Spatial Inequity of Multi-Level Healthcare Services in a Rapid Expanding Immigrant City of China: A Case Study of Shenzhen

Abstract

Since the onset of reform and opening up in China, large cities in the nation have been experiencing problems related to limited medical resources. These resource limitations are due to rapid population growth and urban expansion. As the country’s fastest growing city, Shenzhen has experienced a substantial misalignment between the supply and the demand of healthcare services. Numerous researchers have analyzed spatial inequity in healthcare services by focusing on the spatial accessibility of medical facilities, such as hospitals, clinics, and community health service centers (CHSCs). However, the issue of inequity in healthcare services for vulnerable groups has largely been ignored. We chose general hospitals (GHs) and CHSCs, which provide direct healthcare services to residents, as the study objects. By performing spatial accessibility analysis using the gravity model and the two-step floating catchment area method, we investigated healthcare services inequity for vulnerable groups based on four dimensions: residential type, age, education level, and occupation. We found that the services provided by GHs cannot meet the demand in Shenzhen. This inadequacy is characterized by spatial centralization and neglect of those who reside in urban villages, who have low education levels, and who are employed in the manufacturing industry. In contrast, CHSCs generally serve a relatively broad population. This phenomenon is related to differences in the land and capital needs between GHs and CHSCs. Our study reveals that an appropriate adjustment of GH location could significantly improve healthcare services inequity. Therefore, to alleviate this inequity, it is particularly necessary to increase the number of GHs in the peripheral circle and in areas with large vulnerable populations, accelerate the implementation of the hierarchical medical system, and promote the transfer of medical resources to grassroot institutes through CHSCs. This study helps improve our understanding of healthcare services inequity in rapid expanding cities, which is of substantial significance for improving the planning and construction of medical facilities, facilitating scientific decision-making, and promoting social equity.

Hierarchical two-step floating catchment area (2SFCA) method: measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China

“…Some studies have evaluated the spatial accessibility to hierarchical healthcare facilities in Shenzhen or other similar contexts. Hu et al [ 49 ] measured the spatial accessibility to the bi-level healthcare facilities in Shenzhen. All GHs were considered as one level.…”

“…Specifically, two levels of healthcare services, i.e., general hospitals and community health service centers, were included. They took into account the differences in service scopes of facilities at various levels, but did not consider the availability of multiple transport modes and the variability in accessibility by using different modes [ 49 ].…”

Retrospective analysis of the changes in the surgical treatment of benign prostatic hyperplasia during an 11-year period: a single-center experience

“…First, drug therapy is more common than surgery, particularly for patients with mild-to-moderate symptoms. 9 Second, because of the implementation of a hierarchical medical system and the development of primary hospitals, 10 11 an increasing number of patients chose to undergo surgery in local primary hospitals or private hospital. Third, the annual number of surgeries that was able to be performed at our center might have already been reached, even though the number of patients with BPH continued to increase.…”

An integrated analysis of spatial access to the three-tier healthcare delivery system in China: A case study of Hainan Island

“…Second, which tiers and/or types of healthcare institutions being considered depend on individual research questions. In most cases, the catchment area sizes of different tiers/levels/types of healthcare institutions are set differently, and general access is calculated as the sum of access for all healthcare institutions [9,47]. However, Zhang et al [48] measured shortest travel time to city-level hospitals, county-level hospitals, and community-level health centers, identifying different types of healthcare resource shortage areas.…”