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-huan, XIE Xin-yu

HUMAN GEOGRAPHY ›› 2026, Vol. 41 ›› Issue (5) : 23-32.

PDF(48390 KB)
PDF(48390 KB)
HUMAN GEOGRAPHY ›› 2026, Vol. 41 ›› Issue (5) : 23-32. DOI: 10.13959/j.issn.1003-2398.2026.05.003
SOCIETY

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
Author information +
History +

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.

Key words

mismatch of medical resources supply and demand / hierarchical diagnosis and treatment / aging / community scale / H2SFCA model / Nanjing

Cite this article

Download Citations
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

References

[1] 黎艳娜, 王艺桥.我国老年人慢性病共病现状及模式研究[J]. 中国 全科医学, 2021, 24(31):3955-3962, 3978.[Li Yanna, Wang Yiqiao. Prevalence and patterns of multimorbidity among Chinese elderly people[J]. Chinese General Practice, 2021, 24(31):3955-3962, 3978.]
[2] 郭亮, 彭雨晴, 贺慧, 等.分级诊疗背景下的武汉市医疗设施供需特 征与优化策略[J]. 经济地理, 2021, 41(7):73-81.[Guo Liang, Peng Yuqing, He Hui, et al. Supply-demand characteristics of medical resources and its optimizing countermeasures in Wuhan under the background of graded diagnosis and treatment[J]. Economic Geography, 2021, 41(7):73-81.]
[3] 申梦晗, 李亚青.医疗保险干预能否缓解三级医院的“虹吸效应”? 基于某大城市的实证研究[J]. 公共行政评论, 2021, 14(2):61-84, 229-230.[Shen Menghan, Li Yaqing. "Siphon effect" of tertiary hospitals and the effects of changes in cost-sharing on patient behavior [J]. Journal of Public Administration, 2021, 14(2):61-84, 229-230.]
[4] 华迎迎, 高丽娜.人口老龄化、地方财政能力对医疗卫生资源供给 的影响[J]. 卫生经济研究, 2023, 40(1):9-13.[Hua Yingying, Gao Lina. The impact of population aging and local financial capacity on the supply of health care resources[J]. Health Economics Research, 2023, 40(1):9-13.]
[5]支涵颖.全国基层医疗卫生资源区域性配置差异研究[J]. 社会科学 前沿, 2024, 13(5):410-418.[Zhi Hanying. Research on regional allocation differences of grassroots medical and health resources in China[J]. Advances in Social Sciences, 2024, 13(5):410-418.]
[6] Hansen W G. How accessibility shapes land use[J]. Journal of the American Institute of Planners, 1959, 25:73-76.]
[7] Frochen S, Ailshire J, Rodnyansky S. Residential care in Los Angeles: Evaluating the spatial distribution of facilities and neighborhood access to care among older adults[J]. Local Environment, 2019, 24(3):274-288.
[8] 魏伟, 洪梦谣, 周婕, 等. “城市人”视角下城市基本公共服务设施评 估方法:以武汉市为例[J]. 城市规划, 2020, 44(10):71-80.[Wei Wei, Hong Mengyao, Zhou Jie, et al. Study on evaluation method of spatial equalization of basic public service facilities from the perspective of homo-urbanists: Taking Wuhan as an example[J]. City Planning Review, 2020, 44(10):71-80.]
[9] Paul J, Edwards E. Temporal availability of public healthcare in developing countries of the Caribbean: An improved two‐step floating catchment area method for estimating spatial accessibility to health care[J]. The International Journal of Health Planning and Management, 2019, 34(1): e536-e556.
[10]伍眉函, 井晓鹏, 王博, 等.基于改进型两步移动搜索法的医疗设施 可达性评价:以西安市长安区为例[J]. 上海城市规划, 2024(1):89-94.[Wu Meihan, Jin Xiaopeng, Wang Bo, et al. Accessibility evaluation of medical facilities based on the improved twostep floating catchment area method: A case study of Chang'an district in Xi'an [J]. Shanghai Urban Planning Review, 2024(1):89-94.]
