Research On The Spatial Equalization Of Rural Basic Public Medical Services

As the economy and society develops rapidly,prominent improvement of the living standards in rural areas can be seen nowadays,which has also promoted higher residents' requirements for the life quality,and the increasingly diversified demands for for medical services.While because of the urban-rural system separation in our country for a long time,it leads to the concentration of high-quality medical resources in urban areas,so a typical "inverted pyramid" structure of medical resource allocation is formed between urban and rural areas.Under this situation,the problem of unbalanced allocation is increasingly prominent,which also causes the severe contradiction between supply and demand.By virtue of the equalization degree of the scientific evaluation of the accessibility to medical treatment,the rational allocation of medical resources should be guided by optimizing the layout of facilities,and the overall level of urban and rural medical services can be improved,so as to achieve the equalization of basic public medical services,which has gradually attracted the attention of the academic community.However,the research that has been carried out at present mainly focuses on the urban community,which almost does not involve rural areas.Besides,it mostly relies on the qualitative perspective to carry out the analysis,so the rational evaluation of the accessibility and equalization level of rural basic public medical services lacks a quantitative research theory and method system.Haikou City is chosen by the World Health Organization as the first "World Health City" pilot site.Over the years,the scale of its health industry has been constantly expanded,which has formed the clustering pattern in the initial stage.While in contrast with other developed regions,it still meets problems as a weak industry,which cover uneven allocation of medical and health resources,as well as weak gross-roots medical and health service ability.Therefore,the "facility layout" is taken as the starting point and the "equalization" is taken as the goal,and 3SFCA is improved to G3 SFCA,then the accessibility evaluation will be more accurate and will take into account of the actual situation in rural areas.After that,the method system and research framework for the equalization of rural basic public medical services will be constructed in this thesis.From a global and local perspective,the equalization level of rural basic public medical services in Haikou City will be measured based on 500m×500m grid units,which also finds out the areas that are shortages of medical services.The binary logistic regression model will be adopted to carry out the analysis on the influencing factors of the uneven configuration of medical facilities.Finally,the layout of medical facilities is optimized by using the Location-Allocation model.According to the above research,this thesis proposes some countermeasures and suggestions,so that the scientific basis can be provided for the policy formulation to realize the equalization of medical services in rural areas of Haikou City.The main conclusions are as follows:(1)The good effects are embodied through the improved algorithm G3 SFCA,the scientificity and rationality of the equalization evaluation method of basic public medical services in rural areas is embodied.The regional accessibility can be assessed by G3 SFCA at a more granular level,so the detailed differences in accessibility can be accurately embodied,and the true status of accessibility to medical care in concentrated rural areas o population can be reflected.From the result,the strong operability for the spatial equalization evaluation method system of rural basic public medical services is embodied,so the spatial distribution of rural areas lacking medical care can be more accurately identified.(2)The problems are found,such as the poor accessibility of basic public medical services in rural areas of Haikou City,poor equalization situation in a whole,and wide distribution of the areas with shortage of medical services.The distribution of high-value accessibility areas is mainly in a few townships in the east of the studied area,while the distribution of low-value areas is in the western contiguous area,which occupies 94.2% of the area.Due to the severe unbalance of the allocation of medical resources in various townships,the basic public medical services fail to benefit the entire population and match with the population distribution though the number of existing medical institutions is generally very equal.The areas with low population density and well-developed transportation have balanced and relatively balanced medical services,which have higher levels of medical facilities and adequate medical resources.While in the areas with the medium-and high-density of population belong to unbalanced service areas,in which 85% rural residents cannot enjoy nearby medical services.(3)The features of demand subject attributes such as population density,whether there is poor population and the per capita disposable income of residents cause some influence on the equalization level of rural basic public medical services in Haikou City,which are also under the influence of the object attribute features of facilities such as hardware level,medical level and service capacity.Besides,the mechanism factors such as the nature of residence,the level of urbanization,policy support,financial expenditures,and the shortest medical treatment time also cause some influence on it.In areas with high population density,poor people,as well as the longest medical treatment time,the medical services are even more uneven.With good hardware facilities,high medical standards,and strong service capabilities for the medical points,the center of the town as the residential area,the high level of urbanization,and the more per capita disposable income of rural residents,the medical services tend to be more equal.(4)By relying on the Location-Allocation model to optimize the layout of medical facilities,the rural areas of Haikou City are basically covered by the basic public medical services,which sees the significant improvement of the accessibility and equalization level.The areas with shortages of public medical services still exist after upgrading the 27 village clinics with excessively high demand and being searched by the minimized impedance model.By using the minimum facility points model to further improve the equalization of medical services,44 new medical facilities are added on the basis of the continued operation of the original 198 medical institutions.After carrying out the optimization,some achievements have obtained,such as prominent improvement of the accessibility of medical treatment in rural areas,the great enhancement of the efficiency of medical treatment,and the significant increase of the coverage of balanced and relatively balanced medical service areas.Thus,it basically realizes the basic public medical services of residents in the whole region.