卫生服务空间可及性评估模型的比较研究  

A Comparative Study on Statistical Models for Evaluating the Spatial Accessibility to Healthcare Services

作　　者：覃青连 徐斌[2] 韦雪 苏玉璐 林越东 李峤 唐咸艳 Qin Qinglian;Xu Bin;Wei Xue(Department of Epidemiology and Biostatistics,School of Public Health,Guangxi Medical Univeristy 530021,Nanning)

机构地区：[1]广西医科大学公共卫生学院流行病与生物统计学系,530021 [2]南宁市疾病预防控制中心 [3]南宁市卫生健康宣传信息中心

出　　处：《中国卫生统计》2024年第1期35-40,44,共7页Chinese Journal of Health Statistics

基　　金：国家自然科学基金(82160646;81960615);美国中华医学基金(CMB 19-307)。

摘　　要：目的比较供需比例法、重力模型、传统两步移动搜索法及改进两步移动搜索法四种模型在卫生服务空间可及性评估中的原理方法和应用价值,为卫生服务空间可及性评估模型的科学选用提供参考。方法以南宁市妇幼卫生服务为例,收集南宁市行政区划矢量地图、道路交通网络矢量图、妇幼卫生资源及需求人口等资料,采用供需比例法、重力模型、传统两步移动搜索法及改进两步移动搜索法分别从县区、乡镇/街道、行政村多尺度上综合评估南宁市妇幼卫生服务的空间可及性。结果四种模型均发现南宁市妇幼卫生服务空间可及性呈明显的空间分异性,可及性从市中心向周边地区递减。但不同模型和不同空间尺度下探测到的可及性高值/低值区域,可及性递减趋势,可及性中位数和四分位数间距等存在较大差异。结论供需比例法、重力模型、传统两步移动搜索法及改进两步移动搜索法在卫生服务空间可及性评估中的应用价值不同,测算出的空间可及性强度亦不同。应用时需参考四种模型结果从多维空间尺度上仿真现实情景,综合评估卫生服务的空间可及性。Objective To compare the principles,methods and applications of provider-to-population ratios method,gravity-based model,two-step floating catchment area(2SFCA)method and improved two-step floating catchment area method for evaluating the spatial accessibility to healthcare services.Methods Taking the spatial accessibility to maternal and child healthcare services in Nanning prefecture for example,we collected data on vector map,transportation network,population size,and the number of health professionals in maternal and child health institutions.Provider-to-population ratios method,gravity-based model,2SFCA method and improved 2SFCA method were applied to evaluate the spatial accessibility to maternal and child healthcare services,on the scales of county level,township level and village level,respectively.Results The four models showed that the spatial heterogeneity of spatial accessibility to maternal and child health services was significant,and the spatial accessibility was gradually decreased from urban areas of Nanning to rural areas.However,regions with high spatial accessibility and regions with low spatial accessibility,decreasing trend in spatial accessibility across regions,the median and inter quartile range of spatial accessibility were different across the four models.Conclusion The practical significance in evaluating spatial accessibility to healthcare services for provider-to-population ratios method,gravity-based model,2SFCA method and improved 2SFCA method was different,yet the spatial accessibility varied somewhat across the four models.Thus,integrating findings of the four models based on multi space scales is strongly recommended to evaluate the spatial accessibility to healthcare services comprehensively and robustly.

关 键 词：卫生服务空间可及性 供需比例法 重力模型 传统两步移动搜索法 改进两步移动搜索法 

分 类 号：R197.1[医药卫生—卫生事业管理]