[11]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.]
[12]周聪惠.公园绿地绩效的概念内涵及评测方法体系研究[J]. 国际 城市规划, 2020(2):73-79.[ Zhou Conghui. Research on conceptual connotation and assessing methods of the performance of parkland [J]. Urban Planning International, 2020(2):73-79.]
[13]王笑文, 陈宇.基于时空演化的公共服务设施社会公平绩效评价 研究:以深圳市为例[J]. 住区, 2024(3):92-102.[Wang Xiaowen, Chen Yu. Research on social equity performance evaluation of public service facilities based on temporal and spatial evolution: Taking Shenzhen as an example[J]. Design Community, 2024(3): 92- 102.]
[14]常飞, 王录仓, 马玥, 等.城市公共服务设施与人口是否匹配?基于 社区生活圈的评估[J]. 地理科学进展, 2021, 40(4):607-619.[Chang Fei, Wang Lucang, Ma Yue, et al. Do urban public service facilities match population demand? Assessment based on community life circle[J]. Progress in Geography, 2021, 40(4):607-619.]
[15]徐杜江南, 方遥, 何乐, 等.公平视角下南京市公共服务设施空间布 局评估[J]. 城市建筑, 2023, 20(4):64-68.[Xudu Jiangnan, Fang Yao, He Le, et al. Evaluation on spatial layout of public service facilities in Nanjing from the perspective of equity[J]. Urbanism and Architecture, 2023, 20(4):64-68.]
[16]Qiang H H, Xie X Y, Wang H, et al. Spatial mismatch and hierarchical optimization of healthcare facilities: A multi-source geospatial analysis of accessibility and supply-demand dynamics[J]. International Journal of Health Geographics, 2025, 25(1):1-6.
[17]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.]
[18]翁剑成, 张云飞, 林鹏飞, 等.基于就医活动推断的老年人公交就医 可达性研究[J]. 交通运输系统工程与信息, 2024(1): 221-229. [Weng Jiancheng, Zhang Yunfei, Lin Pengfei, et al. Healthcare accessibility for the elderly by bus based on inferring seeking health-care activities[J]. Journal of Transportation Systems Engineering and Information Technology, 2024(1):221-229.]
[19]张思敏, 管洁祎, 高兴川, 等.城市更新背景下宁波市老年群体就医 公平性及影响因素[J]. 宁波大学学报(理工版), 2025, 38(4):86-94. [Zhang Simin, Guan Jieyi, Gao Xingchuan, et al. Equity and influencing factors of healthcare for the elderly in Ningbo city under the background of urban renewal[J]. Journal of Ningbo University (Natural Science & Engineering Edition), 2025, 38(4):86-94.]
[20]白雪雅, 张志斌, 马晓敏, 等.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, et al. Accessibility of medical facilities in Lanzhou city from the perspective of the elderly population[J]. Arid Land Geography, 2025, 48(7):1317-1327.]
[21]张蕾, 王乐陈.英国初级卫生保健转诊系统对我国分级诊疗及基 层医疗信息化建设的借鉴[J]. 中国全科医学, 2019, 22(16):1904- 1907.[Zhang Lei, Wang Lechen. Drawing lessons from NHS referral system to strengthen the hierarchical medical service system and grassroots medical informatization in China[J]. Chinese General Practice, 2019, 22(16):1904-1907.]
[22]陈多, 李芬, 王常颖, 等.日本整合型医疗服务体系的构建及对我国 的启示[J]. 卫生软科学, 2019, 33(10): 64-68.[Chen Duo, Li Fen, Wang Changying, et al. Establishment of Japanese integrated health care service system and its enlightenment to China[J]. Soft Science of Health, 2019, 33(10):64-68.]
[23]季舒铭, 王维, 张佩, 等.分级诊疗背景下医院人力资源配置的合理 性研究[J]. 中国循证医学杂志, 2020, 20(9):1004-1011.[Ji Shuming, Wang Wei, Zhang Pei, et al. Research on the rationality of hospital human resources allocation under the background of graded diagnosis and treatment[J]. Chinese Journal of Evidence-based Medicine, 2020, 20(9):1004-1011.]
