Spatial accessibility of primary health care in China: A case study in Sichuan Province

Wang, Xiuli; Yang, Huazhen; Duan, Zongshuan; Pan, Jay

doi:10.1016/j.socscimed.2018.05.023

Cited by 180 publications

(187 citation statements)

References 35 publications

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“…With the rapid development of urbanization and the evolution of the urban spatial structure, the mismatch between the growing needs of people and uneven infrastructure development has become the main contradiction in Chinese society. Accurate assessment of the current distribution of hospital facilities is crucial for understanding and solving existing injustices [16]. Therefore, researchers are paying increasing attention to the accessibility of hospital facilities and the socio-spatial problems caused by it [17,18].…”

Section: Introductionmentioning

confidence: 99%

Spatial Accessibility to Hospitals Based on Web Mapping API: An Empirical Study in Kaifeng, China

et al. 2019

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The accessibility of hospital facilities is of great importance not only for maintaining social stability, but also for protecting the basic human right to health care. Traditional accessibility research often lacks consideration of the dynamic changes in transport costs and does not reflect the actual travel time of urban residents, which is critical to time-sensitive hospital services. To avoid these defects, this study considered the city of Kaifeng, China, as an empirical case, and directly acquired travel time data for two travel modes to the hospital in different time periods through web mapping API (Application Program Interface). Further, based on travel time calculations, we compared five baseline indicators. For the last indicator, we used the optimal weighted accessibility model to measure hospital accessibility for each residential area. The study discovered significant differences in the frequency and spatial distribution of hospital accessibility using public transit and self-driving modes of transportation. In addition, there is an imbalance between accessibility travel times in the study area and the number of arrivals at hospitals. In particular, different modes of transportation and different travel periods also have a certain impact on accessibility of medical treatment. The research results shed new light on the accessibility of urban public facilities and provide a scientific basis with which local governments can optimize the spatial structure of hospital resources.

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Section: Introductionmentioning

confidence: 99%

Spatial Accessibility to Hospitals Based on Web Mapping API: An Empirical Study in Kaifeng, China

et al. 2019

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“…Moreover, we found an obvious regional disparity in spatial accessibility to county hospital exist across the Shaanxi Province. This disparity should be taken seriously, the regional disparities of spatial accessibility were also observed at primary health institutions in Sichuan Province and public hospitals in Beijing City [10,12]. Regional variations are also commonly existed in the world.…”

Section: Discussionmentioning

confidence: 97%

“…These studies find that the distribution of hospital beds at the county level has been highly spatially clustered [9]. There has been gaps of spatial access to primary health care within Sichuan Province in China [10], 69% of villages have lower spatial accessibility of health services comparing with the average of the county in Jiangsu Province [11], spatial accessibility of public hospitals in Beijing was improved by referral reform that was launched at 2015 and increased the inequality of access to medical resources between towns and streets [12]. Second, some studies have implemented various methods to evaluate the feasibility of using these methods to measure special accessibility.…”

Section: Introductionmentioning

confidence: 99%

“…China's health care delivery system showing an urban-rural dual structure, three-tier health care delivery system plays the most important role of providing accessible and sustainable basic health services in rural areas of China [1,10]. County-level hospitals are the highest level of health care institutions in the county regions, the appropriate accessibility to county-level hospitals is an important prerequisite for the guarantee of rural residents' health [15].…”

Section: Introductionmentioning

confidence: 99%

“…The commonly used methods to measure residents' spatial accessibility to public services are provider-to-population ratios (PPR), nearest-neighbor analysis (NNA), two-step floating catchment area (2SFCA) and a series of modified methods [3,10,[17][18][19]. There are two problems in the measurement of spatial accessibility: i) identification of the population distribution, ii) accurate calculation of time and distance between the residential areas and the health care institutions.…”

Section: Introductionmentioning

confidence: 99%

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Measuring spatial accessibility and disparity to county hospitals in western China: based on the web map navigation data

