北京市核心区医疗设施可达性研究
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摘要
基于空间化的人口数据及改进的两步移动搜寻法,分析北京市核心区医疗设施的可达性和分布公平性。结果表明:北京核心区医疗设施的可达性空间分异特征显著,总体上呈现从中心向外围递减的圈层结构,且东北部高于西南部,其影响因素主要包括医疗设施的空间分布及服务能力、居住需求点的人口密度以及二者之间的交通状况;核心区高就医可达性街道相比于低就医可达性街道常住人口和老年人口占比更小,总体居住环境更差,医疗资源供给与需求的空间匹配程度较低。据此提出改善核心区医疗设施可达性分布的均衡性和公平性的政策建议。
This study analyzes the accessibility and its distributional equity of medical facilities in Beijing's central area based on spatialized population data and an enhanced two-step floating catchment area method or E-2 SFCA. The results reveal that the medical accessibility of Beijing's central area exhibits significant spatial heterogeneity. It shows an overall ring structure with medical accessibility values emanating from the center to the periphery,while the northeastern region presenting higher accessibility than the southwestern region. The above pattern results from the spatial distribution and service capabilities of medical facilities,as well as the population density at the residential demand point and the traffic conditions between these two. Compared with the sub-districts of lower medical accessibility,those with higher accessibility have smaller share of permanent residents and elderly population,and also features worse overall living environment,which proves the spatial mismatch of medical supply and demand within the central area. Based on these results,the policy recommendations are proposed to realize the equalization and equity of the medical accessibility distribution in the central area of Beijing.
This study analyzes the accessibility and its distributional equity of medical facilities in Beijing's central area based on spatialized population data and an enhanced two-step floating catchment area method or E-2 SFCA. The results reveal that the medical accessibility of Beijing's central area exhibits significant spatial heterogeneity. It shows an overall ring structure with medical accessibility values emanating from the center to the periphery,while the northeastern region presenting higher accessibility than the southwestern region. The above pattern results from the spatial distribution and service capabilities of medical facilities,as well as the population density at the residential demand point and the traffic conditions between these two. Compared with the sub-districts of lower medical accessibility,those with higher accessibility have smaller share of permanent residents and elderly population,and also features worse overall living environment,which proves the spatial mismatch of medical supply and demand within the central area. Based on these results,the policy recommendations are proposed to realize the equalization and equity of the medical accessibility distribution in the central area of Beijing.
引文
[1]彭菁,罗静,熊娟,等.国内外基本公共服务可达性研究进展[J].地域研究与开发,2012,31(2):20-25.
[2]常修泽.逐步实现基本公共服务均等化[N].人民日报,2007-01-31(009).
[3]罗敏,祝小宁.城乡公共服务的社会空间均衡研究[J].社会科学研究,2010(4):63-67.
[4] HANSEN W G. How Accessibility Shapes Land Use[J].Journal of the American Institute of Planners,1959,25(2):73-76.
[5] MORRIS J M,DUMBLE P L,WIGAN M R. Accessibility Indicators for Transport Planning[J]. Transportation Research Part A:General,1979,13(2):91-109.
[6]冯广超,覃成林.可达性研究动态及测算模型修订[J].地域研究与开发,2016,35(2):6-11.
[7] GOLD M. Beyond Coverage and Supply:Measuring Access to Healthcare in Today’s Market[J]. Health Services Research,1998,33(3):625-652.
[8] JOSEPH A E,PHILLIPS D R. Accessibility and Utilization:Geographical Perspectives on Health Care Delivery[M]. London:Harper and Row,1984:52-54.
[9]姜海宁,谷人旭,李广斌,等.南京市星级酒店空间可达性格局研究[J].地域研究与开发,2012,31(2):129-134.
[10] ADAY L A,ANDERSEN R. A Framework for the Study of Access to Medical Care[J]. Health Services Research,1974,9(3):208-220.
[11] MCLAFFERTY S,GRADY S. Immigration and Geographic Access to Prenatal Clinics in Brooklyn,NY:A Geographic Information Systems Analysis[J]. American Journal of Public Health,2005,95(4):638-640.
