Examining Accessibility to Medical Resources for Urban Older Adults with Common Diseases Using Multisource Data: A Case Study of Beijing
Publication: Journal of Urban Planning and Development
Volume 149, Issue 4
Abstract
With population aging becoming increasingly prominent, it has been recognized as a critical issue for urban planners whether older adults can access fair, high-quality medical services. Yet, few studies have investigated urban medical accessibility at a departmental level for older adults. Taking Beijing as a case study, this study puts forth a novel framework augmented by multisource data to analyze subdistrict-scale accessibility to urban medical departments, with a particular emphasis on older adults’ common diseases. Online registration data were collected to indicate the supply capacity of medical services, with the influence of department reputation taken into account when determining the facilities’ service range. A hierarchical two-step floating catchment area method was employed to examine accessibility for older adults to the cardiovascular, orthopedic, endocrinology, respiratory, and neurology departments. Subsequently, Gini indices were calculated to evaluate medical accessibility equity across urban spaces. Additionally, multiple linear regression was used to explore the correlations between medical accessibility and potential influencing factors. Results showed that medical accessibility is typically higher in downtown areas and decreases from the urban center to the peripheral areas in Beijing. Cardiovascular, respiratory, and orthopedic patients face relatively greater difficulty in accessing appropriate medical resources. Furthermore, significant inequity in medical accessibility was observed among the subdistricts at different locations, with accessibility inequity in the ecological conservation area being particularly concerning. Additionally, seven factors were found to significantly affect accessibility, including distance to the urban center, density of arterial and collector roads, proportion of residential land use, proportion of public service land use, proportion of transportation land use, and proportion of vehicle ownership. The proposed framework could identify subdistricts with low accessibility for older adult patients to access different medical departments. Therefore, it could potentially support the policy-making process by offering guidelines to adjust the construction plan of the medical system in metropolises and optimize the direction for resource input.
Get full access to this article
View all available purchase options and get full access to this article.
Acknowledgments
The authors are immensely grateful to the anonymous reviewers for their valuable comments. This research was funded by a grant from the National Natural Science Foundation of China (52008006) and a grant from the Beijing Association on Aging.
References
Acheampong, E., A. Nadutey, P. Bredu-Darkwa, P. Agyei-Baffour, and A. K. Edusei. 2022. “Personal factors that affect disabled people’s access to healthcare in the Bosomtwe District of Ghana.” Health Promot. Int. 37 (2): daab058. https://doi.org/10.1093/heapro/daab058.
Al-Omari, A., N. Shatnawi, and A. Al-Mashaqbeh. 2022. “Use of an E2SFCA method to assess healthcare resources in Jordan during COVID-19 pandemic.” Egypt. J. Remote Sens. Space Sci. 25 (4): 1057–1068. https://doi.org/10.1016/j.ejrs.2022.11.007.
Antwi, T., J. A. Quaye-Ballard, A. Arko-Adjei, W. Osei-wusu, and N. L. Quaye-Ballard. 2020. “Comparing spatial accessibility and travel time prediction to commercial centres by private and public transport: A case study of Oforikrom district.” J. Adv. Transp. 2020: 8319089. https://doi.org/10.1155/2020/8319089.
Bauer, J., and D. A. Groneberg. 2016. “Measuring spatial accessibility of health care providers—introduction of a variable distance decay function within the floating catchment area (FCA) method.” PLoS One 11 (7): e0159148. https://doi.org/10.1371/journal.pone.0159148.
Beijing Municipal Commission of Urban Planning. 2017. Beijing urban master plan (2016–2035). Beijing: China Architecture & Building Press.
Bivina, G. R., A. Gupta, and M. Parida. 2020. “Walk accessibility to metro stations: An analysis based on meso-or micro-scale built environment factors.” Sustainable Cities Soc. 55: 102047. https://doi.org/10.1016/j.scs.2020.102047.
Boisjoly, G., R. Deboosere, R. Wasfi, H. Orpana, K. Manaugh, R. Buliung, and A. El-Geneidy. 2020. “Measuring accessibility to hospitals by public transport: An assessment of eight Canadian metropolitan regions.” J. Transp. Health 18: 100916. https://doi.org/10.1016/j.jth.2020.100916.
Cao, M., H. Yao, J. Xia, G. Fu, Y. Chen, W. Wang, J. Li, and Y. Zhang. 2021. “Accessibility-based equity assessment of urban parks in Beijing.” J. Urban Plann. Dev. 147 (3): 05021018. https://doi.org/10.1061/(ASCE)UP.1943-5444.0000695.
