Accessibility Of Medical And Health Services And Its Influence Factors In Urban And Rural Area In China

Improved living standards and an increasing emphasis on health stem from socioeconomic progress sharply raise the quantity of medical and health consultations in recent years in China.Under this context,limited medical and health resources are harder to satisfy people's daily needs for medical and health services.As a kind of public goods which can be competed for and has the feature of service objects exclusivity for those at a distance,spatial accessibility,inequality,and reasonability of the distribution of medical and health resources have a significant impact on the satisfaction of people's demand for it.With the rapid progress of urbanization,the medical and health industry has developed a lot and the service system has gradually improved.Thus,we need to understand the current situation of the relationship between resource supply and people's demand for medical and health services in urban and rural areas.In the meantime,due to the diversified topography and remarkable local characteristics of different areas,the distribution of medical and health resources in China is affected by geo-influence factors to a certain degree.Therefore,to alleviate the imbalance of medical and health resources between different regions,exploring hidden geo-influence factors of the disparity between supply and demand for local medical and health resources based on the analysis of its spatial characteristics is meaningful and necessary,to support local governments to accurately resolve the problems.On the basis of the modified two-step floating catchment area method and consideration of the service areas and abilities of different levels of medical and health facilities,this paper measured and analyzed the accessibility and distribution inequality of medical and health resources of four geographic scales in China from the multiple perspectives of macro-,middle-level,and micro-geography,including the areas of southwest half and northeast half of Bole-Taipei line,eight comprehensive economic zones,provincial-level administrative regions,and county-level administrative areas.Then,based on the analysis of the spatial patterns of medical and health resources,this paper utilized the ordinary lease square regression model(OLS)and geographically weighted regression model(GWR)to investigate the influence factors of medical and health resources accessibility of different regions,in order to excavate the similarities and differences of local geo-influence factors.Then,combined with the dual structure of urban and rural land in China,this paper compared the medical and health service accessibility of urban and rural populations in county-level administrative areas.Dividing urban land into different land use structures and rural land into several topographic structures,this paper also explored the differences of medical and health resources distribution in different types of urban and rural land,in order to analyze the dual structure of spatial distribution of medical and health resources in urban and rural areas in China.The results show that(1)the holistic accessibility of medical and health services in the areas of the southeast of China is high and the northwest of China is low.The areas with relative high accessibility possess high-level supplies of different levels of medical and health resources.The inequality of medical and health distribution exists in the entire medical and health system.Even though people and medical and health facilities are dense in a part of areas,both of them may spatially mismatch with each other,resulting in local low-level accessibility in these areas.(2)The establishment of the Bole-Taipei line(or Botai line)is beneficial to resolve the differences between the medical and health resources allocation in the northeast and southwest of China and narrow the gaps of services between regions.(3)Per capita GDP,the tertiary industry as a percentage to GDP,per capita local public budget expenditure,urbanization rate of land,urbanization rate of population,and average slope of topography have a stronger impact on medical and health services accessibility than per area GDP and average elevation in different regions.Among these factors,urbanization rates of land and urbanization rates of population have the strongest influence on the accessibility in most of the areas,followed by the tertiary industry as a percentage to GDP.(4)Because urban development is at an early stage,inadequate supplies of basic medical and health resources lead to lower accessibilities of urban residents than the rural population in some areas.The gap between urban and rural populations' accessibility in an area is affected by the land use structure of its neighboring units.Generally speaking,the accessibility levels of medical and health services in the two half regions besides the Botai line have small differences.Compared to the areas of the southwest half,the areas of northeast half have lower accessibility and higher inequality.The government should encourage the development of the medical and health industry in northeast half areas,taking the Botai line as the baseline of regional strategic development to balance different regions and advance the entire medical and health industry in China.Meanwhile,considering the current allocation policy of limited medical and health resources in China,we should emphasize the improvement of the medical and health service ability of the areas where populations are dense but mismatch with medical and health resources,with the advancement of medical and health industry in the areas of low population density.The findings in this paper can assist to grasp the current situation of the mismatch between distributions of population and medical and health resources as well as its local geo-influence factors in different areas in China,in order to provide government and relevant management administrations with decision basis to resolve the contradiction between the demand and supply of medical and health resources from multiple socioeconomic and natural aspects.