[12] THOUEZ J M,BODSON P,JOSEPH A E. Some Methods for Measuring the Geographic Accessibility of Medical Services in Rural Regions[J]. Medical Care,1988,26(1):34-44.
[13] PHILLIPS D R. Health and Health Care in the Third World[M]. Essex:Longman,1990.
[14]陶海燕,陈晓翔,黎夏.公共医疗卫生服务的空间可达性研究——以广州市海珠区为例[J].测绘与空间地理信息,2007,30(1):1-5.
[15]吴建军,孔云峰,李斌.基于GIS的农村医疗设施空间可达性分析——以河南省兰考县为例[J].人文地理,2008,23(5):37-42.
[16]张莉,陆玉麒,赵元正.医院可达性评价与规划——以江苏省仪征市为例[J].人文地理,2008,23(2):60-66.
[17]宋正娜,陈雯,车前进,等.基于改进潜能模型的就医空间可达性度量和缺医地区判断——以江苏省如东县为例[J].地理科学,2010,30(2):213-219.
[18]齐兰兰,周素红,闫小培.广州市医疗设施可达性模型中端点吸引的影响因素检验[J].地理科学,2014,34(5):580-586.
[19]陈晨,修春亮.基于交通网络中心性的长春市大型综合医院空间可达性研究[J].人文地理,2014,29(5):81-87.
[20]张琦,李同昇,史荣.服务老年人群的城市高等级医院交通可达性测评——以西安市三级甲等医院为例[J].陕西师范大学学报(自然科学版),2016,44(1):96-101.
[21] GIBIN M,LONGLEY P,ATKINSON P. Kernel Density Estimation and Percent Volume Contours in General Practice Catchment Area Analysis in Urban Areas[C]//WINSTANLEY A C. Proceedings of the Geographical Information Science Research UK Conference,County Kildare,Ireland:Citeseer,2007:270-276.
[22]陶卓霖,程杨,戴特奇.北京市养老设施空间可达性评价[J].地理科学进展,2014,33(5):616-624.
[23] RADKE J,MU L. Spatial Decompositions,Modeling and Mapping Service Regions to Predict Access to Social Programs[J]. Geographic Information Sciences,2000,6(2):105-112.
[24] LUO W,WANG F. Measures of Spatial Accessibility to Health Care in A GIS Environment:Synthesis and A Case Study in the Chicago Region[J]. Environment and Planning B:Planning and Design,2003,30(6):865-884.
[25] LUO W,WANG F. Spatial Accessibility to Primary Care and Physician Shortage Area Designation:A Case Study in Illinois with GIS Approaches[M]//KHAN O A,SKINNER R. Geographic Information Systems and Health Applications. Hershey,PA:Idea Group Publishing,2002:260-278.
[26]陶卓霖,程杨.两步移动搜寻法及其扩展形式研究进展[J].地理科学进展,2016,35(5):589-599.
[27] GUAGLIARDO M F. Spatial Accessibility of Primary Care:Concepts,Methods and Challenges[J]. International Journal of Health Geographics,2004,3(1):3.
[28] ALBERT D P,BUTAR F B. Estimating the De-designation of Single-county HPSAs in the United States by Counting Naturopathic Physicians as Medical Doctors[J]. Applied Geography,2005,25(3):271-285.
[29] YANG D H,GOERGE R,MULLNER R. Comparing GIS-based Methods of Measuring Spatial Accessibility to Health Services[J]. Journal of Medical Systems,2006,30(1):23-32.
[30] LANGFORD M,HIGGS G. Measuring Potential Access to Primary Healthcare Services:The Influence of Alternative Spatial Representations of Population[J]. The Professional Geographer,2006,58(3):294-306.
[31] WANG L. Immigration,Ethnicity,and Accessibility to Culturally Diverse Family Physicians[J]. Health&Place,2007,13(3):656-671.
[32] WANG F,MCLAFFERTY S,ESCAMILLA V,et al. Late-stage Breast Cancer Diagnosis and Health Care Access in Illinois[J]. The Professional Geographer,2008,60(1):54-69.
