Accessibility Analysis And Layout Optimization Of Urban Medical Institutions

As an indispensable part of urban public infrastructure,medical institutions play an important role in safeguarding residents’ health and undertaking social medical and health services,etc.Their reasonable layout can make full use of limited medical resources and effectively reduce social costs,while the reality reflects that many urban medical institutions have unbalanced layout in space,which needs to be scientifically optimized in order to meet the diversified demand for medical care.In this study,the accessibility of medical institutions and the parity of medical services are analyzed,and the layout of the medical shortage areas is optimized by adding new medical institutions,taking the major urban areas of Nanjing as an example.The service area of medical institutions in major urban areas was first constructed using the service area analysis method,and the accessibility was measured by Gaussian two step floating catchment area method.The results of the service area analysis method show that within a 30 minutes drive,secondary and higher-rated hospitals are able to cover approximately 77% of the sub-districts in major urban areas.The accessibility measures showed that for the general medical needs of residents,i.e.,accessibility within 30 and 60 minutes of driving,the accessibility values were generally higher for sub-districts in the central city,and lower for sub-districts in the peripheral areas;for the emergency medical needs of residents,i.e.,accessibility to tertiary hospitals within 15 minutes of driving,the results showed that about 60% of the sub-districts could not receive emergency medical assistance from tertiary hospitals in a timely manner.Next,the global Moran index and local Moran index were used to study the parity of medical services in the major urban areas of Nanjing.The results of the global Moran index for both secondary and tertiary hospitals were positive,indicating the existence of global autocorrelation in the accessibility values of medical institutions in major urban areas,where the global Moran index value for secondary hospitals accessible within 30 minutes was 0.5639,and the global Moran index values for tertiary hospitals accessible within 15,30 and 60 minutes were 0.7507,0.7358 and0.4510,respectively,reflecting the characteristics of clustering distribution of medical services in general.The calculation of the local Moran index shows that the high-high type agglomerations are mainly distributed in the sub-districts of the central city,the low-low type agglomerations are mainly distributed in the sub-districts of the peripheral areas,and the high-low and low-high type agglomerations are less.The above results indicate that the spatial distribution of medical services received by the residents is uneven,with the residents in the sub-districts of the central area receiving better medical services and the residents in the sub-districts of the peripheral areas receiving poorer medical services.Finally,the results of the minimization impedance analysis,combined with the findings of the accessibility and parity analyses,were used to identify the medical shortage areas in the major urban areas of Nanjing and to optimize them by building new hospitals in the medical shortage areas.The results showed that the sub-districts in the northern part of Liuhe District,the southern part of Jiangning District and the southwestern part of Pukou District are areas with medical shortage,and a new secondary general hospital is proposed in the southwestern part of Pukou District,and a new tertiary general hospital is proposed in the northern part of Liuhe District and the southern part of Jiangning District,respectively.The accessibility was recalculated after the new hospitals were added and it was found that the accessibility level was improved overall.