老年群体视角下兰州市医疗设施可达性研究

doi:10.12118/j.issn.1000-6060.2024.495

摘要/Abstract

摘要： 人口老龄化和健康中国战略背景下，合理配置城市医疗设施对老年人口的健康水平及民生福祉提升具有重要意义。基于第七次全国人口普查、医疗设施兴趣点（POI）和路径规划等多源数据，采用平均最近邻、改进两步移动搜索法和双变量局部空间自相关等方法，探究2020年兰州市老年人口就医可达性及其供需匹配度。结果表明：（1）兰州市老年人口数量空间分布不均衡，老年人口密度和老龄化率呈现“双核心”结构。（2） 3类医疗设施空间集聚特征不同。市级医疗设施呈“单中心”结构形态，区级医疗设施呈“一主多次”分布模式，街道级医疗设施呈“多中心”分布格局。（3）各级医疗设施可达性空间分布差异显著。其中，市级和区级医疗设施可达性空间分布不均衡，街道级医疗设施可达性高值区的分布范围最广，但仍有个别街道存在可达性较低的“盲区”。（4）由于医疗设施空间分布不均衡，不论是市级、区级还是街道尺度，都不同程度地存在老年人口与医疗设施空间不匹配现象。研究结果可为城市医疗设施合理配置以及健康城市建设提供依据。

关键词: 老年人口, 医疗设施, 可达性, 匹配度, 兰州市

Abstract:

In the context of an aging population and the “healthy China” strategy, the rational allocation of urban medical facilities is crucial for enhancing the health and well-being of the elderly. This study utilizes multi-source data, including the Seventh National Census, points of interest for medical facilities, and path planning, along with methodologies such as the average nearest neighbor, an improved two-step floating catchment area method, and bivariate local spatial autocorrelation analysis, to investigate the accessibility of medical treatment for the elderly and the alignment of supply and demand in Lanzhou City, Gansu, China in 2020. The results reveal the following. (1) The elderly population in Lanzhou is unevenly distributed, exhibiting a “ual core” structure characterized by varying density and aging rates. (2) The spatial clustering patterns of medical facilities differ by level: city-level facilities exhibit a “single-center” structure, district-level facilities follow a “one main, multiple secondary” distribution pattern, and street-level facilities adopt a “multi-center” distribution pattern. (3) Accessibility to medical facilities varies significantly among different levels, Specifically, the city and district levels show considerable unevenness, street-level facilities have the broadest range of high-accessibility areas, even though some streets remain low-accessibility “blind spots”. (4) The uneven distribution of medical facilities leads to a mismatch between the elderly population and available medical services at the city, district, and street levels. These research results offer valuable insights for the rational allocation of urban medical facilities and the development of healthy cities.

Key words: elderly population, medical facilities, accessibility, matching degree, Lanzhou City

白雪雅, 张志斌, 马晓敏, 李化英, 付兰星. 老年群体视角下兰州市医疗设施可达性研究[J]. 干旱区地理, 2025, 48(7): 1317-1327.

BAI Xueya, ZHANG Zhibin, MA Xiaomin, LI Huaying, FU Lanxing. Accessibility of medical facilities in Lanzhou City from the perspective of the elderly population[J]. Arid Land Geography, 2025, 48(7): 1317-1327.

