基于GIS的农村医疗设施空间可达性分析——以河南省兰考县为例

针对农村医疗设施空间分布的公平性问题,提出了使用GIS技术和空间可达性指标评估医疗设施的区域分布特征。以兰考县乡级以上卫生院为例,建立人口分布、医疗设施位置、行政区域等地理数据库,选择人均医疗资源分配、就医的最近距离、选择医院的机会、重力模型及改进的重力模型5个空间可达性模型,计算了各乡镇、各行政村的医疗设施可达性指标,并制作了相应的专题地图;在此基础上对医疗设施的空间布局进行了分析。空间可达性指标全面地反映医疗设施的空间分布特征,鉴别出资源分配较薄弱的区位,是农村医疗改革中设施规划和资源分配的重要依据。

THE SPATIAL ACCESSIBILITY ANALYSIS OF RURAL MEDICAL FACILITIES BASED ON GIS: A CASE STUDY OF LANKAO COUNTY, HENAN PROVINCE

Both equality and efficiency are critical issues on assessing and planning of public facilities,especially for the rural areas in developing countries. Considering the uneven spatial distribution of medical facilities in rural China,this paper aims to assess the equality of rural medical services by introducing geographic information systems(GIS) and spatial accessibility indexes. Lankao County of Henna Province is selected as a study area. For its medical resources,there are 21 township and county-level hospitals with 625 licensed doctors,2517 nurses and technical employees,2015 beds and 328 costly medical equipment. The general data,such as administration boundary,transportation network,remote sensing image,and village's name,location and population,are gathered from government authorities. The statistics of township and county-level hospitals,including hospital name,location,number of doctors,nurses,technicians and hospital beds,and major medical facilities,are collected from the Bureau of Medical Management,Lankao County. Using ESRI's ArcGIS software,the authors have created four map layers of administration boundary,demographics,medical facilities and transportation networks. The village-level indexes of spatial accessibility to the township and county-level hospitals,in terms of provider-to-population ratio,distance to nearest provider,number of neighbor providers,gravity model and improved gravity model,are calculated in ArcGIS 9.2 software. The statistics,map visualization and spatial analysis of these indexes for every village show that there exists quite different accessibility in the study area. The areal and locational medical accessibility and equality are discussed systematically;especially the locations with weak medical services are identified. The research results can be used for local medical planning,resources allocation and reallocation of some hospitals. Based on this case study,the authors argue that the GIS technology and spatial accessibility are the essential tools for assessing not only the spatial equality of rural medical facilities,but also potentials in the service planning and resource allocation in rural medical reforms. Furthermore,a practical GIS system for medical facility planning can be developed by deliberating the accessibility models and utilizing more geographic and socioeconomic data.