[33] CERVIGNI F,SUZUKI Y,ISHII T,et al. Spatial Accessibility to Pediatric Services[J]. Journal of Community Health,2008,33(6):444-448.
[34]刘钊,郭苏强,金慧华,等.基于GIS的两步移动搜寻法在北京市就医空间可达性评价中的应用[J].测绘科学,2007,32(1):61-63.
[35]胡瑞山,董锁成,胡浩.就医空间可达性分析的两步移动搜索法——以江苏省东海县为例[J].地理科学进展,2012,31(12):1600-1607.
[36]于珊珊,彭鹏,田晓琴,等.基于GIS的长沙市医院空间布局及优化研究[J].长沙大学学报,2012,26(2):90-94.
[37]车莲鸿.基于高斯两步移动搜索法空间可达性模型的医院布局评价[J].中国医院管理,2014,34(2):31-33.
[38]邓丽,邵景安,郭跃,等.基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例[J].地理科学进展,2015,34(6):716-725.
[39]付加森,王利,赵东霞,等.基于GIS医疗设施空间可达性的研究——以大连市为例[J].测绘与空间地理信息,2015,38(4):102-105.
[40]钟少颖,杨鑫,陈锐.层级性公共服务设施空间可达性研究——以北京市综合性医疗设施为例[J].地理研究,2016,35(4):731-744.
[41]赵东霞,韩增林,王利,等.基于两步移动搜寻法的城市居家养老服务设施可达性研究——以大连市沙河口区低龄老年人为例[J].地域研究与开发,2014,33(6):27-32.
[42] LUO W,QI Y. An Enhanced Two-step Floating Catchment Area(E2SFCA)Method for Measuring Spatial Accessibility to Primary Care Physicians[J]. Health&Place,2009,15(4):1100-1107.
[43] DAI D. Black Residential Segregation,Disparities in Spatial Access to Health Care Facilities,and Late-stage Breast Cancer Diagnosis in Metropolitan Detroit[J].Health&Place,2010,16(5):1038-1052.
[44] MCGRAIL M R. Spatial Accessibility of Primary Health Care Utilising the Two Step Floating Catchment Area Method:An Assessment of Recent Improvements[J]. International Journal of Health Geographics,2012,11(1):50.
[45]付加森,王利,赵东霞,等.公共医疗设施可达性评价——以大连市为例[J].卫生经济研究,2014(11):27-30.
[45]北京市交通委员会. 2011年北京市交通发展年报[R].北京:北京市交通委员会,2011:47-52.
[47] WELZL E. Constructing the Visibility Graph for n-Line Segments in O(n2)Time[J]. Information Processing Letters,1985,20(4):167-171.
[48]宋贵伦,鲍宗豪.中国社会建设报告2014[M].北京:中国社会科学出版社,2015.
[49] TSOU K W,HUNG Y T,CHANG Y L. An Accessibility-based Integrated Measure of Relative Spatial Equity in Urban Public Facilities[J]. Cities,2005,22(6):424-435.
[50]张纯,李晓宁,满燕云.北京城市保障性住房居民的就医可达性研究——基于GIS网络分析方法[J].人文地理,2017,32(2):59-64.
[51]肖周燕.北京产业疏解带动人口疏解的政策效应[J].地域研究与开发,2018,37(6):160-164.
[2]常修泽.逐步实现基本公共服务均等化[N].人民日报,2007-01-31(009).
[3]罗敏,祝小宁.城乡公共服务的社会空间均衡研究[J].社会科学研究,2010(4):63-67.
[4] HANSEN W G. How Accessibility Shapes Land Use[J].Journal of the American Institute of Planners,1959,25(2):73-76.
[5] MORRIS J M,DUMBLE P L,WIGAN M R. Accessibility Indicators for Transport Planning[J]. Transportation Research Part A:General,1979,13(2):91-109.
[6]冯广超,覃成林.可达性研究动态及测算模型修订[J].地域研究与开发,2016,35(2):6-11.
[7] GOLD M. Beyond Coverage and Supply:Measuring Access to Healthcare in Today’s Market[J]. Health Services Research,1998,33(3):625-652.