图/表 8

图1

表1

图2

图3

表2

图4

图5

图6

参考文献 34

[1]	高晓路, 吴丹贤, 许泽宁, 等. 中国老龄化地理学综述和研究框架构建[J]. 地理科学进展, 2015, 34(12): 1480-1494.
	[ Gao Xiaolu, Wu Danxian, Xu Zening, et al. A review and frame-work setting of geographical research on aging in China[J]. Progress in Geography, 2015, 34(12): 1480-1494. ]
[2]	Cheng L, Yang M, Vos J D, et al. Examining geographical accessibility to multi-tier hospital care services for the elderly: A focus on spatial equity[J]. Journal of Transport & Health, 2020, 19: 100926, doi: 10.1016/j.jth.2020.100926.
[3]	申悦, 史祎雯, 王虹翔, 等. 医疗设施可达性对患者就医空间的影响研究——基于上海市医院患者调查的实证[J]. 城市发展研究, 2019, 26(12): 46-52, 61.
	[ Shen Yue, Shi Yiwen, Wang Hongxiang, et al. The impacts of medical facility accessibility on patients’ medical treatment space: A case study in Shanghai[J]. Urban Development Studies, 2019, 26(12): 46-52, 61. ]
[4]	申悦, 李亮. 医疗资源可达性与居民就医行为研究进展[J]. 科技导报, 2020, 38(7): 85-92.
	[ Shen Yue, Li Liang. Progress of research on medical resource accessibility and residents’ health seeking behavior[J]. Science & Technology Review, 2020, 38(7): 85-92. ]
[5]	Sibley L M, Weiner J P. An evaluation of access to health care services along the rural-urban continuum in Canada[J]. Bmc Health Services Research, 2011, 11(1): 1-11.
[6]	Guida C, Carpentieri G, Masoumi H. Measuring spatial accessibility to urban services for older adults: An application to healthcare facilities in Milan[J]. European Transport Research Review, 2022, 14(1): 23, doi: 10.1186/s12544-022-00544-3.
[7]	Donald H T, Hoenig H. Access to health care services for the disabled elderly[J]. Health Services Research, 2010, 41(3): 743-758.
[8]	赵立志, 廖筱萱, 王佩玉. 居家养老模式下城市基层医疗设施配置研究——以北京城市副中心为例[J]. 城市发展研究, 2022, 29(8): 14-19.
	[ Zhao Lizhi, Liao Xiaoxuan, Wang Peiyu. Research on the allocation of urban primary medical facilities under home care model: Take Beijing sub-center as an example[J]. Urban Development Studies, 2022, 29(8): 14-19. ]
[9]	张纯, 李晓宁, 满燕云. 北京城市保障性住房居民的就医可达性研究——基于GIS网络分析方法[J]. 人文地理, 2017, 32(2): 59-64.
	[ Zhang Chun, Li Xiaoning, Man Yanyun. Accessibility to health care service of the affordable housing residents in Beijing: Base on GIS network analysis[J]. Human Geography, 2017, 32(2): 59-64. ]
[10]	陶印华, 申悦. 医疗设施可达性空间差异及其影响因素——基于上海市户籍与流动人口的对比[J]. 地理科学进展, 2018, 37(8): 1075-1085.
	[ Tao Yinhua, Shen Yue. Spatial difference of medical facility accessibility and influencing factors: A comparative study of registered and floating populations in Shanghai[J]. Progress in Geography, 2018, 37(8): 1075-1085. ]
[11]	Yin C H, He Q S, Liu Y F, et al. Inequality of public health and its role in spatial accessibility to medical facilities in China[J]. Applied Geography, 2018, 92: 50-62.
[12]	胡舒云, 陆玉麒, 胡国建, 等. 基于多源大数据的深圳市医疗设施可达性与公平性测算[J]. 经济地理, 2021, 41(11): 87-96.
	[ Hu Shuyun, Lu Yuqi, Hu Guojian, et al. Measuring accessibility and equity of medical resources in Shenzhen based on multi-source big data[J]. Economic Geography, 2021, 41(11): 87-96. ]
[13]	许婧雪, 张文忠, 谌丽, 等. 基于弱势群体需求的北京服务设施可达性集成研究[J]. 人文地理, 2019, 34(2): 64-71.
