Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China
Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China
复制标题
评估中国四川公立和私立医院的空间可达性：私营部门对中国医疗保健地理的影响
DOI：
10.1016/j.socscimed.2016.09.042
复制
发表时间：
2016-12-01
影响因子：
5.4
通讯作者：
Shi, Xun
中科院分区：
文献类型：
--
作者：
Pan, Jay;Zhao, Hanqing;Shi, Xun
2009年，中国政府启动了新一轮医疗改革，鼓励民营医院发展。与此同时，中国许多公立医院也变得越来越以盈利为导向。这些趋势导致了对社会公正和地区差距的关切。然而，缺乏实证科学分析来支持这一辩论。为了填补这一空白，我们对四川省医院空间可及性的空间变化进行了区域层面的分析。这种差异是医疗资源分配公平性的重要指标。使用2012年的数据，我们打算提供新政策出台几年后的情况。我们采用了两种方法来量化的空间访问：最近邻方法和增强的两步浮动集水区（E2SFCA）的方法。我们认识到四川的两个次区域：农村的川西和发达的川东。我们用所有权和级别对医院进行了分类。我们将分析应用于两个次区域的医院及其组合。这两个次区域在医院的空间可及性方面，无论是数量还是空间格局都有很大的差异。公立医院仍然是四川省医疗服务的主体，特别是川西地区，一直以来都是以公立医院为主。民营医院只在川东地区出现，在基层，民营医院的可达性已经超过公立医院。然而，政府卫生支出似乎与医院空间可及性的实际情况脱节。政府应继续履行其在医疗资源配置方面的责任，谨慎对待公立医院的市场化，并鼓励私立医院向农村地区扩张。从方法上讲，这两种方法的结果是一致的，但不完全相同。E2SFCA方法计算医院的人口调整密度，其测量与预期模式的偏差，因此在评估医院的空间访问与其他因素（例如，人口密度和投资）。(C)2016爱思唯尔有限公司版权所有。
In 2009, the Chinese government launched a new round of healthcare reform, which encourages development of private hospitals. Meanwhile, many public hospitals in China also became increasingly profit-oriented. These trends have led to concerns about social justice and regional disparity. However, there is a lack of empirical scientific analysis to support the debate. We started to fill this gap by conducting a regional-level analysis of spatial variation in spatial access to hospitals in the Sichuan Province. Such variation is an important indication of (in) equity in healthcare resource allocation. Using data of 2012, we intended to provide a snapshot of the situation that was a few years later since the new policies had set out. We employed two methods to quantify the spatial access: the nearest-neighbor method and the enhanced two-step floating catchment area (E2SFCA) method. We recognized two sub-regions of Sichuan: the rural West Sichuan and the well-developed East Sichuan. We classified the hospitals using both ownership and level. We applied the analysis to the resulting groups of hospitals and their combinations in the two sub-regions. The two sub-regions have a high contrast in the spatial access to hospitals, in terms of both quantity and spatial pattern. Public hospitals still dominated the service in the province, especially in the West Sichuan, which had been solely relying on public hospitals. Private hospitals only occurred in the East Sichuan, and at the primary level, they had surpassed public hospitals in terms of spatial accessibility. However, the governmental health expenditures seemed to be disconnected with the actual situation of the spatial access to hospitals. The government should continue carrying on its responsibility in allocating healthcare resources, be cautious about marketizing public hospitals, and encourage private hospitals to expand into rural areas. Methodologically, the results from the two methods are concurring but not identical. The E2SFCA method calculates population-adjusted density of hospitals, which measures deviation from the expected pattern, and therefore is more meaningful in assessing associations of the spatial access to hospitals with other factors (e.g., population density and investment). (C) 2016 Elsevier Ltd. All rights reserved.