| 摘要: |
| 近年来，乡村医疗资源的数量和质量都
有显著提升，但不同地区乡村居民在获得医疗机
会、就医成本等方面存在较大差异，医疗设施布
局不合理问题仍存在。医疗设施可达性作为衡量
医疗设施空间布局是否合理的关键指标，为解决
医疗资源分配不合理和改善医疗资源分配不公
等问题提供了重要依据。针对传统高斯两步移
动搜索法（Gaussian-Based 2SFCA）对于山地
乡村地区医疗资源可达性在供给与需求思考不
足的问题，将其进行改进，从而更为科学客观地
评价可达性。研究选取重庆市九龙坡区乡村地区
为研究对象，借助Arcgis平台分析乡村医疗设施
供需情况，引介改进高斯两步移动搜索法分析设施可达性，在此基础上，借助SPSS软件进行K聚类分析，揭示乡村医疗设施可达性影响因素。研
究发现：第一，各类医疗设施的可达性数值综合层面上的高可达性区域主要是由于临近医疗资源
高供给能力的县综合医院和乡镇卫生院所贡献的，而村级医疗设施对综合可达性空间差异影响较
小；第二，山地乡村地区公共医疗设施配置存在医疗资源与人口分布的空间不匹配的情况，主要体
现在村级医疗设施；第三，区域可达性水平与交通通达性高低没有必然联系，受人口需求（人口规
模、人口密度）、医疗设施供给服务能力及分布的影响更大。最后针对不同可达性区域提出优化策
略。本研究为西南山地乡村地区医疗设施可达性评价提供了一套具有实践操作性的方法体系。 |
| 关键词: 西南山地乡村地区 医疗设施 空间可达性 改进两步移动搜索法 重庆市九龙坡区 |
| DOI：10.13791/j.cnki.hsfwest.20240508 |
| 分类号: |
| 基金项目:重庆市自然科学基金面上项目（CSTB2022NSCQMSX1567）；
重庆市研究生科研创新项目（CYB
22034） |
|
| Spatial accessibility evaluation of rural medical facilities in southwest mountainous area:Taking Jiulongpo District, Chongqing Municipality as an example |
|
XU Miao,LIAO Qing,XIE Zhuoming
|
| Abstract: |
| In recent years, the quantity and quality of rural medical resources have been significantly
improved. However, the accessibility to medical care and the medical expense varies a lot. There
is a huge gap between different rural communities. The irrational layout of medical facilities in
mountainous rural areas has aggravated this gap, mostly because of the scattered and fragmented
pattern of villages and settlements. Accessibility of medical facilities is a measure of healthcare
facilities. As a key indicator of whether the spatial layout of medical facilities is reasonable, the
accessibility of medical facilities provides an important basis for solving the problems of irrational
allocation of medical resources. This research has found that the traditional method of Gaussian-
Based 2SFCA (Gaussian-Based 2SFCA) is insufficient for analyzing the supply and demand of
medical resources in terms of accessibility in mountainous rural areas. Therefore, by improving the
method from the aspects of population demand, transportation network, and access cost, this study
evaluates the accessibility more scientifically and objectively.1) Affected by the topography of terrain
and landscape, mountainous villages mean small population scale and scattered village distribution
in the aspect of population demand. To scientifically reflect the differences in local population
distribution, this paper characterizes the population unit with a scale of 500 m×500 m. 2) In terms
of transportation network, the directly obtained plane traffic distance can hardly reflect the cost of
access in the mountainous terrain conditions. So, this study firstly generates the slope based on the
elevation data. The real traffic distance of the mountainous roads is calculated based on the slope
and the straight-line distance of the roads when calculating the OD cost. In this way, the plane traffic
distance is calculated by combining the slope and the straight-line distance of the roads, which is a
more objective way of evaluating the accessibility. The planar road network is considered in three
dimensions. 3) As for the access cost, the research is mostly based on the field visit in the study
area. The research finds that if not encountered critical illnesses, most residents will choose to walk,
ride two-wheeled electric vehicles (hereinafter referred to as electric vehicles) or take a shuttle busto go to the medical treatment. There is comprehensive research about the actual speed standards of mountainous terrain which determine the travel mode
adopted by the residents to the various levels of medical facilities and the acceptable time. Based on the case study in the rural areas of Jiulongpo District,
Chongqing Municipality, this research has analyzed the supply and demand of rural medical facilities with the help of ArcGIS platform with improved
Gaussian two-step mobile search method and the accessibility of the facilities. And the K clustering analysis is followed up with the help of SPSS software,
to reveal the factors affecting the accessibility of rural medical facilities. The findings can be summed up as below. Firstly, the high accessibility areas at the
comprehensive level of the accessibility values of various types of medical facilities were mainly contributed by the proximity of county general hospitals
and township health centers with high supply capacity of medical resources, while the village-level medical facilities had less influence on the spatial
differences in comprehensive accessibility; secondly, there was a spatial mismatch between the allocation of public healthcare facilities and the distribution
of populations in the mountainous rural areas, which was mainly manifested in the village-level medical facilities; thirdly, the level of regional accessibility
is not necessarily related to the level of transportation accessibility, but is more affected by the population demand (population size, population density), and
the service capacity and distribution of medical facilities supply. This paper concludes with optimizing proposals for different accessibility areas: 1) low
accessibility areas should promote the flexible mobility of consultation, as such areas are often blocked by high mountains with geographical disadvantage
of segregation; 2) medium accessibility areas should improve the quality of medical facilities. Although such areas are mainly located in relatively flat
rural areas with a larger number of medical facilities, the supply of medical resources is insufficient compared with the demand of the population; 3) high
accessibility areas should focus on the long-term adaptation optimization strategy of medical facilities, such areas are mainly near the city, and may share a
large number of high-quality medical resources with urban areas. |
| Key words: southwestern mountainous rural areas medical facilities spatial accessibility modified Gaussian two-step floating catchment area method Jiulongpo District, Chongqing |