	[ Xu Jingxue, Zhang Wenzhong, Chen Li, et al. Research on the integration of Beijing service facilities accessibility based on the needs of disadvantaged groups[J]. Human Geography, 2019, 34(2): 64-71. ]
[14]	高瑗, 原新. 老龄化背景下中老年人口的健康转变模式特征及其应对[J]. 河北学刊, 2018, 38(3): 170-175.
	[ Gao Yuan, Yuan Xin. Aging health and its public policy responses in the context of healthy China[J]. Hebei Academic Journal, 2018, 38(3): 170-175. ]
[15]	王德, 任熙元. 日常流动视角下的上海市实有人口分布与流动性构成[J]. 城市规划学刊, 2019(2): 36-43.
	[ Wang De, Ren Xiyuan. Distribution and composition of actual population in urban space from daily human mobility view[J]. Urban Planning Forum, 2019(2): 36-43. ]
[16]	胡莉蓉, 何深静, 苏世亮. 深圳市公共住房居民就医可达性——基于互联网地图服务和改进两步移动搜索法[J]. 热带地理, 2024, 44(2): 226-235.
	[ Hu Lirong, He Shenjing, Su Shiliang. Accessibility of healthcare resources to public housing in Shenzhen, China: Indirect map service and optimized two-step floating catchment area method[J]. Tropical Geography, 2024, 44(2): 226-235. ]
[17]	陈全, 幸丽君, 孙桂英, 等. 城市老年健康资源空间公平性——以武汉市中心城区为例[J]. 资源科学, 2023, 45(7): 1424-1439.
	[ Chen Quan, Xing Lijun, Sun Guiying, et al. Spatial equity of urban health resources for the elderly from an active-passive health perspective: A case study of central Wuhan City[J]. Resources Science, 2023, 45(7): 1424-1439. ]
[18]	钟少颖, 杨鑫, 陈锐. 层级性公共服务设施空间可达性研究——以北京市综合性医疗设施为例[J]. 地理研究, 2016, 35(4): 731-744.
	[ Zhong Shaoying, Yang Xin, Chen Rui. The accessibility measurement of hierarchy public service facilities based on multi-mode network dataset and the two-step 2SFCA: A case study of Beijing’s medical facilities[J]. Geographical Research, 2016, 35(4): 731-744. ]
[19]	Szeto W Y, Yang L C, Wong R C P, et al. Spatio-temporal travel characteristics of the elderly in an ageing society[J]. Travel Behaviour and Society, 2017, 9: 10-20.
[20]	林琳, 马飞. 广州市人口老龄化的空间分布及趋势[J]. 地理研究, 2007, 26(5): 1043-1054.
	[ Lin Lin, Ma Fei. Spatial distribution and trends of the aging of population in Guangzhou[J]. Geographical Research, 2007, 26(5): 1043-1054. ]
[21]	曹开军, 商宁, 王秘秘. 中国西北五省乡村旅游重点村时空分布格局与可达性分析[J]. 干旱区地理, 2023, 46(7): 1196-1205.
	[ Cao Kaijun, Shang Ning, Wang Mimi. Spatial distribution pattern and accessibility analysis of the key rural tourism villages in the five northwestern provinces of China[J]. Arid Land Geography, 2023, 46(7): 1196-1205. ]
[22]	周海涛, 马钰松, 樊亚宇, 等. 内蒙古红色旅游资源空间分布及可达性分析[J]. 干旱区地理, 2023, 46(5): 814-822.
	[ Zhou Haitao, Ma Yusong, Fan Yayu, et al. Spatial distribution and accessibility analysis of red tourism resources in Inner Mongolia[J]. Arid Land Geography, 2023, 46(5): 814-822. ]
[23]	仝德, 孙裔煜, 谢苗苗. 基于改进高斯两步移动搜索法的深圳市公园绿地可达性评价[J]. 地理科学进展, 2021, 40(7): 1113-1126.
	[ Tong De, Sun Yiyu, Xie Miaomiao. Evaluation of green space accessibility based on improved Gaussian two-step floating catchment area method: A case study of Shenzhen City, China[J]. Progress in Geography, 2021, 40(7): 1113-1126. ]
[24]	程敏, 黄维维. 基于高斯两步移动搜索法的上海市养老设施空间可达性评价[J]. 复旦学报(自然科学版), 2020, 59(2): 129-136.