Chen, Y., B. Liu, Y. Shen, and L. Li. 2022. “Assessing accessibility to service facilities for older people in age-restricted communities from the perspective of equity.” J. Transp. Health 27: 101515. https://doi.org/10.1016/j.jth.2022.101515.
Cheng, L., M. Yang, J. De Vos, and F. Witlox. 2020. “Examining geographical accessibility to multi-tier hospital care services for the elderly: A focus on spatial equity.” J. Transp. Health 19: 100926. https://doi.org/10.1016/j.jth.2020.100926.
Dai, D., and F. Wang. 2011. “Geographic disparities in accessibility to food stores in southwest Mississippi.” Environ. Plann. B: Plann. Des. 38 (4): 659–677. https://doi.org/10.1068/b36149.
Delamater, P. L. 2013. “Spatial accessibility in suboptimally configured health care systems: A modified two-step floating catchment area (M2SFCA) metric.” Health Place 24: 30–43. https://doi.org/10.1016/j.healthplace.2013.07.012.
Fan, P., L. Xu, W. Yue, and J. Chen. 2017. “Accessibility of public urban green space in an urban periphery: The case of Shanghai.” Landscape Urban Plann. 165: 177–192. https://doi.org/10.1016/j.jtrangeo.2018.12.003.
Gao, Y., and Z. Li. 2022. “Optimization and adjustment of multilevel medical facilities for the elderly from the perspective of accessibility.” J. Urban Plann. Dev. 148 (2): 05022011. https://doi.org/10.1061/(ASCE)UP.1943-5444.0000833.
Geurs, K. T., and B. Van Wee. 2004. “Accessibility evaluation of land-use and transport strategies: Review and research directions.” J. Transp. Geogr. 12 (2): 127–140. https://doi.org/10.1016/j.jtrangeo.2003.10.005.
Ghorbanzadeh, M., K. Kim, E. E. Ozguven, and M. W. Horner. 2020. “A comparative analysis of transportation-based accessibility to mental health services.” Transp. Res. Part D: Transp. Environ. 81: 102278. https://doi.org/10.1016/j.trd.2020.102278.
Gini, C. 1997. “Concentration and dependency ratios.” Riv. Polit. Econ. 87: 769–792.
Gong, P., et al. 2020. “Mapping essential urban land use categories in China (EULUC-China): Preliminary results for 2018.” Sci. Bull. 65 (3): 182–187. https://doi.org/10.1016/j.scib.2019.12.007.
Guo, S., et al. 2019. “Accessibility to urban parks for elderly residents: Perspectives from mobile phone data.” Landscape Urban Plann. 191: 103642. https://doi.org/10.1016/j.landurbplan.2019.103642.
Hansen, W. G. 1959. “How accessibility shapes land use.” J. Am. Inst. Plann. 25 (2): 73–76. https://doi.org/10.1080/01944365908978307.
Hao, H., and Y. Wang. 2022. “Disentangling relations between urban form and urban accessibility for resilience to extreme weather and climate events.” Landscape Urban Plann. 220: 104352. https://doi.org/10.1016/j.landurbplan.2022.104352.
Hewko, J., K. E. Smoyer-Tomic, and M. J. Hodgsonc. 2002. “Measuring neighbourhood spatial accessibility to urban amenities: Does aggregation error matter?” Environ. Plann. A 34 (7): 1185–1206. https://doi.org/10.1068/a34171.
Higgs, G., R. Zahnow, J. Corcoran, M. Langford, and R. Fry. 2017. “Modelling spatial access to general practitioner surgeries: Does public transport availability matter?” J. Transp. Health 6: 143–154. https://doi.org/10.1016/j.jth.2017.05.361.
Hospital Management Institute of Fudan University. 2020. “Authoritative medical ranking list.” Accessed November 25, 2021. http://www.fudanmed.com/institute/news2020-1.aspx/.
Hu, S., W. Song, C. Li, and J. Lu. 2020. “A multi-mode Gaussian-based two-step floating catchment area method for measuring accessibility of urban parks.” Cities 105: 102815. https://doi.org/10.1016/j.cities.2020.102815.
