Study On The Accessibility And Equalization Of Rural Public Medical Services In The Xiantao County Of Hubei Province

It is an accelerating reshaping process for spatial pattern of tertiary-level health service network, population and settlements in rural areas in ten years. With the enhancing of economic and social development and people’s income level, the supply and demand of medical service have changed. Especially under the background of rapid urbanization in China, the population in rural areas continues to decline, which has a huge impact on the rural public health services. So, to pursue comprehensive and balanced full-cover too early may lead to great waste of resources. Therefore, in order to cope with such a dilemma, the rural areas centralized public health services, expanded the scale of the facilities, and improved the quality of services through measures such as village-dismiss and town-combination. But under the limitation of medical service resources, the expansion of a single facility inevitably lead to the reducing of the number of facilities, the increase of the radius of and the decrease of accessibility. So under the theory of supply and demand balance, to enhance the accessibility of rural medical service and equalization, to explore the space optimization layout of medical service facilities in rural area is a scientific and reasonable pathway to solve the contradictory between service quality and facilities accessibility.The dissertation combined with the national natural science fund projects (41371183), taking Xiantao city which is typical county in Jianghan plain in Hubei province as a research place. Based on rural settlements accessibility of health service space research, from the spatial and non-spatial perspective, the status quo of problem is found that the shortage region of rural public health service and spatial equitation, through the population spatial prediction and the simulation experiment of optimization model, to explore the basic theory and application of rural medical space planning tool. Xiantao city is a typical county unit in Jianghan plain, with natural and economic geography homogeneity plains, which facilitate the resolution and the construction of model, which owns representative significance in research on the public health service equal space optimization to improve the rural public service.The dissertation includes nine chapters:The first chapter is introduction. Starting from the new problems under China’s rapid urbanization process for rural public health service facilities, according to the construction of a harmonious society and the realistic requirement of construction of new urbanization, the dissertation put forward the goal of this study, the contents and writing method and technical route, and describes the present situation of a case study on the area and the methods of establishing the database.The second chapter is Research related theory and research progress. On the basis of related concepts, from the philosophy thinking of justice, based on the theory of central place theory, time, geography, medical geography and health theory of Confucian classics, the accessibility of public service at home and abroad are summarized, equalization and facilities space optimization layout research progress, and the related research are reviewed.The third chapter is the survey and evaluation of development pattern in time and space. By analyzing the rural health service system and the cooperation and development of medical system, the problems existing in current medical service system are found. From three aspects of overall medical service supply, medical services and medical institutions service ability, the comprehensive development condition of medical service is evaluated in Xiantao city, and from the perspective of the space, the spatial pattern of rural medical services in Xiantao city is analyzed.The forth chapter is the accessibility measure of rural medical service in space. By using improved potential model and two step mobile search method of comparative analysis, the former is more suitable for the accessibility measure in case region. Rural medical spatial pattern of accessibility and the shortage region of medical services are found.The fifth chapter is equalization evaluation of medical services from the non-spatial perspective. Based on supply-equilibrium theory, the evaluation index system of equal medical services is constructed, using the entropy value method, the coupling coordination degree analysis and deviation analysis, the medical supplies, medical demand and supply and demand balance equal level are evaluated.The sixth chapter is the model research on rural medical service optimization layout. Reasonable layout of public health service facilities is related to the utilization efficiency of medical facilities and medical fairness. Firstly, after comparative analysis of traditional location-allocation (LA) model, introducing the rating scale preference coefficient, the improved location configuration model is constructed. And then with the integration of GIS network analysis, linear programming modeling tools PuLP and linear programming software Cplex, this paper optimizes geographic visualization layout results by using programming language Python to achieve the improved location in ArcGIS10.2 configuration model building, model solvers and rural medical facilities in ArcGIS10.2. Finally, the experiments by optimizing the size and number of medical facilities in rural areas can significantly reduce the cost of resident medical space, meet more medical needs, improve utilization and coverage of medical resources, and also verify the practicality and effectiveness of the secondary development tools.The seventh chapter is on the spatial pattern of population prediction based on multi-factors. In order to avoid the reconstruction and the problem of sparse settlements, the spatial optimization layout of rural medical facilities should be based on the more precise spatial prediction in the future on the rural population. This chapter by analyzing the present population distribution and the present condition of the system of urbanization in Xiantao city based on population spatial discretization method from multiple elements, to predict the future population distribution and urbanization system in case region, and then calculate population and medical needs in the future.The eighth chapter is on countermeasures for rural public health service equalization. Countermeasures research on equalization of the countryside medical service mainly from the perspective of spatial and non-spatial. Space policies focus on site selection of the new medical facilities, the number and scale adjusting and optimizing of medical service facilities, and the measures on reducing the spatial accessibility impedance. Non-spatial policies focus on the new farming and health care system, to strengthen rural medical personnel training, improve the medical configuration mechanism and promote the construction of the grading system, etc.The ninth chapter is conclusion and prospect. The findings of the study and innovation points are summarized, and the research deficiency and the outlook for further research are pointed out.