基于可达性的医疗服务均等化研究
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摘要
中国县域城乡和不同乡镇之间的发展存在较大差异,在卫生领域表现尤为突出。在偏远农区,医疗资源短缺、卫生服务落后和健康保障缺位现象普遍存在。作为公共服务体系规划的重要组成部分,医疗服务规划不仅要解决看病难问题,也要兼顾医疗资源利用的效率和资源分配的公平性。本文运用GIS技术,采取可达性测算和空间统计分析评估医疗服务的空间分布特征,发现医疗服务短缺区及其形成原因并为中长期医疗服务规划提供决策依据。
以湖北省松滋市为研究区,作者主要完成了以下研究工作：(1)通过实地调研和数据收集,建立包括行政区划、人口分布、道路交通网络、医疗服务设施等空间要素的医疗服务数据库。(2)采用行进成本分析法和吸引力指数分析法,选取空间可达性指标,测算了松滋市270个聚落点和16个乡镇的医疗服务可达性水平。(3)结合乡镇地理位置与可达性现状,运用全局自相关和局部自相关分析方法,评估县域范围内医疗服务的空间均等化水平。(4)对以上计算结果进行综合分析,制作多项专题地图,从整体分析医疗服务水平的布局特征,鉴别出医疗服务短缺区,探讨其形成原因并提出政策建议。
本研究在ArcGIS10.0软件和Geodata Analysis软件支持下完成。利用GIS数据管理功能整理各种数据,建立地理空间数据库,制作各种专题地图；利用GIS网络分析工具(Network Analyst)计算聚落点与医院之间的最短时间；利用GIS空间统计分析(Spatial Statistics Analysis)和Geodata Analysis软件分别实现全局自相关和局部自相关计算分析。
案例研究发现：(1)无论是从医疗服务发展的社会经济环境,还是从就医的便捷程度方面来看,松滋市医疗服务水平在县域尺度和镇域尺度均存在不均衡的情况。(2)空间可达性是影响看病就医的重要因素,其指标能直观地评估聚落点就医成本与方便程度。(3)空间关联分析在公共服务公平性现状研究、空间规划方面具有巨大的应用价值。(4)要在深入研究各地经济发展和卫生事业发展差异的基础上,根据居民的健康需求和政府的供给能力来设计均等化路径,有计划、有步骤地推进医疗服务均等化。
It exists large disparities in the development between urban and rural areas, and also between different villages and towns in China, which is especially prominent in the field of health care. It is common to see that the remote rural areas are suffering from a shortage of medical resources, the medically backward service, and the poor healthcare security. As the important part of public service system, the healthcare reform and planning is not only to solve the difficulties of getting medical treatment, but also to give consideration to the efficiency of facility utilization and the equality of resource allocation. This paper aims to evaluate the regional distribution characteristics of medical service by using GIS, accessibility calculating and Spatial Statistics Analysis, and to find shortage area of medical service and provide the decision-making basis for healthcare reform and planning.
Taking the county of Songzi in Hubei Province as its survey region, the following studies have mainly been completed. Firstly, through the field survey and data collection, the database of medical service has been established, including administrative areas, population distribution, medical service facilities and transportation network diagram of geographic elements. Secondly, cost analysis and attractive index analysis have been used to select five spatial accessibility indexes and calculate the accessibility of medical service of270settlements and16towns in Songzi county. Thirdly, combing with the geographical position and accessibility status, global and local autocorrelation analysis area utilized to assess medical service level in county area. Fourthly, comprehensively analyze the results above and create thematic maps, and then analysis of layout characteristics of medical facilities as a whole to identify the shortage area of medical service and discuss the forming reason and policy recommendations.
All the geospatial data are managed in ArcGIS10.0software and Geo-data Analysis software. Using GIS data management function to settle all kinds of data, and to establish geographical spatial database and make thematic maps. Using GIS Network Analyst to calculate the shortest time between settlements and hospitals. Using Spatial Statistics Analysis and Geo-data Analysis software to realize the analysis of global and local autocorrelation.
There are several findings from cases. Firstly, whether from the per capita medical resources distribution and medical access, or from the convenience of seeking medical advice of the side, medical service level of Songzi County exists unbalanced conditions of county area and town area. Secondly, as the important factor of seeking medical advice, spatial accessibility index can directly assess the medical treatment cost of settlement points and the convenience. Thirdly, spatial relation analysis has enormously application value in the current situation study of public service equalization and spatial planning. Fourthly, based on further studying of the difference between varying economic development and health development, according to health needs of residents and the government's supply ability, the equal access to the path should be designed, and medical service equalization must be accomplished step by step.