[8] JOSEPH A E,PHILLIPS D R. Accessibility and Utilization:Geographical Perspectives on Health Care Delivery[M]. London:Harper and Row,1984:52-54.
[9]姜海宁,谷人旭,李广斌,等.南京市星级酒店空间可达性格局研究[J].地域研究与开发,2012,31(2):129-134.
[10] ADAY L A,ANDERSEN R. A Framework for the Study of Access to Medical Care[J]. Health Services Research,1974,9(3):208-220.
[11] MCLAFFERTY S,GRADY S. Immigration and Geographic Access to Prenatal Clinics in Brooklyn,NY:A Geographic Information Systems Analysis[J]. American Journal of Public Health,2005,95(4):638-640.
[12] THOUEZ J M,BODSON P,JOSEPH A E. Some Methods for Measuring the Geographic Accessibility of Medical Services in Rural Regions[J]. Medical Care,1988,26(1):34-44.
[13] PHILLIPS D R. Health and Health Care in the Third World[M]. Essex:Longman,1990.
[14]陶海燕,陈晓翔,黎夏.公共医疗卫生服务的空间可达性研究——以广州市海珠区为例[J].测绘与空间地理信息,2007,30(1):1-5.
[15]吴建军,孔云峰,李斌.基于GIS的农村医疗设施空间可达性分析——以河南省兰考县为例[J].人文地理,2008,23(5):37-42.
[16]张莉,陆玉麒,赵元正.医院可达性评价与规划——以江苏省仪征市为例[J].人文地理,2008,23(2):60-66.
[17]宋正娜,陈雯,车前进,等.基于改进潜能模型的就医空间可达性度量和缺医地区判断——以江苏省如东县为例[J].地理科学,2010,30(2):213-219.
[18]齐兰兰,周素红,闫小培.广州市医疗设施可达性模型中端点吸引的影响因素检验[J].地理科学,2014,34(5):580-586.
[19]陈晨,修春亮.基于交通网络中心性的长春市大型综合医院空间可达性研究[J].人文地理,2014,29(5):81-87.
[20]张琦,李同昇,史荣.服务老年人群的城市高等级医院交通可达性测评——以西安市三级甲等医院为例[J].陕西师范大学学报(自然科学版),2016,44(1):96-101.
[21] GIBIN M,LONGLEY P,ATKINSON P. Kernel Density Estimation and Percent Volume Contours in General Practice Catchment Area Analysis in Urban Areas[C]//WINSTANLEY A C. Proceedings of the Geographical Information Science Research UK Conference,County Kildare,Ireland:Citeseer,2007:270-276.
[22]陶卓霖,程杨,戴特奇.北京市养老设施空间可达性评价[J].地理科学进展,2014,33(5):616-624.
[23] RADKE J,MU L. Spatial Decompositions,Modeling and Mapping Service Regions to Predict Access to Social Programs[J]. Geographic Information Sciences,2000,6(2):105-112.
[24] LUO W,WANG F. Measures of Spatial Accessibility to Health Care in A GIS Environment:Synthesis and A Case Study in the Chicago Region[J]. Environment and Planning B:Planning and Design,2003,30(6):865-884.
[25] LUO W,WANG F. Spatial Accessibility to Primary Care and Physician Shortage Area Designation:A Case Study in Illinois with GIS Approaches[M]//KHAN O A,SKINNER R. Geographic Information Systems and Health Applications. Hershey,PA:Idea Group Publishing,2002:260-278.
[26]陶卓霖,程杨.两步移动搜寻法及其扩展形式研究进展[J].地理科学进展,2016,35(5):589-599.
[27] GUAGLIARDO M F. Spatial Accessibility of Primary Care:Concepts,Methods and Challenges[J]. International Journal of Health Geographics,2004,3(1):3.
[28] ALBERT D P,BUTAR F B. Estimating the De-designation of Single-county HPSAs in the United States by Counting Naturopathic Physicians as Medical Doctors[J]. Applied Geography,2005,25(3):271-285.
