Evaluation Of Medical Accessibility In Karst Mountainous Areas Based On Rural Settlement Patch

Accessibility of medical services refers to the convenience of residents to enjoy various medical resources under specific transportation modes,which is one of the important indicators to evaluate and study the rationality and equity of spatial layout of public medical services.Especially in the era of rapid development of science and technology and economy,people’s living standards have been significantly improved,and people’s demands for "national health" are increasingly strong.As an important component of basic public services,medical service has become a health guarantee for balanced development of regional public health undertakings and high-quality economic development.However,there are still social problems such as resource misallocation,uneven distribution and limited supply in many regions.These problems are especially prominent in karst mountainous areas,which are manifested by practical problems such as uneven allocation of medical resources and wide differences in service capabilities.Therefore,sorting out the current situation of spatial allocation of regional medical resources and the relationship between supply and demand,calculating the difference of spatial accessibility of residents’ access to medical resources,and exploring the mechanism of spatial differentiation of accessibility can effectively improve the accessibility level of population medical services,improve the shortage of medical services in marginal mountainous areas,and provide theoretical reference for scientific and reasonable planning of medical service resources.In this paper,Qixingguan District of Bijie City in karst mountainous area is taken as the research area.Based on the patch scale of rural settlements,spatial statistical data such as medical facility points,settlements,transportation network,elevation and geological disasters are used.With the help of kernel density estimation,hot spot analysis,standard deviation ellipse and other methods in the spatial analysis function of Arc GIS platform and combined with statistical calculation methods,Firstly,the current situation of medical demand population,medical resource distribution,service capacity,supply and demand of Qixingguan District was analyzed,and the spatial coupling degree of medical facilities and population at different levels was compared and analyzed.Secondly,the spatial accessibility of medical services at different levels under different travel time thresholds was analyzed by using Gaussian two-step mobile search method and hot spot analysis.Based on the accessibility analysis results,the spatial agglomeration characteristics were analyzed.Finally,Pearson index and geographic detector model were used to explore the influence mechanism of spatial heterogeneity of medical accessibility.The main research conclusions are as follows:(1)The spatial distribution and agglomeration characteristics of the population with medical demand showed obvious spatial differences.The areas with high density of population with medical demand were mainly distributed in the northeast and the towns in the southwest,while the areas with low density of demand were distributed near the central urban areas.The spatial agglomeration characteristics and spatial differentiation characteristics of the population with medical needs are similar.The distribution characteristics of hot spots,sub-cold spots and cold spots are staggered.The hot spots are mainly concentrated in southwest and central regions,while the cold spots are mainly concentrated in northeast regions.In addition,as there is no distribution of rural residential areas,the central urban area forms cold spots where the population in demand gathers.Most of the population in need of medical treatment is distributed in the range of 1270-1628 m above sea level and the range of gentle slope(6°-15°).(2)The spatial configuration of medical facilities is significantly different.In terms of spatial distribution,the spatial distribution density of medical resources is relatively low in most regions.The areas with high density of medical resources are distributed near the central urban area,and the sub-high density areas are distributed in a ring around the central urban area.In terms of spatial service scope,the coverage rate of medical facilities in Qixingguan District is generally low,among which,the coverage rate of primary,secondary and tertiary medical facilities is 41.94%,2.56% and 0.01%,respectively.The spatial distribution of secondary and tertiary medical facilities and the spatial coupling of medical demand population are poor.(3)The spatial difference of medical resource supply and demand allocation is significant.From the perspective of demand,the areas with good supply and demand relationship are mainly distributed in the central urban area,the sub-supply and demand relationship is mainly distributed around the center of towns and villages,and the areas with poor supply and demand relationship are mainly distributed in the peripheral towns and villages and the areas around the central urban area and the northeastern region caused by the mismatch of supply and demand.From the perspective of supply,Qixingguan District cannot fully meet residents’ demand for medical and inpatient services.The imbalance ratio of overall medical supply and demand is as high as94.93%,and the balance ratio of primary,secondary and tertiary medical supply and demand is 3.89%,35.96% and 38.40%,respectively.Only the secondary and tertiary medical supply and demand relationship is ideal.(4)The overall accessibility of medical service space is good,but the spatial differentiation is obvious.High accessibility and high accessibility are mainly distributed in the central urban area and radiate to the surrounding areas,while low accessibility is mainly distributed in the peripheral areas.With the increase of the search radius,high accessibility spreads from the central urban area to the peripheral area and gradually decreases.Among all levels of hospitals,first-level hospitals have better accessibility.From the perspective of accessibility agglomeration,the above analysis results of spatial distribution pattern of medical accessibility are consistent.Hot spots cluster near the central urban area,while cold spots mainly cluster in the southwestern and northeastern marginal mountainous areas.Hot spots show strong resource and economic orientation,and spread and shrink discontinuously from the central urban area to the peripheral areas.(5)The spatial heterogeneity of medical service accessibility was significant.From the perspective of spatial correlation,the medical service accessibility in Qixingguan District was significantly correlated with all factors,but the correlation strength of economic characteristic factors was stronger than that of natural characteristic factors.From the perspective of the influence mechanism of accessibility,among the economic characteristic factors,educational accessibility level and road density had the strongest effect on spatial differentiation of accessibility,with explanatory power of 0.26 and 0.17,respectively.Among the natural characteristic factors,the degree of stony desertification and soil erosion had the most significant influence,with single explanatory power of 0.16 and 0.14,respectively.