BackgroundShenzhen has rapidly grown into a megacity in the recent decades. It is a challenging task for the Shenzhen government to provide sufficient healthcare services. The spatial configuration of healthcare services can influence the convenience for the consumers to obtain healthcare services. Spatial accessibility has been widely adopted as a scientific measurement for evaluating the rationality of the spatial configuration of healthcare services.MethodsThe multi-modal two-step floating catchment area (2SFCA) method is an important advance in the field of healthcare accessibility modelling, which enables the simultaneous assessment of spatial accessibility via multiple transport modes. This study further develops the multi-modal 2SFCA method by introducing online map APIs to improve the estimation of travel time by public transit or by car respectively.ResultsAs the results show, the distribution of healthcare accessibility by multi-modal 2SFCA shows significant spatial disparity. Moreover, by dividing the multi-modal accessibility into car-mode and transit-mode accessibility, this study discovers that the transit-mode subgroup is disadvantaged in the competition for healthcare services with the car-mode subgroup. The disparity in transit-mode accessibility is the main reason of the uneven pattern of healthcare accessibility in Shenzhen.ConclusionsThe findings suggest improving the public transit conditions for accessing healthcare services to reduce the disparity of healthcare accessibility. More healthcare services should be allocated in the eastern and western Shenzhen, especially sub-districts in Dapeng District and western Bao’an District. As these findings cannot be drawn by the traditional single-modal 2SFCA method, the advantage of the multi-modal 2SFCA method is significant to both healthcare studies and healthcare system planning.

BackgroundThe residential care system is rapidly developing and plays an increasingly important role in care for the elderly in Beijing. A noticeable disparity in the accessibility to existing residential care facilities, however, is demonstrated in existing studies. The spatial optimization of residential care facility (RCF) locations is urgently needed to promote equal access to residential care resources among the elderly population.MethodsA two-step floating catchment area method with an additional distance-decay function is adopted to measure accessibility to residential care facilities. The spatial optimization model is developed to maximize equity in accessibility by minimizing the total square difference between the accessibility score of each demand location and the weighted average accessibility score. The Particle Swarm Optimization (PSO) method is implemented for the solution.ResultsThe optimized RCF layouts improve equal spatial access to residential care resources with very low accessibility standard variation (0.0066). A relatively large number of beds (51% of the total beds) to be located in the suburban districts between the central and periphery districts of Beijing are optimized. A smaller number of beds to be located in the central and periphery districts (33% and 16% respectively) are optimized. The gaps between the existing and optimized layouts suggest that more RCF beds (5961 beds) are needed in suburban districts, while the RCF beds in some subdistricts located in the central and periphery districts are oversupplied (5253 and 1584 surplus beds respectively).ConclusionsThe optimized results correspond to the municipal special plan proposed by the Beijing government. The optimization objective of this study is different from traditional facility location optimization models, and the method is efficient in maximizing equal access to residential care facilities. This method can support knowledge-based policy-making and planning of residential care facilities.

Background Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies. Methods Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement. Results The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making. Conclusions The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

In the context of rapid population aging, Beijing is facing great challenges in providing healthcare services for the elderly. The objective of this study is to measure the spatial accessibility of the elderly to healthcare services in Beijing. A major challenge is that healthcare services are not exclusive for the elderly, so the elderly must compete with the non-elderly for access to healthcare services. In this study, we have developed a multi-mode and variable-demand two-step floating catchment area model for measuring spatial accessibility of the elderly to healthcare services, taking into account the competition between the elderly and non-elderly. This is modeled by differences in demand intensity and mobility. The elderly have a higher demand intensity and are disadvantaged in mobility due to their higher dependence on public transportation than the non-elderly. To improve the elderly’s healthcare accessibility, more healthcare resources should be allocated and the public transportation to hospitals should be improved, especially in peripheral areas. The proposed model can also be applied in other scenarios considering multiple population groups with different demand intensity for public services and mobility.