Ishikawa, T., H. Mizuguchi, H. Murayama, K. Fujiwara, T. Tanikawa, E. Kobayashi, and K. Ogasawara. 2019. “Relationship between accessibility and resources to treat acute ischemic stroke. Hokkaido, Japan: Analysis of inequality and coverage using geographic information systems.” Health Policy Technol. 8 (4): 337–342. https://doi.org/10.1016/j.hlpt.2019.10.001.
Kong, Y. F., X. J. Li, and X. F. Zhang. 2008. “Analysis of spatial accessibility for school redistricting in rural China: A case study of the secondary schools in Gongyi city, Henan province.” J. Remote Sens. 12 (5): 800–809.
Kowal, P., and J. E. Dowd. 2001. Definition of an older person. Proposed working definition of an older person in Africa for the MDS Project, 5188–9286. Geneva: World Health Organization.
Langford, M., G. Higgs, and R. Fry. 2016. “Multi-modal two-step floating catchment area analysis of primary health care accessibility.” Health Place 38: 70–81. https://doi.org/10.1016/j.healthplace.2015.11.007.
Li, W., H. Guan, Y. Han, H. Zhu, and P. Zhao. 2021. “Accessibility of multimode transport facilities to suburban tourist attractions: Analysis based on meso- or microcommunity scale in Beijing.” J. Urban Plann. Dev. 147 (3): 04021026. https://doi.org/10.1061/(ASCE)UP.1943-5444.0000708.
Liu, M., S. Luo, and X. Du. 2021. “Exploring equity in healthcare services: Spatial accessibility changes during subway expansion.” ISPRS Int. J. Geo-Inf. 10 (7): 439. https://doi.org/10.3390/ijgi10070439.
Liu, S., Y. Qin, and Y. Xu. 2019. “Inequality and influencing factors of spatial accessibility of medical facilities in rural areas of China: A case study of Henan Province.” Int. J. Environ. Res. Public Health 16 (10): 1833. https://doi.org/10.3390/ijerph16101833.
Lu, C., Z. Zhang, and X. Lan. 2019. “Impact of China's referral reform on the equity and spatial accessibility of healthcare resources: A case study of Beijing.” Social Sci. Med. 235: 112386. https://doi.org/10.1016/j.socscimed.2019.112386.
Luo, J., G. Chen, C. Li, B. Xia, X. Sun, and S. Chen. 2018. “Use of an E2SFCA method to measure and analyse spatial accessibility to medical services for elderly people in Wuhan, China.” Int. J. Environ. Res. Public Health 15 (7): 1503. https://doi.org/10.3390/ijerph15071503.
Luo, J., X. Zhang, C. Jin, and D. Wang. 2009. “Inequality of access to health care among the urban elderly in northwestern China.” Health Policy 93 (2–3): 111–117. https://doi.org/10.1016/j.healthpol.2009.06.003.
Luo, W., and F. Wang. 2003. “Measures of spatial accessibility to health care in a GIS environment: Synthesis and a case study in the Chicago region.” Environ. Plann. B: Plann. Des. 30 (6): 865–884. https://doi.org/10.1068/b29120.
Luz, G., M. H. Barboza, L. Portugal, M. Giannotti, and B. Van Wee. 2022. “Does better accessibility help to reduce social exclusion? Evidence from the city of São Paulo, Brazil.” Transp. Res. Part A: Policy Pract. 166: 186–217. https://doi.org/10.1016/j.tra.2022.10.005.
Mayaud, J. R., M. Tran, and R. Nuttall. 2019. “An urban data framework for assessing equity in cities: Comparing accessibility to healthcare facilities in Cascadia.” Comput. Environ. Urban Syst. 78: 101401. https://doi.org/10.1016/j.compenvurbsys.2019.101401.
McGrail, M. R., and J. S. Humphreys. 2014. “Measuring spatial accessibility to primary health care services: Utilising dynamic catchment sizes.” Appl. Geogr. 54: 182–188. https://doi.org/10.1016/j.apgeog.2014.08.005.
Mohri, S. S., S. Mortazavi, and N. Nassir. 2021. “A clustering method for measuring accessibility and equity in public transportation service: Case study of Melbourne.” Sustainable Cities Soc. 74: 103241. https://doi.org/10.1016/j.scs.2021.103241.
Norin, A., C. Große, and L. Olsson. 2022. “Municipal accessibility: A multi-linear regression model with a principal component analysis approach.” In Proc., 2022 IEEE Int. Conf. on Industrial Engineering and Engineering Management. New York: IEEE.
