Inequalities of spatial primary healthcare accessibility in China

Peng Jia; Youfa Wang; Min Yang; Limin Wang; Xuchao Yang; Xinyu Shi; Lijian Yang; Jin Wen; Yi Liu; Maokang Yang; Junguo Xin; Fengying Zhang; Lihua Jiang; Chunhua Chi; Luxia Zhang; Xudong Ma; Xiao Ma; Li Zhao; Weimin Li

doi:10.1016/j.socscimed.2022.115458

Inequalities of spatial primary healthcare accessibility in China

Soc Sci Med. 2022 Dec:314:115458. doi: 10.1016/j.socscimed.2022.115458. Epub 2022 Oct 15.

Authors

Peng Jia¹, Youfa Wang², Min Yang³, Limin Wang⁴, Xuchao Yang⁵, Xinyu Shi⁶, Lijian Yang⁷, Jin Wen⁸, Yi Liu³, Maokang Yang⁹, Junguo Xin¹⁰, Fengying Zhang¹¹, Lihua Jiang¹², Chunhua Chi¹³, Luxia Zhang¹⁴, Xudong Ma¹⁵, Xiao Ma¹⁶, Li Zhao¹⁷, Weimin Li¹⁸

Affiliations

¹ School of Resource and Environmental Sciences, Wuhan University, Wuhan, Hubei, China; School of Public Health, Wuhan University, Wuhan, Hubei, China; International Institute of Spatial Lifecourse Health (ISLE), Wuhan University, Wuhan, Hubei, China. Electronic address: jiapengff@hotmail.com.
² Global Health Institute, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
³ Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
⁴ National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
⁵ Ocean College, Zhejiang University, Zhoushan, Zhejiang, China.
⁶ University College Twente, University of Twente, Enschede, the Netherlands.
⁷ Center for Statistical Science, Tsinghua University, Beijing, China.
⁸ Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
⁹ Division of Rural Health, Sichuan Hospital Association, Chengdu, Sichuan, China.
¹⁰ School of Public Health, Chengdu Medical College, Chengdu, Sichuan, China.
¹¹ West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
¹² Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
¹³ Department of General Practice, Peking University Health Sciences Center, Beijing, China; Health Management Center, Peking University First Hospital, Beijing, China.
¹⁴ National Institute of Health Data Science, Peking University, Beijing, China; Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
¹⁵ Bureau of Medical Administration, National Health Commission of the People's Republic of China, Beijing, China.
¹⁶ Department of Health-Related Social and Behavioral Sciences, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: antiaids@163.com.
¹⁷ Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: zhaoli@scu.edu.cn.
¹⁸ Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address: weimi003@scu.edu.cn.

PMID: 36279792
DOI: 10.1016/j.socscimed.2022.115458

Abstract

A key step to the establishment of a tiered healthcare system is equitable access to basic primary healthcare services for all. However, no quantitative research on the national status quo of primary healthcare accessibility in China exists. We filled this gap by estimating spatial accessibility to primary healthcare centers (PHCs) and mapping its inequality across the mainland China. Four national datasets during 2015-2018, including administrative boundaries, residential communities, points-of-interest (including PHCs), and road networks, were collected to calculate the distance to the nearest PHC for each community. Five other national datasets including census, elevation, land use, vegetation, and nightlight, were collected to model 100m × 100 m population grids, based on which geographical modeling was used to calculate PHC accessibility of each community. Inequalities in PHC accessibility across China were described with concentration indices. About 44% of communities across China representing approximately 30% of the overall population had no access to PHCs within their 6-km catchment areas; about 78% of communities across China representing approximately 68.4% of the overall population had no access to PHCs within their 1.5-km catchment areas. Some municipalities/provinces like Shanghai, Beijing, Tianjin, Jiangsu, Shandong, and Zhejiang generally had higher proximity to the nearest PHCs, while others like Tibet, Guizhou, and Guangxi had lower proximity to the nearest PHCs. However, assuming similar basic service capacity across all PHCs, Shanghai, Tianjin, and Chongqing showed the lowest PHC accessibility due to high population density. Variations in PHC accessibility existed, with more inequalities observed in the north and northeastern provinces and less inequalities in southwestern and south-central provinces. This study demonstrates primary healthcare accessibility and inequality at province and city levels, and identifies communities with lower proximity and accessibility to PHCs in China. It would serve as a starting point to facilitate precise healthcare planning and preparedness for health emergencies in China.

Keywords: China; Community healthcare; Healthcare accessibility; Inequality; Population modeling; Primary healthcare; Spatial accessibility.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Catchment Area, Health
China / epidemiology
Health Services Accessibility*
Health Services*
Humans
Primary Health Care