An integrated analysis of spatial access to the three-tier healthcare delivery system in China: a case study of Hainan Island

International Journal for Equity in Health

Barnabas C. Seyler¹  Xiuli Wang²  Jay Pan²  Wei Han³ 

[1] Department of Environment, Sichuan University, No.24 South Section 1, Yihuan Road, 610065, Chengdu, China;HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 People’s South Road, 610041, Chengdu, China;Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No.17 People’s South Road, Chengdu, China;Health, Nutrition and Population Global Practice, World Bank, No.1 Jianguomenwai Street, Chaoyang district, 100020, Beijing, China;

关键词: Three-tier health care delivery system;    Spatial access;    Enhanced two-step floating catchment area method (E2SFCA);    Overlay analysis;   

DOI  :  10.1186/s12939-021-01401-w

来源: Springer

【 摘 要 】

BackgroundAccess to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs).MethodsHainan Island was taken as an example to explore the utilization of modern spatial access techniques under China’s specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution’s tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated.ResultsOn Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions.ConclusionSpatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.

【 授权许可】

CC BY