Spatial Accessibility And Influencing Factors Of Medical Service In Mountainous Cities

At present,with the rapid development of social economy,the living standard of residents has been significantly improved,the medical and health care system gradually tends to be sound and perfect,and the medical resources are increasingly rich.However,there are still some social problems such as unreasonable structure,uneven distribution and insufficient service supply in China’s medical resources,especially in mountainous cities,which is not conducive to the realization of the equalization of public services.Therefore,it is of great significance to explore the spatial distribution of medical and health care resources,discuss the spatial accessibility of residents’ access to medical services,and clarify the influencing factors of spatial accessibility of medical facilities,so as to improve the fairness of residents’ medical treatment and promote the development of urban-rural integration.In this paper,taking the central urban area of Chongqing as an example,the spatial accessibility of medical services is studied,and the influencing factors of medical accessibility are discussed,so as to provide reference for the reasonable layout of medical facilities and the reasonable allocation of medical resources.Based on the data of medical facilities,population,road traffic,elevation and GDP,this paper takes Beibei District of Chongqing as an example to compare the two-step floating catchment area method(2SFCA)and the modified two-step floating catchment area method(M2SFCA).Then,it analyzes the convenience of residents’ daily medical treatment by using the nearest facilities tool of Arc GIS software,evaluates the supply-demand relationship of medical resources with the help of MATLAB software and statistical calculation method,and calculates the spatial accessibility of medical services in the central urban area of Chongqing by using the modified two-step floating catchment area method based on the empirical research and comparative analysis of Beibei District,and discusses its spatial differences,spatial agglomeration,urban-rural differences and other characteristics.Finally,Pearson index,geographically weighted regression model,bivariate local Moran index and geographic detector method are used to explore the influencing factors of spatial accessibility of medical services.The main conclusions are as follows:(1)The modified two-step floating catchment area method has obvious advantages in measuring the accessibility of medical services.In terms of method,the distance attenuation factor,the competition factor between medical facilities resources and the level factor of medical facilities are included in the model,which makes the factors more comprehensive.In terms of calculation results,the M2 SFCA results show more significant characteristics of circle transition in spatial distribution,and it has higher sensitivity in identifying internal differences of high accessibility areas and marginal low accessibility areas;in terms of statistical characteristics,compared with the polarization characteristics of 2SFCA,its standard deviation and other statistical values are slightly less than 2SFCA,showing more uniform distribution characteristics;In comparison with the number of hospital beds per 1000 persons in this study area,it also shows a higher consistency.(2)There is a significant spatial difference in the supply and demand of medical resources.From the perspective of demand,the inpatient service in the central urban area can meet the inpatient demand of most residents,and only 13.70 % of the regional supply and demand imbalance.From the perspective of supply,the proportion of imbalance between supply and demand in all hospitals was 64.99%;among all levels of hospitals,the imbalance between supply and demand in the primary hospitals was the most serious,and the imbalance proportion was more than 80%.Both the secondary hospitals and the tertiary hospitals are in the state of supply and demand balance;except for Banan District,the medical resources in all areas are in the state of supply and demand imbalance.(3)The overall convenience of residents’ medical treatment is relatively high,whether it is the daily ordinary medical treatment or the high-quality medical services of tertiary hospitals,most residents can get more convenient access.Most residents spend less than 90 minutes to go to hospitals at all levels and tertiary hospitals,and the time cost of medical treatment is gradually increasing with Yuzhong District as the core;the proportion of residents who can get daily medical services and tertiary hospital medical services within 30 minutes is more than 90 % and 80 % respectively.(4)The spatial accessibility of medical services is good as a whole,but the spatial difference is obvious.Under the scale of residential area and town(street),the accessibility of medical service shows the characteristics of circle layer transition with Yuzhong District as the core and gradually decreasing to the outer circle.The accessibility of most other areas is average or above,more than 80 % of the residents are distributed in the areas with high accessibility.Under the scale of district,Yuzhong District has the highest accessibility index and Banan District has the lowest.The spatial accessibility of medical services presents obvious characteristics of high-high agglomeration and low-low agglomeration.High-high agglomeration mainly occurs in the central area with Yuzhong District as the core,while low-low agglomeration mainly occurs in the northeast and southeast of the central urban area.At different altitudes,the spatial accessibility of medical services decreases with the elevation.The difference of spatial accessibility of medical services between urban and rural areas is obvious.Almost all the population and area in urban areas are concentrated in high accessibility areas,while only about 60 % of the population and 30% of the area in rural areas are distributed in high accessibility areas.(5)The spatial accessibility of medical services in the central urban area of Chongqing is affected by medical point density,population density,road density,GDP,altitude and slope.From the perspective of influence direction,medical point density,population density,road density and GDP have a positive impact on medical accessibility,while altitude and slope have a negative impact;from the perspective of influence intensity,the influence intensity of internal factors is greater than that of external factors,population density and medical point density have the strongest impact,while altitude and slope have the smallest impact,but the impact of various factors on medical accessibility is not independent of each other,but has obvious interaction and enhancement.(6)According to the current situation of high medical accessibility in the central area and poor accessibility in the marginal areas,the study puts forward optimization suggestions from increasing medical resources allocation in mountainous areas,increasing medical investment in rural areas and improving road network construction,in order to promote the rational allocation of medical resources,improve the accessibility and convenience of residents’ medical treatment,so as to realize the fairness and justice of residents’ medical treatment.