【作者】 熊娟；

【导师】 罗静；

【作者基本信息】 华中师范大学 ， 人文地理学， 2012， 硕士

【摘要】 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。作为公共服务体系规划的重要组成部分,医疗服务规划不仅要解决看病难问题,也要兼顾医疗资源利用的效率和资源分配的公平性。本文运用GIS技术,采取可达性测算和空间统计分析评估医疗服务的空间分布特征,发现医疗服务短缺区及其形成原因并为中长期医疗服务规划提供决策依据。以湖北省松滋市为研究区,作者主要完成了以下研究工作：(1)通过实地调研和数据收集,建立包括行政区划、人口分布、道路交通网络、医疗服务设施等空间要素的医疗服务数据库。(2)采用行进成本分析法和吸引力指数分析法,选取空间可达性指标,测算了松滋市270个聚落点和16个乡镇的医疗服务可达性水平。(3)结合乡镇地理位置与可达性现状,运用全局自相关和局部自相关分析方法,评估县域范围内医疗服务的空间均等化水平。(4)对以上计算结果进行综合分析,制作多项专题地图,从整体分析医疗服务水平的布局特征,鉴别出医疗服务短缺区,探讨其形成原因并提出政策建议。本研究在ArcGIS10.0软件和Geodata Analysis软件支持下完成。利用GIS数据管理功能整理各种数据,建立地理空间数据库,制作各种专题地图；利用GIS网络分析工具(Network Analyst)计算聚落点与医院之间的最短时间；利用GIS空间统计分析(Spatial Statistics Analysis)和Geodata Analysis软件分别实现全局自相关和局部自相关计算分析。案例研究发现：(1)无论是从医疗服务发展的社会经济环境,还是从就医的便捷程度方面来看,松滋市医疗服务水平在县域尺度和镇域尺度均存在不均衡的情况。(2)空间可达性是影响看病就医的重要因素,其指标能直观地评估聚落点就医成本与方便程度。(3)空间关联分析在公共服务公平性现状研究、空间规划方面具有巨大的应用价值。(4)要在深入研究各地经济发展和卫生事业发展差异的基础上,根据居民的健康需求和政府的供给能力来设计均等化路径,有计划、有步骤地推进医疗服务均等化。更多还原

【Abstract】 It exists large disparities in the development between urban and rural areas, and also between different villages and towns in China, which is especially prominent in the field of health care. It is common to see that the remote rural areas are suffering from a shortage of medical resources, the medically backward service, and the poor healthcare security. As the important part of public service system, the healthcare reform and planning is not only to solve the difficulties of getting medical treatment, but also to give consideration to the efficiency of facility utilization and the equality of resource allocation. This paper aims to evaluate the regional distribution characteristics of medical service by using GIS, accessibility calculating and Spatial Statistics Analysis, and to find shortage area of medical service and provide the decision-making basis for healthcare reform and planning.Taking the county of Songzi in Hubei Province as its survey region, the following studies have mainly been completed. Firstly, through the field survey and data collection, the database of medical service has been established, including administrative areas, population distribution, medical service facilities and transportation network diagram of geographic elements. Secondly, cost analysis and attractive index analysis have been used to select five spatial accessibility indexes and calculate the accessibility of medical service of270settlements and16towns in Songzi county. Thirdly, combing with the geographical position and accessibility status, global and local autocorrelation analysis area utilized to assess medical service level in county area. Fourthly, comprehensively analyze the results above and create thematic maps, and then analysis of layout characteristics of medical facilities as a whole to identify the shortage area of medical service and discuss the forming reason and policy recommendations.All the geospatial data are managed in ArcGIS10.0software and Geo-data Analysis software. Using GIS data management function to settle all kinds of data, and to establish geographical spatial database and make thematic maps. Using GIS Network Analyst to calculate the shortest time between settlements and hospitals. Using Spatial Statistics Analysis and Geo-data Analysis software to realize the analysis of global and local autocorrelation. There are several findings from cases. Firstly, whether from the per capita medical resources distribution and medical access, or from the convenience of seeking medical advice of the side, medical service level of Songzi County exists unbalanced conditions of county area and town area. Secondly, as the important factor of seeking medical advice, spatial accessibility index can directly assess the medical treatment cost of settlement points and the convenience. Thirdly, spatial relation analysis has enormously application value in the current situation study of public service equalization and spatial planning. Fourthly, based on further studying of the difference between varying economic development and health development, according to health needs of residents and the government’s supply ability, the equal access to the path should be designed, and medical service equalization must be accomplished step by step.更多还原