Acta Geographica Sinica ›› 2019, Vol. 74 ›› Issue (6): 1178-1189.doi: 10.11821/dlxb201906008

• Urban and Regional Development • Previous Articles     Next Articles

Spatial equity and influences of two-level public healthcare resources:A background to hierarchical diagnosis and treatment reform in China

SONG Xueqian1,DENG Wei2,3(),ZHOU Peng2,3,ZHANG Shaoyao2,3,WAN Jiangjun2,3,LIU Ying2,3   

  1. 1. College of Management, Chengdu University of Information Technology, Chengdu 610225, China
    2. Research Center for Mountain Development, Institute of Mountain Hazards and Environment, CAS, Chengdu 610041, China
    3. University of Chinese Academy of Sciences, Beijing 100049, China
  • Received:2018-01-24 Revised:2019-02-18 Online:2019-06-25 Published:2019-06-20
  • Contact: DENG Wei
  • Supported by:
    National Natural Sciences Foundation of China(41601141);National Natural Sciences Foundation of China(41471469);Research Foundation of Chengdu University of Information Technology(J201617)


In present-day China, the unequal distribution of public healthcare resources across different levels and regions is problematic. Hierarchical diagnosis and treatment (HDT) reform is of great significance for optimising the distribution of healthcare resources and promoting fairness across health services. In this study, exploratory spatial data analysis (ESDA) was applied to evaluate spatial patterns at the lower and upper levels of healthcare resources. The Geodetector model was used to analyse the influences of the healthcare system at the municipal and county levels during 2015. The results show that there is significant spatial clustering in the distribution of the two-level healthcare resources. Influences on upper-level healthcare resources are more significant than those on lower levels. The dominant influencing factors of the two-level healthcare resources differ across spatial scales and regions. In terms of upper-level healthcare resources, urbanisation, population density and the level of economic development are the dominant global factors, in addition to the regional factors of population aging, topography and the morbidity of epidemic and endemic diseases. In the case of lower-level healthcare resources, urbanisation is an important influencing factor, while economic development, population aging and morbidity have local effects. Ultimately, population density was the dominant factor. Finally, this paper suggests that, aiming for HDT reform, decision makers should allocate healthcare resources among different regions and levels in consideration of relevant global and local factors, united and targeted policies, and top-down and bottom-up decision-making mechanisms. This could promote the overall function of the healthcare system and enhance the equity and coordination of multi-level healthcare resources.

Key words: public healthcare resources, hierarchical diagnosis and treatment reform in China, spatial equity, geographical detector, China