以湖北省松滋市为研究区,作者主要完成了以下研究工作：(1)通过实地调研和数据收集,建立包括行政区划、人口分布、道路交通网络、医疗服务设施等空间要素的医疗服务数据库。(2)采用行进成本分析法和吸引力指数分析法,选取空间可达性指标,测算了松滋市270个聚落点和16个乡镇的医疗服务可达性水平。(3)结合乡镇地理位置与可达性现状,运用全局自相关和局部自相关分析方法,评估县域范围内医疗服务的空间均等化水平。(4)对以上计算结果进行综合分析,制作多项专题地图,从整体分析医疗服务水平的布局特征,鉴别出医疗服务短缺区,探讨其形成原因并提出政策建议。
本研究在ArcGIS10.0软件和Geodata Analysis软件支持下完成。利用GIS数据管理功能整理各种数据,建立地理空间数据库,制作各种专题地图；利用GIS网络分析工具(Network Analyst)计算聚落点与医院之间的最短时间；利用GIS空间统计分析(Spatial Statistics Analysis)和Geodata Analysis软件分别实现全局自相关和局部自相关计算分析。
案例研究发现：(1)无论是从医疗服务发展的社会经济环境,还是从就医的便捷程度方面来看,松滋市医疗服务水平在县域尺度和镇域尺度均存在不均衡的情况。(2)空间可达性是影响看病就医的重要因素,其指标能直观地评估聚落点就医成本与方便程度。(3)空间关联分析在公共服务公平性现状研究、空间规划方面具有巨大的应用价值。(4)要在深入研究各地经济发展和卫生事业发展差异的基础上,根据居民的健康需求和政府的供给能力来设计均等化路径,有计划、有步骤地推进医疗服务均等化。
It exists large disparities in the development between urban and rural areas, and also between different villages and towns in China, which is especially prominent in the field of health care. It is common to see that the remote rural areas are suffering from a shortage of medical resources, the medically backward service, and the poor healthcare security. As the important part of public service system, the healthcare reform and planning is not only to solve the difficulties of getting medical treatment, but also to give consideration to the efficiency of facility utilization and the equality of resource allocation. This paper aims to evaluate the regional distribution characteristics of medical service by using GIS, accessibility calculating and Spatial Statistics Analysis, and to find shortage area of medical service and provide the decision-making basis for healthcare reform and planning.
Taking the county of Songzi in Hubei Province as its survey region, the following studies have mainly been completed. Firstly, through the field survey and data collection, the database of medical service has been established, including administrative areas, population distribution, medical service facilities and transportation network diagram of geographic elements. Secondly, cost analysis and attractive index analysis have been used to select five spatial accessibility indexes and calculate the accessibility of medical service of270settlements and16towns in Songzi county. Thirdly, combing with the geographical position and accessibility status, global and local autocorrelation analysis area utilized to assess medical service level in county area. Fourthly, comprehensively analyze the results above and create thematic maps, and then analysis of layout characteristics of medical facilities as a whole to identify the shortage area of medical service and discuss the forming reason and policy recommendations.
All the geospatial data are managed in ArcGIS10.0software and Geo-data Analysis software. Using GIS data management function to settle all kinds of data, and to establish geographical spatial database and make thematic maps. Using GIS Network Analyst to calculate the shortest time between settlements and hospitals. Using Spatial Statistics Analysis and Geo-data Analysis software to realize the analysis of global and local autocorrelation.
There are several findings from cases. Firstly, whether from the per capita medical resources distribution and medical access, or from the convenience of seeking medical advice of the side, medical service level of Songzi County exists unbalanced conditions of county area and town area. Secondly, as the important factor of seeking medical advice, spatial accessibility index can directly assess the medical treatment cost of settlement points and the convenience. Thirdly, spatial relation analysis has enormously application value in the current situation study of public service equalization and spatial planning. Fourthly, based on further studying of the difference between varying economic development and health development, according to health needs of residents and the government's supply ability, the equal access to the path should be designed, and medical service equalization must be accomplished step by step.
引文
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[4].WorldBank. Investing in Health [R].THE WORLD BANK, 1993:1-171.
[5].张京祥,葛志兵,罗震东等.城乡基本公共服务设施布局均等化研究——以常州市教育设施为例[J].城市规划,2012,36(2)：9-15.
[6].中共中央,国务院.关于深化医药卫生体制改革的意见[C].国务院常务会议,2009-03-17.
[7].曹书平.农村医疗资源的空间可达性分析——以漯河市源汇区为例[D].西南大学,2009.
[8].吴建军.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[D].河南大学,2008.
[9].葛听.美国健康经济学研究的发展[D].复旦大学,2006.
[10]. James W Henderson,向运华,钟建威,季华璐.健康经济学[M].北京：人民邮电出版社,2008.
[11].魏聪.健康经济学需求理论述评[D].浙江大学,2004.
[12].郭永松.国内外医疗保障制度的比较研究[J].医学与哲学,2007(8)：2-5.
[13]. Hansen W G. How Accessibility Shapes Land Use [J].Journal of the American Institute of Planners,1959,25(2):73-76.
[14].陆大道.区域发展及其空间结构[M].北京：科学出版社,1995：117—124.
[15]. Johnston R J,柴彦威.人文地理学词典[M].北京：商务印书馆,2004.
[16].彭菁,罗静,熊娟等.国内外基本公共服务可达性研究进展[J].地理研究与开发,2012,31(2)：20—25.
[17].林康,陆玉麒.基于可达性角度的公共产品空间公平性的定量评价方法——以江苏省仪征市为例[J].地理研究,2009,28(1)：215—225.
[18].郭亚欣,徐建刚.基于可达性与空间句法分析的商业区人流集聚影响研究[J].山东师范大学学报：自然科学版,2011,26(2)：95-100.
[19].靳诚.基于路网结构的南京市区旅游景点可达性分析[D].南京师范大 学,2008.
[20].张鸿辉,曾永年,金晓斌.南京市城市地价空间自相关分析[J].南京大学学报：自然科学版,2009,45(6)：821-831.
[21].阳福英.中国省区交通基础设施投资差异时空演变特征[D].中山大学,2009.
[22].柏延臣,李新,冯学智.空间数据分析与空间模型[J].地理研究,1999,18(2)：185-189.
[23].李裕瑞,吕爱清,卞新民.江苏省人均粮食地域格局变化特征及驱动机制[J].资源科学,2008,30(3)：423-430.
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