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建设全覆盖公共卫生服务、提高医疗服务水平是“健康中国”的建设重点，现有医疗服务设施可达性和公平性研究对分级诊疗关注不足，仅假设逐级转诊的传统情景，未考虑越级就诊和越级转诊，与现实存在一定差距。本文综合考虑各种分级诊疗情景，改进两步移动搜索法，基于POI和“七普”人口数据对成都市中心城区不同出行方式医疗服务可达性进行评价，采用泰尔指数和双变量局部Moran′s I探究经济社会视角和资源配置视角下成都市中心城区医疗服务公平性。主要结论如下：(1)不同出行方式时间成本呈现梯度差异，驾车方式整体覆盖情况最优，步行方式在15 min内具局部优势且增益递减，公共交通方式在中长时段覆盖水平接近驾车方式；空间上核心城区全出行方式覆盖均衡，外围区域高度依赖驾车出行方式。(2)不同出行方式下医疗服务可达性的高值区主要集中在住房密集区，低值区分布差异显著，综合医疗服务可达性呈明显的“核心—边缘”特征。(3)不同出行方式公平性差异显著，其中驾车方式公平性最优、步行方式最差；不同人口密度区域医疗可达性差异大于经济水平群体间差异，城市医疗资源存在“核心资源过载—外围供给失衡”的矛盾。
Abstract：Establishing a full-coverage public health service system and improving medical service quality are key objectives of the "Healthy China" initiative.Existing studies on the accessibility and equity of medical service facilities have paid insufficient attention to the tiered healthcare system, often assuming only traditional stepwise referral scenarios while overlooking common real-world practices such as bypassing primary care or cross-level referrals, leading to a gap between research assumptions and actual conditions.This study incorporates various realistic referral pathways under the tiered healthcare framework and improves the two-step floating catchment area(2SFCA) method.Using point of interest(POI) data and population data from China′s Seventh National Population Census, we evaluate the accessibility of medical services in the central urban area of Chengdu across different travel modes.The Theil index and bivariate local Moran′s I are applied to examine the equity of medical services from both socioeconomic and resource allocation perspectives.It is found as follows.(1) Travel modes show gradient differences in time cost.Driving provides the best overall coverage, walking offers local advantages within 15 minutes but with diminishing returns, and public transport approaches driving coverage over medium to long durations.Spatially, core urban areas exhibit balanced coverage across all travel modes, whereas peripheral regions rely heavily on driving.(2) Areas with high medical service accessibility across all travel modes are mainly concentrated in high-density residential areas, while low-accessibility areas show significant spatial variation.Integrated medical service accessibility displays a clear "core-periphery" pattern.(3) Equity levels vary notably among travel modes, with driving being the most equitable and walking showing poorest performance.Disparities in medical service accessibility between areas with different population densities exceed those between economic groups, reflecting an urban medical resource conflict characterized by "overload in the core area versus undersupply in the periphery".
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基本信息:
中图分类号:TU984.14
引用信息:
[1]付言川,常跟应,贾芸,等.分级诊疗下超大城市医疗服务可达性及其公平性研究——以成都市中心城区为例[J].地理与地理信息科学,2026,42(03):75-83.
2026-05-25
2026-05-25