Spatial Pattern Of Medical Resources And Differences In Medical Service Accessibility In Shaanxi Province

Since the reform and opening up,China's economic level has been growing,and residents' demand for a better life has been increasing with the improvement of material conditions.At present,the contradiction between supply and demand of public medical resources in China is prominent,and the competition of high-level medical resources is fierce,where the waste of primary medical resources is serious.This problem prompted the government to introduce a policy of "hierarchical diagnosis and treatment" to alleviate the harm of the contradiction between supply and demand to residents' health by regulating residents' medical behavior.Although the government guide the residents' medical treatment behavior with the level of medical resources,the policy does not meet the mandatory conditions.In real life,the residents' medical behavior is mainly affected by the demand for medical treatment,but there are differences between the medical behavior and the policy.Therefore,it is of great significance to study the spatial distribution pattern of hierarchical medical resources and explore the spatial differences and influencing factors of accessibility to medical services under the actual medical behavior by establishing a model of residents' medical behavior.Based on the spatial distribution of medical institutions,transportation network data and socio-economic data,taking Shaanxi Province as the research area,this paper analyzed the spatial distribution shape,equilibrium,complexity and distribution density of medical resources by using the nearest neighbor index,imbalance index,network dimension and kernel density.Then used the improved node cost network analysis method with the space-time distance model and the two-step floating catchment area method,respectively,to analyze the spatial pattern and influencing factors of accessibility to three-level medical services and evaluate the differences in access to medical services in different areas and groups in Shaanxi.The main conclusions are as follows:(1)The spatial distribution of medical resources in different regions and different levels in Shaanxi Province is agglomerative and the nearest neighbor index of high-level medical resources is less than 0.3,and agglomeration degree of high-level medical resources is larger than that of primary medical resources.The distribution of medical resources in different regions is uneven and spatial equilibrium level is poor.In addition,the spatial distribution of medical resources shows unequal probability distribution,and there is a trend of concentration to the economic and cultural center of administrative regions.Except for the primary medical resources,the capacity dimensions of other medical resources and their service capacity are less than 2,and there is a big gap between information dimension and capacity dimension,which indicates that complexity of spatial distribution is high.And different levels of medical resources form a high-density core in the urban built-up areas,and with the improvement of the level of medical resources,the agglomeration scope decreases,which shows that most areas of Shaanxi Province except the urban areas are lack of high-level medical resources,especially the rural areas.(2)The overall level of accessibility to primary medical services is good in Shaanxi,and spatial pattern of accessibility is balanced.The average shortest time to access medical treatment is 23.9mins.However,the polarization of accessibility to secondary and tertiary medical services is extremely serious,and within the research area,a band-shaped multicore spatial structure was formed with the built-up areas of various cities as high-level centers of accessibility to secondary medical services,and the accessibility level of remote rural areas far away from cities is poor.The "core periphery" structure of accessibility to tertiary medical services is also prominent,each city forms a secondary core with Xi'an as a main core.The accessibility level of Guanzhong is significantly higher than that of Shaannan and Shaanbei.The spatial heterogeneity of influencing factors of accessibility to medical service in different regions is strong.On the whole,the accessibility to primary medical services of provincial residents is mainly affected by natural factors such as elevation(coefficient:0.29),slope(coefficient:0.12)and location conditions(coefficient:0.32),while social and economic factors have a weak impact on the accessibility to primary medical services.On the contrary,the accessibility to high-level medical services is more sensitive to social and economic factors such as the service capacity of medical institutions and the level of urbanization.(3)The differences of accessibility for residents in different regions of Shaanxi Province to three-level medical services is generally prominent,and the spatial differences of accessibility to primary medical services are lower than those of secondary and tertiary medical services.Compared with the three geographical regions,the Gini coefficient of accessibility to medical services in Guanzhong is smaller than that in Shaannan and Shaanbei.From the perspective of accessibility to medical services for different groups,there is no obvious gap between accessibility for the aging and the nonaging populations in Shaanxi,but the significant difference in agricultural and the nonagricultural populations is prominent.(4)In addition,the impact of traffic conditions improvement on the spatial pattern of accessibility to primary medical service is limited,but it can significantly improve the accessibility to secondary and tertiary medical services,especially in rural areas,and affect the spatial pattern of accessibility to high-level medical service and reduce regional differences.At the same time,the improvement of traffic conditions can effectively alleviate the gap between different groups in access to medical services and promote the equity among groups.Compared with traffic conditions,the growth of medical service capacity can also improve the level of accessibility to medical services.The increase of service threshold and service capacity weight can increase the average accessibility by 4.26%and 17.02%respectively,but it has limited impact on the spatial pattern of accessibility.