Shen

Zhou

Lai

et al. 2020

Preprint

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Background The Chinese government proposed the initiative of "XIAO BING BU CHU CUN, DA BING BU CHU XIAN” in 2016, which means the rate of health care service provided by county hospitals should reach 90%. The prerequisite for achieving this goal is that residents can access to county hospitals’ services conveniently and impartially. However, little research reported the level of spatial accessibility of county hospitals in western China. Therefore, we aim to measure the spatial accessibility to county hospitals of county residents and identify regional disparities in Shaanxi Province in western China. Methods We implemented a novel method – navigation data of the AutoNavi map (knows as Gaode map in Chinese) – to assess time and distance from villages and neighborhoods to county hospitals. The navigation data was collected by requesting an application-programming-interface using a web crawler in Python. The minimum driving time and distance were extracted from the navigation data. The travel impedance to the nearest provider was used to measure spatial accessibility. Results The results show that county residents in northwestern China's Shaanxi Province have poor spatial accessibility to county hospitals. Only 68.8% of villages and neighborhoods can reach the county hospitals within 60 minutes, while 13.4% of them are reachable beyond 90 minutes. Moreover, a significant within-province disparity exists, with residents in the central area most accessible to county hospitals, while the north and south areas still need improvement. Conclusions Health resource planning is required to improve spatial accessibility and eliminate the regional disparity. Further studies are called for to integrate navigation data of web map with GIS methods to measure spatial accessibility of health facilities in more complex contexts.

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How spatial accessibility to colonoscopy affects diagnostic adherences and adverse intestinal outcomes among the patients with positive preliminary screening findings

et al. 2020

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Background Colonoscopy is an important procedure for early colorectal cancer (CRC) detection, however, patients with positive preliminary screening results in China may not seek for colonoscopy to confirm the diagnosis. We evaluated the spatial accessibility of colonoscopy among the residents with positive preliminary screening results in Guangzhou, China, and investigated how colonoscopy accessibility was associated with the population adherence and adverse intestinal outcomes. Methods This study was based on the Guangzhou community‐based CRC screening program. Spatial accessibility was measured using three metrics including travel time from home to nearest colonoscopy hospital, physician‐to‐population ratio (PPR) and accessibility indicator estimated with enhanced two‐step floating catchment area method (E2SFCA). We used Cox regression and logistic regression to assess the association of colonoscopy accessibility with population adherence and adverse intestinal outcomes, respectively. Results A total of 34 606 people were identified with positive preliminary screening findings. Central areas were reported with higher E2SFCA scores, higher PPR and less travel time. The model adjusting for potential individual level confounders found that PPR > 50 (Hazard Ratio (HR) = 1.88, 95% Confidence Interval (CI): 1.79‐1.97) and higher scores of E2SFCA (HR = 3.78, 95% CI: 2.07‐6.92) were associated with increased adherence, although estimates were not significant in the model adjusting for both individual and district‐level confounders. For adverse intestinal outcomes, the final multilevel logistic model suggested a lower risk of intestinal lesions among the residents in areas with PPR > 50 (Odds Ratio (OR) = 0.49, 95% CI: 0.24‐0.99) and higher scores of E2SFCA (OR = 0.20, 95% CI: 0.05‐0.82). Conclusion Significant inequality of colonoscopy accessibility was observed across Guangzhou. The increased incidence of intestinal lesions was associated with spatial inequalities of medical resources. Policies against the spatial inequality in medical resources should be developed.

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Spatial accessibility of primary health care in China: A case study in Sichuan Province

Cited by 180 publications

References 35 publications

Spatial Accessibility to Hospitals Based on Web Mapping API: An Empirical Study in Kaifeng, China

Spatial Accessibility to Hospitals Based on Web Mapping API: An Empirical Study in Kaifeng, China

Measuring spatial accessibility and disparity to county hospitals in western China: based on the web map navigation data

How spatial accessibility to colonoscopy affects diagnostic adherences and adverse intestinal outcomes among the patients with positive preliminary screening findings

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