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Assessing the Spatial Accessibility of Healthcare Services in Huangmei County Using GIS

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Assessing the Spatial Accessibility of Healthcare Services in Huangmei County Using GIS Assessing the Spatial Accessibility of Healthcare Services in Huangmei County using GIS Haoyun Wang Final Paper for Theory and Practice of Public Informatics Professor Clinton Andrews December 17, 2018 1 Assessing the Spatial Accessibility of Healthcare Services in Huangmei County using GIS Abstract: Large disparities exist in the development of urban and rural areas in China, especially in the field of healthcare. It is common to see remote rural areas suffer from a shortage of medical resources while urbanized cities and towns enjoy a higher level of accessibility to healthcare service. This research uses Huangmei County, the author’s hometown, as a case study and aims to define and evaluate spatial accessibility and spatial inequity (i.e. unequal spatial accessibility in healthcare services for rural and urban areas) through ArcGIS. Finally, it proposes recommendations for decision-makers in healthcare planning to increase people’s spatial accessibility to healthcare services. Keyword: healthcare services, GIS, spatial accessibility, spatial equity 1. INTRODUCTION Although China has witnessed great progress in economic development during the past decade, large disparities still exist in the development of urban and rural areas in China, especially in the distribution of public services, such as schools, hospitals, and transit. It is common to see remote rural areas suffer from a shortage of public services while urbanized cities and towns enjoy a higher level of accessibility to public services. The Chinese government has proposed the equalization of public services at the National Congress to spur efforts to increase public services in undeveloped areas and other places that need them most Among the host of public services, healthcare service is considered as one of the fundamental services. An accurate assessment of the current allocation of healthcare services is essential to understand and address existing inequities, thus narrowing gaps in access to healthcare services and promoting overall population health. The spatial distribution of public services within cities and regions and people’s access to these services have been a central focus in a lot of geographical research. While past studies have varied in contexts, methodological approach and the type of public services, a common task has been to address spatial equity by researching on a question whether the spatial distribution of and access to a particular public service correspond to the geographical variation of ‘need’ for that service. This allows policymakers to assess the effectiveness of existing policies and identify areas of under-provision, thereby beginning the process of improved public service delivery. however, the methods used to calculate accessibility vary among studies and influence the results (Smoyer- Tomic, 2004). Methods measuring spatial accessibility can be roughly classified into four 2 categories: provider-to-population ratios (PPR), distance to nearest provider, average distance to a set of providers, and gravity models (Guagliardo, 2004). With the development of Geographical Information System (GIS), many new techniques have been introduced based on the gravity model, of which the Two-Step Floating Catchment Area (2SFCA) method has gained the most traction (Luo and Wang, 2003). This analysis will use Huangmei County, China as its case study. First, the paper discusses the social and demographic background of Huangmei. Then it analyzes supply and demand of healthcare services, spatial accessibility, and spatial equity. Last but not least, it provides recommendations for future healthcare facilities planning in Huangmei County. 2. DATA AND METHODS 2.1 Study area Huangmei County is located in the southeast of Hubei Province, Central China, and is north of the Changjiang River. Huangmei lies at the intersection of Hubei Province, Jiangxi Province, and Anhui Province. Huangmei has a total area of 1,701 km2 and its population comprises nearly one million residents, with one-tenth of its residents concentrating in the central town (county seat and regional economic center) Huangmei (The name of the central town is the same as the name of the county). Huangmei County enjoys a good transportation system, a combination of waterway, highway, expressway and railway. As shown in Figure2, there are high mountains, which are more than 1000m in height, inthe north of the county, restricting the accessibility of residents to public services. Southern areas consists of plains, which make it easy for people to move around. Figure 1. Overview Mapping of Huangmei Figure2. Elevation Map 3 2.2 Data The population data was obtained from Huangmei Sixth Population Census (2015) and the statistical yearbook of Huangmei (2015). In this paper, a residential point is used as the unit of analysis. The residential point is the centroid of a community in the urban area or a village in the rural area, representing community/village in this paper. Community/village is also currently the smallest measurement unit of public statistics in China. The data related to healthcare services was acquired from the Huangmei Health Bureau. It includes the number of healthcare professionals (doctors, nurses, etc.) and beds offered. The longitude and latitude of residential points and healthcare facilities were acquired from Baidu Maps (similar to Google Maps, the online map database typically used in China)then the locations were geocoded in ArcGIS. The travel impedance data (i.e. the road network), as well as administrative boundary data, were acquired from the 1:25,0000 scale Topographic Database of the National Fundamental Geographic Information System of China. 2.3 Method The following analysis was conducted in the ArcGIS 10.6 version. The distribution of healthcare facilities was analyzed by ArcGIS’sAverage Nearest Neighbor tool. The Closest Facility Analysis in Network Analyst was used to calculate the spatial accessibility metric of each residential point to its nearest healthcare facility based on time cost (i.e. time distance). Then, spatial accessibility score is calculated by integrating the spatial accessibility metric and population together. The steps of this analysis will be discussed in detail in the sections below. Finally, this study proposes locationsto build new hospitals to improve spatial accessibility based on the analysis. This paper seeks to address these questions: How are the healthcare services distributed in Huangmei? How can we evaluate the spatial accessibility and spatial equity of healthcare services? How is the spatial accessibility and equity in Huangmei in terms of healthcare services? Where should new healthcare facilities be established to increase spatial accessibility and equity? How much will spatial accessibility or equity be improved if the new healthcare facilities are built? 3. HEALTHCARE SERVICES SUPPLY-DEMAND IN HUANGMEI Healthcare services demand is measured by the total population. A higher number of people 4 should correspond with a higher supply of healthcare facilities. To be specific, it is ideal if healthcare services demand were measured by the number of people who are vulnerable to diseases such as children, elders, and the disabled. Due to the lack of demographic data on these vulnerable groups, the overall population is used as an indicator of the demand. Figure 3 shows the distribution of healthcare services demand (residential points) and supply (healthcare facilities). A large percentage of residents are distributed in the central area and southern area of Huangmei County. With respect to healthcare services supply, there are 169 healthcare facilities in Huangmei County. According to the national criteria of the main functions of healthcare facilities and the number of beds provided, they are divided into five categories and three levels. There are 4 comprehensive hospitals, 3 specialty hospitals, 4 regional hospitals, 20 township hospitals and 138 community clinics. The spatial locations of healthcare facilities are shown in Figure 3. Demand Supply Figure 3. Distribution of Healthcare Services Demand and Supply (Residential Points and Healthcare Facilities) Table1. Categories and Main Functions of Healthcare Facilities in Huangmei Category Level Main functions beds number Comprehensive County r\Responsible for providing >20 4 hospital level comprehensive health services, as well as (People’s medical education and conducting Hospital, Second research on a regional basis. It has a large People’ S Hospital number of beds for intensive care and Chinese Medicine additional beds for patients who need Hospital, Tongji long-term care. Hospital, ) 5 Specialty County Deals with specific medical needs such as 50-200 3 hospital level psychiatric treatment (see psychiatric (Children’s hospital) and certain disease categories. Hospital, Women’s Hospital, Orthopaedic Hospital) Regional Municipal Provide basic healthcare services to 50-100 4 hospital level several towns. It is less comprehensive than county-level hospitals and meets the demand of local residents. They are tasked with providing preventive care, minimal health care and rehabilitation services. Township Municipal Provide healthcare services to the local 20-50 20 hospital level town. Usually, one town has its own township hospital. Community Community It is run by a government agency for <10 138 clinic level health services or a private partnership of physicians. It provides assistance to basic healthcare service (such as flu shots). Patients diagnosed with severe diseases
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