Xiuli Wang1,2, Barnabas C Seyler3, Wei Han4, Jay Pan5,6. 1. HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 People's South Road, Chengdu, 610041, China. 2. Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No.17 People's South Road, Chengdu, China. 3. Department of Environment, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, 610065, China. 4. Health, Nutrition and Population Global Practice, World Bank, No.1 Jianguomenwai Street, Chaoyang district, Beijing, 100020, China. 5. HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.17 People's South Road, Chengdu, 610041, China. panjie.jay@scu.edu.cn. 6. Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, No.17 People's South Road, Chengdu, China. panjie.jay@scu.edu.cn.
Abstract
BACKGROUND: Access to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs). METHODS: Hainan Island was taken as an example to explore the utilization of modern spatial access techniques under China's specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution's tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated. RESULTS: On Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions. CONCLUSION: Spatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.
BACKGROUND: Access to healthcare is critical for the implementation of Universal Health Coverage. With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial access methodologies have been developed in Western countries, whose healthcare systems are different from those in Low- and Middle-Income Countries (LMICs). METHODS: Hainan Island was taken as an example to explore the utilization of modern spatial access techniques under China's specialized Three-Tier Health Care Delivery System. Healthcare institutions were first classified according to the three tiers. Then shortest travel time was calculated for each institution's tier, overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method was also calculated. RESULTS: On Hainan Island, about 90% of the population lived within a 60-min service range for Tier 3 (hospital) healthcare institutions, 80% lived within 30 min of Tier 2 (health centers), and 75% lived within 15 min of Tier 1 (clinics). Based on local policy, 76.36% of the population living in 48.52% of the area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but the regional disparity was large, with 64.66% being contributed by Tier 3 healthcare institutions. CONCLUSION: Spatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequity between regions and imbalance between different healthcare institution tiers exist. Primary healthcare institutions, especially in Tier 2, should be strengthened.
Entities:
Keywords:
Enhanced two-step floating catchment area method (E2SFCA); Overlay analysis; Spatial access; Three-tier health care delivery system