Spatial Accessibility
2023-7-26
Assessing Spatial Accessibility of Community Hospitals for the Elderly in Beijing, China
This paper examines limitations in current methods for measuring spatial accessibility to healthcare and proposes a new approach to account for suboptimal configurations of facilities.
Abstract:
Accessibility of health services signifies the quality and equitability of universal health provision. The hierarchical medical system recently implemented in China offers the policy instruments to improve medical services to the elderly in an aging society. As the critical primary care gateway, accessibility to community hospitals has significant impacts on people’s health. However, current research has paid little attention to spatial accessibility within walking distance of community hospitals, especially for the elderly. This study selected four districts with different urbanization levels in the rapidly developing Beijing metropolis. The spatial interaction model was applied to measure the accessibility of community hospitals for the elderly at the community level. An attractiveness index was computed based on key hospital traits. The results showed that: (1) community hospitals could cover 82.66% of elderly residents, and 77.63% of the communities were within walking distance. The served elderly proportion was relatively high in central urban areas and low in the suburbs. (2) The attractiveness indices of hospitals varied notably between districts, with higher values in more urbanized areas. (3) The spatial accessibility for the elderly of hospitals differed significantly between the four districts, with a descending gradient from central to suburban and rural areas, as indicated by the Gini coefficients and Lorenz curves. (4) The accessibility index was strongly related to the served elderly population and the hospital-residence distance. The findings provide policy directions to the government, including providing more primary-care resources to suburban and rural areas, building new community hospitals in identified provision gaps, upgrading some clinics to hospitals in rural areas, and planning hospitals according to the projected trend of the elderly population in terms of quantity and distribution. The considerable provision disparity between core urban, suburban and rural areas can be addressed by refined spatial health planning informed by research.
Summary:
-
Background and Introduction
- Aging populations increase demands on health services, especially primary care which elderly rely on
- Spatial accessibility is important due to mobility limitations of the elderly
- China aims to establish equitable primary care with hierarchical medical system reform
- Community hospitals are critical gateway for basic services but little research on spatial accessibility for elderly
-
Study Area and Data
- 4 districts of Beijing representing different urbanization levels
- Community hospital locations and traits from government and fieldwork
- Elderly population data estimated from households and population raster
- Defined walking catchments based on planning standards for elderly
-
Methods
- Spatial interaction model to measure accessibility using attractiveness index
- Gini coefficient and Lorenz curve to assess equity of accessibility between districts
-
Results
- 77-98% of communities within walking distance, lower in suburbs
- Attractiveness generally low, better in urban areas
- Accessibility higher in central urban, lower in suburbs
- Significant inequity between and within districts
-
Discussion
- SIM flexible for small-scale accessibility with multi-factor attractiveness
- Suburbs have gaps in elderly services, low attractiveness
- Accessibility related to served elderly and distance
- Inequity indicates need to reallocate resources by government
-
Conclusion
- Accessibility discrepancies between urban-suburban-rural
- Planning should consider projected elderly demand
- Refined accessibility research can inform health equity improvements
Study questions and answers:
| Study Questions | Answers |
|---|---|
| What was the purpose of this study? | To assess the spatial accessibility of community hospitals for the elderly in different urbanization areas of Beijing. |
| What methods were used? | Spatial interaction model, attractiveness index, Gini coefficient, Lorenz curve. |
| What were the main findings? | Significant differences in accessibility and attractiveness between central urban and suburban areas. Inequity in accessibility within and between districts. |
| What are the implications for health planning? | More resources needed in suburbs and rural areas. New hospitals in gaps. Upgrade clinics to hospitals. Plan based on projected elderly demand and distribution. |
| What are limitations and future research suggestions? | Limited data requiring estimates. More attractiveness factors needed. Include other accessibility measures. Link with health outcomes. |