Exploring Equity in a Hierarchical Medical Treatment System: A Focus on Determinants of Spatial Accessibility

Abstract

It is essential to understand the spatial equity of healthcare services to achieve the Sustainable Development Goals. Spatial and non-spatial factors affect access to healthcare, resulting in inequality in the hierarchical medical treatment system. Thus, to provide a comprehensive equity evaluation, it is indispensable to investigate the extent to which spatial accessibility to healthcare services varies due to various factors. This study attempted to analyze the determinants of healthcare accessibility under multi-trip modes and integrate them into Theil index, as a demand index to evaluate spatial equity in the system. The results reveal an inadequate and inequitable distribution of healthcare resources. While access to primary hospitals is limited (47.37% of residential locations cannot access them on foot), 96.58% of residential locations can access general and tertiary hospitals via public transport or driving. Furthermore, inequitable access to the three-tiered medical system was evaluated on a more granular scale, with primary hospitals being closest to achieving equity (inequitable for only 48.83% of residential locations), followed by general and tertiary hospitals (82.01% and 89.20%, respectively). The unequal residential locations brought on by an abundance of medical resources are far from those with a shortage of resources (66.86% > 5.34%). It is thus suggested that services be expanded or resources be transferred to move toward a more equitable system. Our findings provide policymakers with insights into how to increase accessibility to public health.