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Spatial accessibility of primary health care in China: A case study in Sichuan Province

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  • Wang, Xiuli
  • Yang, Huazhen
  • Duan, Zhanqi
  • Pan, Jay

Abstract

Access to primary health care is considered a fundamental right and an important facilitator of overall population health. Township health centers (THCs) and Community health centers (CHCs) serve as central hubs of China's primary health care system and have been emphasized during recent health care reforms. Accessibility of these hubs is poorly understood and a better understanding of the current situation is essential for proper decision making. This study assesses spatial access to health care provided by primary health care institutions (THCs/CHCs) in Sichuan Province as a microcosm in China. The Nearest-Neighbor method, Enhanced Two-Step Floating Catchment Area (E2SFCA) method, and Gini Coefficient are utilized to represent travel impedance, spatial accessibility, and disparity of primary health care resources (hospital beds, doctors, and health professionals). Accessibilities and Gini Coefficients are correlated with social development indexes (GDP, ethnicity, etc.) to identify influencing factors. Spatial access to primary health care is better in southeastern Sichuan compared to northwestern Sichuan in terms of shorter travel time, higher spatial accessibility, and lower inequity. Social development indexes all showed significant correlation with county averaged spatial accessibilities/Gini Coefficients, with population density ranking top. The disparity of access to primary health care is also apparent between ethnic minority and non-minority regions. To improve spatial access to primary health care and narrow the inequity, more township health centers staffed by qualified health professionals are recommended for northwestern Sichuan. Improved road networks will also help. Among areas with insufficient primary health care, the specific counties where demographics are dominated by older people and children due to widespread rural-urban migration of the workforce, and by ethnic minorities, should be especially emphasized in future planning.

Suggested Citation

  • Wang, Xiuli & Yang, Huazhen & Duan, Zhanqi & Pan, Jay, 2018. "Spatial accessibility of primary health care in China: A case study in Sichuan Province," Social Science & Medicine, Elsevier, vol. 209(C), pages 14-24.
    • Handle: RePEc:eee:socmed:v:209:y:2018:i:c:p:14-24
    DOI: 10.1016/j.socscimed.2018.05.023
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    Citations

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    Cited by:

    1. Yang Yu & Yijin Wu & Xin Xu & Yun Chen & Xiaobo Tian & Li Wang & Siyun Chen, 2021. "Spatial Disparities and Correlated Variables of Community Care Facility Accessibility in Rural Areas of China," Sustainability, MDPI, vol. 13(23), pages 1-14, December.
    2. Zhicheng Zheng & Haoming Xia & Shrinidhi Ambinakudige & Yaochen Qin & Yang Li & Zhixiang Xie & Lijun Zhang & Haibin Gu, 2019. "Spatial Accessibility to Hospitals Based on Web Mapping API: An Empirical Study in Kaifeng, China," Sustainability, MDPI, vol. 11(4), pages 1-14, February.
    3. Voicu, Bogdan & Fărcășanu, Dana & Mustață, Mirela & Deliu, Alexandra & Vișinescu, Iulia, 2023. "Using laws, common sense, and statistical approaches to design indicators for ‘medical desertification’. An application on the Romanian case," Social Science & Medicine, Elsevier, vol. 327(C).
    4. Ting Chen & Jay Pan, 2022. "The Effect of Spatial Access to Primary Care on Potentially Avoidable Hospitalizations of the Elderly: Evidence from Chishui City, China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 160(2), pages 645-665, April.
    5. Jia, Peng & Wang, Youfa & Yang, Min & Wang, Limin & Yang, Xuchao & Shi, Xinyu & Yang, Lijian & Wen, Jin & Liu, Yi & Yang, Maokang & Xin, Junguo & Zhang, Fengying & Jiang, Lihua & Chi, Chunhua & Zhang,, 2022. "Inequalities of spatial primary healthcare accessibility in China," Social Science & Medicine, Elsevier, vol. 314(C).
    6. Shen, Chi & Lai, Sha & Deng, Qiwei & Cao, Dan & Zhao, Dantong & Zhao, Yaxin & Zhou, Zhongliang & Dong, Wanyue & Chen, Xi, 2023. "Do Primary Healthcare Facilities in More Remote Areas Provide More Medical Services? Spatial Evidence from Rural Western China," GLO Discussion Paper Series 1309, Global Labor Organization (GLO).
    7. Wantong Xu & Fuguang Zhang & Biao Zeng & Taibao Yang & Hui Wang, 2019. "Spatial Access to Medical Services in the Underdeveloped Region of Northwestern China: A Case Study in Lanzhou City," Sustainability, MDPI, vol. 11(23), pages 1-14, November.
    8. Bai, Xue & Zhong, Jingqiu & Huang, Dong, 2024. "Economic instruments for natural resource efficiency: The role of carbon taxation and fiscal policy," Resources Policy, Elsevier, vol. 89(C).
    9. Xiuli Wang & Barnabas C. Seyler & Ting Chen & Weiyan Jian & Hongqiao Fu & Baofeng Di & Winnie Yip & Jay Pan, 2024. "Disparity in healthcare seeking behaviors between impoverished and non-impoverished populations with implications for healthcare resource optimization," Palgrave Communications, Palgrave Macmillan, vol. 11(1), pages 1-12, December.
    10. Liu, Yun & Kong, Qingxia & de Bekker-Grob, Esther W., 2019. "Public preferences for health care facilities in rural China: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 237(C), pages 1-1.
    11. Yang, Nan & Shen, Liyin & Shu, Tianheng & Liao, Shiju & Peng, Yi & Wang, Jinhuan, 2021. "An integrative method for analyzing spatial accessibility in the hierarchical diagnosis and treatment system in China," Social Science & Medicine, Elsevier, vol. 270(C).
    12. Lin, Xiaojun & Lu, Liyong & Pan, Jay, 2021. "Hospital market competition and health technology diffusion: An empirical study of laparoscopic appendectomy in China," Social Science & Medicine, Elsevier, vol. 286(C).
    13. Zhou, Yasong & Li, Yuqing & Chen, Chen, 2024. "The key role of digital governance, natural resource depletion, and industrialization in social well-being: A case study of China," Resources Policy, Elsevier, vol. 93(C).
    14. Lu, Liyong & Pan, Jay, 2019. "The association of hospital competition with inpatient costs of stroke: Evidence from China," Social Science & Medicine, Elsevier, vol. 230(C), pages 234-245.
    15. Willberg, Elias & Fink, Christoph & Toivonen, Tuuli, 2023. "The 15-minute city for all? – Measuring individual and temporal variations in walking accessibility," Journal of Transport Geography, Elsevier, vol. 106(C).
    16. Kelobonye, Keone & Zhou, Heng & McCarney, Gary & Xia, Jianhong (Cecilia), 2020. "Measuring the accessibility and spatial equity of urban services under competition using the cumulative opportunities measure," Journal of Transport Geography, Elsevier, vol. 85(C).
    17. Li Wang & Huan Shi & Lu Gan, 2018. "Healthcare Facility Location-Allocation Optimization for China’s Developing Cities Utilizing a Multi-Objective Decision Support Approach," Sustainability, MDPI, vol. 10(12), pages 1-22, December.
    18. Bec, Caroline & Wells, Geoff, 2020. "Structural barriers to health-provider training programmes for ethnic minorities: the case of the Katu and diabetes management in Vietnam," SocArXiv s78xa, Center for Open Science.

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