	[ Cheng Min, Huang Weiwei. Measuring the accessibility of residential care facilities in Shanghai based on Gaussian two-step floating catchment area method[J]. Journal of Fudan University (Natural Science Edition), 2020, 59(2): 129-136. ]
[25]	Du M Y, Cheng L, Li X F, et al. Factors affecting the travel mode choice of the urban elderly in healthcare activity: Comparison between core area and suburban area[J]. Sustainable Cities and Society, 2019, 52: 101868, doi: 10.1016/j.scs.2019.101868.
[26]	黄建中, 吴萌. 特大城市老年人出行特征及相关因素分析——以上海市中心城为例[J]. 城市规划学刊, 2015(2): 93-101.
	[ Huang Jianzhong, Wu Meng. An investigation and analysis of travel characteristics and related factors of the elderly population in megacities: The case of the central area in Shanghai[J]. Urban Planning Forum, 2015(2): 93-101. ]
[27]	Newgard C D, Schmicker R H, Hedges J R, et al. Emergency medical services intervals and survival in trauma: Assessment of the “Golden Hour” in a North American prospective cohort[J]. Annals of Emergency Medicine, 2010, 55(3): 235-246.
[28]	Korah P I, Nunbogu A M, Ahmed A. Measuring access to health facilities in Ghana: Implications for implementation of health interventions and the sustainable development goal 3[J]. Applied Geography, 2023, 158: 103026, doi: 10.1016/j.apgeog.2023.103026.
[29]	顾宗倪, 罗小龙. 县域养老设施发展水平的空间不匹配研究——以江苏省为例[J]. 人文地理, 2024, 39(1): 40-47, 112.
	[ Gu Zongni, Luo Xiaolong. Examining the spatial mismatch of the elderly care development level: A case study of Jiangsu Province[J]. Human Geography, 2024, 39(1): 40-47, 112. ]
[30]	马璐, 张志斌. 兰州市老龄人口空间分布及其形成机制[J]. 人文地理, 2015, 30(6): 132-137.
	[ Ma Lu, Zhang Zhibin. The spatial distribution and formation mechanism of the elderly population in Lanzhou[J]. Human Geography, 2015, 30(6): 132-137. ]
[31]	马晓敏, 张志斌, 公维民, 等. 兰州市制造业空间格局演化及驱动因子识别[J]. 地理科学, 2023, 43(3): 519-529.
	[ Ma Xiaomin, Zhang Zhibin, Gong Weimin, et al. Spatial pattern evolution and driving factors identification of manufacturing industry in Lanzhou[J]. Scientia Geographica Sinica, 2023, 43(3): 519-529. ]
[32]	郭燕, 张志斌, 陈龙, 等. 居住自选择视角下城市建成环境对通勤模式选择的影响——以兰州市主城区为例[J]. 干旱区地理, 2024, 47(2): 307-318.
	[ Guo Yan, Zhang Zhibin, Chen Long, et al. Impact of urban built environment on commuting mode choices from the residential self-selection perspective[J]. Arid Land Geography, 2024, 47(2): 307-318. ]
[33]	Tao Z L, Cheng Y. Modelling the spatial accessibility of the elderly to healthcare services in Beijing, China[J]. Environment and Planning B: Urban Analytics and City Science, 2019, 46(6): 1132-1147.
[34]	李花, 张志斌, 王伟军. 兰州市大中型超市的空间分布格局及其影响因素[J]. 经济地理, 2016, 36(9): 85-93.
	[ Li Hua, Zhang Zhibin, Wang Weijun. Spatial distribution and patterns and influential factors of large and medium supermarkets in Lanzhou[J]. Economic Geography, 2016, 36(9): 85-93. ]

等级	类型	服务能力/人	数量/个
市级	三级甲等医院	-	19
区级	一般性综合医院	300	75
区级	专科医院	100	193
街道级	社区卫生院	20	190
	诊所	10	833
	药店	10	799

各级医疗设施	t≤15 min	15<t≤30 min	30<t≤60 min	t>60 min
市级医疗设施	7.42	56.55	34.10	1.93
区级医疗设施	28.02	65.28	6.70	0.00
街道级医疗设施	91.61	8.39	0.00	0.00