中国县域城乡和不同乡镇之间的发展存在较大差异,在卫生领域表现尤为突出。在偏远农区,医疗资源短缺、卫生服务落后和健康保障缺位现象普遍存在。本文以湖北省松滋市为研究区域,以包括行政村和居委会的聚落点为基本研究单元,将可达性分析与聚类分析相结合,评估并表达不同区域医疗服务均等化水平并探讨相关公共政策。结果表明:(1)在县域尺度,医疗服务均等化水平空间差异明显,呈现出中心城区向周边递减的情况;(2)医疗服务均等化水平与经济发展水平分布格局上存在空间同型特征;(3)聚落中心、交通沿线可达性较高,而交通的改善会显著降低空间阻抗系数,促进均等化进程。

Currently in China, there exist large disparities in the development between urban and rural areas, and also between different villages and towns at the county level, which is especially true in the field of health care. In close conjunction with the local finances, the equalization should be carried out systematically, scientifically, and step by step on the foundation of an intensive study on the differences in economical development, the medical service demand of the public, and the development of the medical service in all kinds of areas. Taking the County of Songzi in Hubei Province as its survey region, this paper first of all makes a detailed assess on the standard of the equalization of the medical service by way of combining accessibility analysis (making use of the shortest transport time and the accessibility model) with spatial equity analysis (utilizing global clustering and local clustering model); then the paper identifies the shortage of medical service and puts the research results via GIS. Regarding the clusters including administrative villages and neighborhood committees as the basic research unit, this paper finally comes to the conclusion that the standard of equalized access to medical service in the County of Songzi is closely linked with the geographic conditions, economic performance and transportation in each village and town: (1) in the region of one county, the standard of equalized access to medical service displays marked spatial variability, decreasing progressively from the central urban district to neighbor areas; (2) the spatial distribution of the medical service equalization standard is similar to that of the economic development; (3) it is more accessible for the cluster centers and the areas with transport corridors, and the improvement of transportation will observably lower the coefficient of spatial separation in favor of promoting the process of equalization.