[29] YANG D H,GOERGE R,MULLNER R. Comparing GIS-based Methods of Measuring Spatial Accessibility to Health Services[J]. Journal of Medical Systems,2006,30(1):23-32.
[30] LANGFORD M,HIGGS G. Measuring Potential Access to Primary Healthcare Services:The Influence of Alternative Spatial Representations of Population[J]. The Professional Geographer,2006,58(3):294-306.
[31] WANG L. Immigration,Ethnicity,and Accessibility to Culturally Diverse Family Physicians[J]. Health&Place,2007,13(3):656-671.
[32] WANG F,MCLAFFERTY S,ESCAMILLA V,et al. Late-stage Breast Cancer Diagnosis and Health Care Access in Illinois[J]. The Professional Geographer,2008,60(1):54-69.
[33] CERVIGNI F,SUZUKI Y,ISHII T,et al. Spatial Accessibility to Pediatric Services[J]. Journal of Community Health,2008,33(6):444-448.
[34]刘钊,郭苏强,金慧华,等.基于GIS的两步移动搜寻法在北京市就医空间可达性评价中的应用[J].测绘科学,2007,32(1):61-63.
[35]胡瑞山,董锁成,胡浩.就医空间可达性分析的两步移动搜索法——以江苏省东海县为例[J].地理科学进展,2012,31(12):1600-1607.
[36]于珊珊,彭鹏,田晓琴,等.基于GIS的长沙市医院空间布局及优化研究[J].长沙大学学报,2012,26(2):90-94.
[37]车莲鸿.基于高斯两步移动搜索法空间可达性模型的医院布局评价[J].中国医院管理,2014,34(2):31-33.
[38]邓丽,邵景安,郭跃,等.基于改进的两步移动搜索法的山区医疗服务空间可达性——以重庆市石柱县为例[J].地理科学进展,2015,34(6):716-725.
[39]付加森,王利,赵东霞,等.基于GIS医疗设施空间可达性的研究——以大连市为例[J].测绘与空间地理信息,2015,38(4):102-105.
[40]钟少颖,杨鑫,陈锐.层级性公共服务设施空间可达性研究——以北京市综合性医疗设施为例[J].地理研究,2016,35(4):731-744.
[41]赵东霞,韩增林,王利,等.基于两步移动搜寻法的城市居家养老服务设施可达性研究——以大连市沙河口区低龄老年人为例[J].地域研究与开发,2014,33(6):27-32.
[42] LUO W,QI Y. An Enhanced Two-step Floating Catchment Area(E2SFCA)Method for Measuring Spatial Accessibility to Primary Care Physicians[J]. Health&Place,2009,15(4):1100-1107.
[43] DAI D. Black Residential Segregation,Disparities in Spatial Access to Health Care Facilities,and Late-stage Breast Cancer Diagnosis in Metropolitan Detroit[J].Health&Place,2010,16(5):1038-1052.
[44] MCGRAIL M R. Spatial Accessibility of Primary Health Care Utilising the Two Step Floating Catchment Area Method:An Assessment of Recent Improvements[J]. International Journal of Health Geographics,2012,11(1):50.
[45]付加森,王利,赵东霞,等.公共医疗设施可达性评价——以大连市为例[J].卫生经济研究,2014(11):27-30.
[45]北京市交通委员会. 2011年北京市交通发展年报[R].北京:北京市交通委员会,2011:47-52.
[47] WELZL E. Constructing the Visibility Graph for n-Line Segments in O(n2)Time[J]. Information Processing Letters,1985,20(4):167-171.
[48]宋贵伦,鲍宗豪.中国社会建设报告2014[M].北京:中国社会科学出版社,2015.
[49] TSOU K W,HUNG Y T,CHANG Y L. An Accessibility-based Integrated Measure of Relative Spatial Equity in Urban Public Facilities[J]. Cities,2005,22(6):424-435.
[50]张纯,李晓宁,满燕云.北京城市保障性住房居民的就医可达性研究——基于GIS网络分析方法[J].人文地理,2017,32(2):59-64.
[51]肖周燕.北京产业疏解带动人口疏解的政策效应[J].地域研究与开发,2018,37(6):160-164.