Potential accessibility scores for hospital care in a province of Japan: GIS-based ecological study of the two-step floating catchment area method and the number of neighborhood hospitals.
Potential accessibility scores for hospital care in a province of Japan: GIS-based ecological study of the two-step floating catchment area method and the number of neighborhood hospitals.
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DOI：
10.1186/s12913-017-2367-0
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发表时间：
2017-06-26
影响因子：
2.8
通讯作者：
Kotani K
中科院分区：
文献类型：
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作者：
Nakamura T;Nakamura A;Mukuda K;Harada M;Kotani K
为了实现初级卫生保健可获得性的公平，衡量潜在的地理可及性是至关重要的。提供者与人口的比率是最常用的衡量标准。然而，由于它没有考虑到其边界之外的人民和卫生服务，因此很难在较近的地区使用。为了克服这一问题，我们使用距离测量和改进的两步浮动集水区(E2SFCA)方法测量了潜在的医院通道。这项研究的目的是比较附近医院的数量和E2SFCA评分在就医数量和公平性方面的差异。这项描述性研究使用了2010年的公开数据。E2SFCA评分和邻里医院的数量是使用地理信息系统从日本的Tochigi省获得的。获得了每个人口普查区域的四项指标的数据集。这些指标是E2SFCA评分、5公里范围内的医院数量、10公里范围内的医院数量和15公里范围内的医院数量。用洛伦兹曲线和基尼系数进行相关和差异分析。这些措施是在一个较小的区域内获得的，而不是用地理方法考虑邻近地区的市政当局。E2SFCA得分为5.3[3.2-7.3]医院/百万(中位数[分位数范围])，而给定地区的医院总数为5.6/百万。5公里、10公里和15公里范围内的医院数量中位数分别为1家、39家和47家。三分之一的街区在5公里范围内没有医院。10公里范围内的医院数量和15公里范围内的医院数量都有很好的相关性。随着统计医院数量的距离增大，地区差异逐渐缩小。较少的医院与较高的E2SFCA得分之间的差距表明社区医院位于人口稀少地区。由于E2SFCA方法提供了较近的子区域的信息，因此E2SFCA方法在医院空间通道分析中具有优势。在10公里以外的范围内，就医机会几乎看不到地区差异。需要在其他区域和国家进行进一步研究，以进行准确的评估。
For achieving equity of the accessibility to primary healthcare, measuring potential geographical accessibility is essential. The provider-to-population ratio is the most frequently used measure. However, it is difficult to be used in closer region because it does not take into consideration the people and health services beyond its boundary. In order to overcome this problem, we measured the potential access to hospital, using both distance measures and the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to compare the number of hospitals in the neighborhood and the E2SFCA score with regard to the amount and equity for access to hospitals. This descriptive study used publicly available data from 2010. The E2SFCA score and number of neighborhood hospitals were obtained from Tochigi province in Japan using a geographic information system. Dataset of four measures by each census tract was obtained. The measures were E2SFCA score, number of hospitals within the 5 km range, number of hospitals within the 10 km range, and number of hospitals within the 15 km range. Correlation and disparity analyses with the Lorenz curve and Gini coefficient were performed. The measures were obtained in a smaller area than municipality considering adjacent areas using a geographical approach. The E2SFCA score was 5.3 [3.2–7.3] hospitals/million (median [quantile range]), compared to 5.6 hospitals/million in total for the given district. The median number of hospitals within the 5 km, 10 km, and 15 km ranges were 1, 39, and 47, respectively. There was no hospital within the 5 km range in one third of the blocks. Both the number of hospitals within the 10 km range and those within the 15 km range were well correlated. Regional difference became smaller as the distance to count the number of hospitals increased. The gap between small number of hospitals and the high E2SFCA score indicated the location of community hospital in depopulated areas. The E2SFCA method is superior for analyzing spatial access to hospital, because it provides information in the closer sub-regions. Regional differences were hardly seen in access to hospital beyond the 10 km range. Further studies in other regions and countries are needed for precise assessment.