbourhood committees and 3 village committees in Sichuan Province, China.Participants744 people (362 men and 382 women) aged 65–74 years were included.Outcome measuresOral health outcomes included the decayed, missing and filled teeth (DMFT) index and its components. SES was assigned by educational level, household income and type of household. The bivariate association between the participants’ characteristics and DMFT was analysed using non-parametric tests. Four logistic regression models were used to analyse the associations between SES and dental caries by regulating confounders.ResultsPoor oral health was observed in these participants. Bivariate analysis showed a significant association between SES and DMFT (p﹤0.05). Only adjusting gender, high educational level (adjusted (AOR)=0.34, 95% CI 0.17 to 0.66), high household income (AOR=0.47, 95% CI 0.41 to 0.77) were protective factors against dental caries, and living in agricultural families (AOR=1.86, 95% CI 1.32 to 2.63) was risk factor (p﹤0.05). After adjusting other confounders, SES was partly related to the dental caries. Moreover, an interaction existed among SES indicators.ConclusionsSES is associated with dental caries, and older people with low SES have poor oral health. The associations were explained partly by diet, behaviour and awareness. Our results provide effective evidence in targeted policy-making and intervention measures and implicate that pertinence measures, economic assistance and medical insurance funds should be provided to older people of low SES. Furthermore, a follow-up design should attempt to confirm the causal relationship between SES and dental caries and evaluate the effect of intervention.

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“…According to China’s Statistical Yearbook of Health, nearly 60 % of outpatient and emergency treatment, and more than 70 % of inpatient treatment was provided by hospitals in 2012. Hence, differences in spatial access to hospitals represent a considerable barrier to the government’s equity goals: in 2010, 34.6 % of rural respondents to a national survey (83.87 million people) cited distance as a major barrier in getting timely hospital treatment versus only 1.37 % of urban residents [ 11 ]. Ethnic minorities are particularly vulnerable to such inequalities, since many live in remote, rural regions.…”

Section: Introductionmentioning

confidence: 99%

Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China

Wang¹,

Pan

2016

BMC Health Serv Res

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BackgroundThere is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future.MethodsSichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment.ResultsIn Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region.ConclusionsThe combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

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Assessing the spatial accessibility of hospital care in Sichuan Province, China

Cited by 46 publications

References 28 publications

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Disparities in health system input between minority and non-minority counties and their effects on maternal mortality in Sichuan province of western China

Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: a cross-sectional study

Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China

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