[24]聂艺菲, 冯长春.基于分级诊疗的就医可达性研究:以潍坊市中心 城区为例[J]. 北京大学学报:自然科学版, 2020, 56(2): 307-314. [Nie Yifei, Feng Changchun. Research on accessibility of medical treatment based on grading treatment: A case study of Weifang city center area[J]. Acta Scientiarum Naturalium Universitatis Pekinensi, 2020, 56(2):307-314.]
[25]杨珍, 王伟, 陈准, 等.分级诊疗制度下洛阳市医疗服务空间可达性 及影响因素研究[J]. 河南大学学报:自然科学版, 2024(2):142-156, 167.[Yang Zhen, Wang Wei, Chen Zhun, et al. Research on reachability and influencing factors of medical service space in Luoyang under the hierarchical diagnosis and treatment system[J]. Journal of Henan University (Natural Science), 2024(2):142-156, 167.]
[26]Manley D J. Scale, aggregation, and the modifiable areal unit problem[M]//Fischer M, Nijkamp P, eds. Handbook of Regional Science. Vol 2. 1 ed. Berlin: Springer Verlag, 2013:1157-1171.
[27]申悦, 李亮.年龄分层视角下医疗设施可达性对居民就医行为的 影响:以上海市崇明岛为例[J]. 人文地理, 2021, 36(2):46-54.[Shen Yue, Li Liang. The influence of medical facility accessibility on residents' health seeking behaviors from the perspective of age stratification: A case study of Shanghai Chongming Island[J]. Human Geography, 2021, 36(2):46-54.]
[28]Zhuo L T, Yang C, Ji X L. Hierarchical two-step floating catchment area (2SFCA) method: Measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China[J]. International Journal for Equity in Health, 2020, 19: 164. https://doi.org/10.1186/s12939-020-01280-7.
[29] He Y F, Pu H X, Liu N H, et al. An analysis of food accessibility of mountain cities in China: A case study of Chongqing[J]. Applied Sciences Basel, 2022, 12(7):3236. https://doi.org/10.3390/app12073236.
[30]Rong P, Zheng Z, Kwan M, et al. Evaluation of the spatial equity of medical facilities based on improved potential model and map service Api: A case study in Zhengzhou, China[J]. Applied Geography, 2020(119):102192. https://doi.org/10.1016/j.apgeog.2020.102192.
[31]Min Z, Jin M W, Si J Li. Tempo-spatial changes and main anthropogenic influence factors of vegetation fractional coverage in a largescale opencast coal mine area from 1992 to 2015[J]. Journal of Cleaner Production, 2019, 232:940-952.
[32]顾大治, 惠强, 郑志元, 等.城市公共医疗设施分布的社会公平绩效 评价及优化策略研究:以合肥市主城区为例[J]. 现代城市研究, 2024(11):53-60.[Gu Dazhi, Hui Qiang, Zheng Zhiyuan, et al. Research on social justice performance evaluation and optimization strategy of urban public medical facilities distribution: A case study of the main urban area of Hefei city[J]. Modern Urban Research, 2024(11):53-60.]
[33]钟晴, 李俊林, 李毅琳, 等.武汉市居民基本医疗素养现状及影响因 素分析[J]. 中国公共卫生, 2019, 35(5):558-562.[Zhong Qing, Li Junlin, Li Yilin, et al. Status and influencing factors of basic medical literacy among residents in Wuhan city, 2016[J]. Chinese Journal of Public Health, 2019, 35(5):558-562.]
[34]张帆, 胡亮.构建更为韧性的医疗卫生防疫体系策略研究:以北京 医疗卫生服务设施为例[J]. 城市规划, 2020, 44(11):9-14.[Zhang Fan, Hu Liang. Research on resilience improvement strategies for medical care and epidemic prevention: A case study on medical facility in Beijing[J]. City Planning Review, 2020, 44(11):9-14.]
PDF(48390 KB)

Accesses

Citation

Detail

Sections
Recommended

/

〈 〉