老龄化城市分级医疗设施空间匹配的多维诊断与治理响应——基于南京社区尺度的实证

强欢欢; 谢欣雨

doi:10.13959/j.issn.1003-2398.2026.05.003

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人文地理 ›› 2026, Vol. 41 ›› Issue (5) : 23-32. DOI: 10.13959/j.issn.1003-2398.2026.05.003

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老龄化城市分级医疗设施空间匹配的多维诊断与治理响应——基于南京社区尺度的实证

强欢欢¹, 谢欣雨²

作者信息 +

MULTIDIMENSIONAL DIAGNOSIS AND GOVERNANCE RESPONSE TO SPATIAL MATCHING OF HIERARCHICAL MEDICAL SYSTEM IN AGING CITIES: EMPIRICAL EVIDENCE AT THE COMMUNITY SCALE IN NANJING

QIANG Huan-huan¹, XIE Xin-yu²

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文章历史 +

摘要

在深度老龄化与高质量城镇化背景下，医疗资源的空间错配制约了分级诊疗的效能。既有研究多关注设施的空间可达性，却忽视了其背后的功能适配性危机。本文基于空间公平与复杂适应系统理论，在评估空间匹配的基础上，引入服务能力指数（SCI），构建“空间—功能”双维诊断框架，以识别医疗设施应对老龄化需求时的结构与功能失衡。基于南京市1518个社区的实证研究发现：①老年医疗需求呈“核心极化—外围稀释”特征，老城区医疗负荷被低估51%至64%，新兴开发区则稀释近50%，凸显“千人指标”对异质需求的识别局限；②在“三级集聚、二级过渡、基层失衡”的空间格局之上，系统存在更深层的功能承载危机，32.57%的社区面临基层“高需—低供”错配，且广泛分布着SCI低于0.5的“潜在服务危机区”，预示系统在未来老龄化进程中的高度脆弱性。由此，研究提出从“空间适配”转向“功能重构”的治理路径，通过“嵌入式增容+资源再配置”的空间策略和“强基层—优布局—建医联体”的制度设计，为老龄化城市医疗资源精准配置与分级诊疗制度落地提供科学依据。

Abstract

Under deep aging and urbanization, medical resource spatial mismatch restricts the effectiveness of tiered healthcare systems. Using spatial equity theory and complex adaptive systems, this paper introduces the Service Capacity Index (SCI) to construct a dual-dimensional“space-function”framework. Studying 1, 518 Nanjing communities, we find: 1) Elderly healthcare demand shows a“core-periphery”pattern, revealing those per capita indicators underestimate demand heterogeneity; 2) 32.57% of communities face grassroots“high demand-low supply”mismatches, while potential crisis areas have SCI values below 0.5, indicating functional vulnerabilities under future aging. The study proposes shifting from“spatial adaptation”to “functional reconstruction”through embedded capacity expansion, resource reallocation, grassroots strengthening, and medical consortiums to support precise medical resource allocation and hierarchical healthcare.

导出引用

强欢欢, 谢欣雨. 老龄化城市分级医疗设施空间匹配的多维诊断与治理响应——基于南京社区尺度的实证[J]. 人文地理. 2026, 41(5): 23-32 https://doi.org/10.13959/j.issn.1003-2398.2026.05.003

QIANG Huan-huan, XIE Xin-yu. MULTIDIMENSIONAL DIAGNOSIS AND GOVERNANCE RESPONSE TO SPATIAL MATCHING OF HIERARCHICAL MEDICAL SYSTEM IN AGING CITIES: EMPIRICAL EVIDENCE AT THE COMMUNITY SCALE IN NANJING[J]. HUMAN GEOGRAPHY. 2026, 41(5): 23-32 https://doi.org/10.13959/j.issn.1003-2398.2026.05.003

中图分类号： C912.8

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