Allocation of public medical facilities affects the health and well-being of urban and rural residents, therefore a scientific and accurate estimation of equal accessibility of public medical facilities in rural areas is of great significance. In rural areas, the population is scattered and the scale of settlement is small, and the medical care demand of residents is different from that of urban residents. The 2-step floating catchment area (2SFCA) and 3-step floating catchment area (3SFCA) algorithms are unable to accurately reflect the pattern of population distribution in rural areas, the characteristics of medical care-related travels, and residents' preference for higherlevel medical institutions. Therefore, the 3SFCA method is not effective in evaluating the accessibility of medical facilities in rural areas. This study improved the 3SFCA algorithm from three aspects-selecting the distance attenuation function according to the travel pattern of the rural residents in Haikou City, gridding the study area into population demand points, and considering the attraction of medical institutions of different levels to residents. Then the methodological framework for evaluating the accessibility and spatial equality of public medical facilities in rural areas was established, and an empirical analysis of Haikou City was conducted.The results show that: 1) The improved 3SFCA algorithm can accurately evaluate spatial accessibility at a finer grid, and the established rural medical facility accessibility and spatial equality evaluation model is more objective. 2) The accessibility of public medical facilities in the rural areas of Haikou City is poor, and the spatial differences are obvious. The high-value areas are distributed in the east of the study area, such as Sanjiang, Yunlong, and Jiazi towns, and the low-value areas are mainly concentrated in the west of the study area. 3) The spatial equality of the allocation of public medical facilities in the rural areas of Haikou City is also poor. A small number of areas of high and medium-high equality level are located in the low-and medium-density areas, while the areas of low and very low spatial equality level cover a large number of high-density areas, and the spatial equality of medical resource allocation urgently needs to be improved.
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