Paez, A., R. G. Mercado, S. Farber, C. Morency, and M. Roorda. 2010. “Accessibility to health care facilities in Montreal Island: An application of relative accessibility indicators from the perspective of senior and non-senior residents.” Int. J. Health Geographics 9 (1): 1–15. https://doi.org/10.1186/1476-072X-9-52.
Pizzol, B., M. Giannotti, and D. B. Tomasiello. 2021. “Qualifying accessibility to education to investigate spatial equity.” J. Transp. Geogr. 96: 103199. https://doi.org/10.1016/j.jtrangeo.2021.103199.
Qi, Z., S. Lim, and T. Hossein Rashidi. 2020. “Assessment of transport equity to central business district (CBD) in Sydney, Australia.” Transp. Lett. 12 (4): 246–256. https://doi.org/10.1080/19427867.2019.1584694.
Radke, J., and L. Mu. 2000. “Spatial decompositions, modeling and mapping service regions to predict access to social programs.” Geogr. Inf. Sci. 6 (2): 105–112. https://doi.org/10.1080/10824000009480538.
Shinjo, D., and T. Aramaki. 2012. “Geographic distribution of healthcare resources, healthcare service provision, and patient flow in Japan: A cross sectional study.” Social Sci. Med. 75 (11): 1954–1963. https://doi.org/10.1016/j.socscimed.2012.07.032.
Song, Y., Y. Tan, Y. Song, P. Wu, J. C. Cheng, M. J. Kim, and X. Wang. 2018. “Spatial and temporal variations of spatial population accessibility to public hospitals: A case study of rural-urban comparison.” GISci. Remote Sens. 55 (5): 718–744. https://doi.org/10.1080/15481603.2018.1446713.
Stepniak, M., and P. Rosik. 2013. “Accessibility improvement, territorial cohesion and spillovers: A multidimensional evaluation of two motorway sections in Poland.” J. Transp. Geogr. 31: 154–163. https://doi.org/10.1016/j.jtrangeo.2013.06.017.
Székely, V., and J. Novotný. 2022. “Public transport-disadvantaged rural areas in relation to daily accessibility of regional centre: Case study from Slovakia.” J. Rural Stud. 92: 1–16. https://doi.org/10.1016/j.jrurstud.2022.03.015.
Tao, Z., and Y. Cheng. 2019. “Modelling the spatial accessibility of the elderly to healthcare services in Beijing, China.” Environ. Plann. B: Urban Anal. City Sci. 46 (6): 1132–1147. https://doi.org/10.1177/2399808318755145.
Tao, Z., Y. Cheng, T. Dai, and M. W. Rosenberg. 2014. “Spatial optimization of residential care facility locations in Beijing, China: Maximum equity in accessibility.” Int. J. Health Geographics 13 (1): 1–11. https://doi.org/10.1186/1476-072X-13-33.
Tao, Z., Y. Cheng, and J. Liu. 2020. “Hierarchical two-step floating catchment area (2SFCA) method: Measuring the spatial accessibility to hierarchical healthcare facilities in Shenzhen, China.” Int. J. Equity Health 19 (1): 1–16. https://doi.org/10.1186/s12939-020-01280-7.
Tavares, L. P., and F. Zantomio. 2017. “Inequity in healthcare use among older people after 2008: The case of southern European countries.” Health Policy 121 (10): 1063–1071. https://doi.org/10.1016/j.healthpol.2017.08.011.
Tiznado-Aitken, I., J. C. Muñoz, and R. Hurtubia. 2021. “Public transport accessibility accounting for level of service and competition for urban opportunities: An equity analysis for education in Santiago de Chile.” J. Transp. Geogr. 90: 102919. https://doi.org/10.1016/j.jtrangeo.2020.102919.
UN (United Nations). 2017. World population ageing 2017. New York: UN.
UN (United Nations). 2019. World population ageing 2019. New York: UN.
Wang, J., Y. Deng, C. Song, and D. Tian. 2016. “Measuring time accessibility and its spatial characteristics in the urban areas of Beijing.” J. Geog. Sci. 26 (12): 1754–1768. https://doi.org/10.1007/s11442-016-1356-2.
Williams, R. F., and D. P. Doessel. 2006. “Measuring inequality: Tools and an illustration.” Int. J. Equity Health 5 (1): 1–8. https://doi.org/10.1186/1475-9276-5-5.
Wu, C., X. Ye, Q. Du, and P. Luo. 2017. “Spatial effects of accessibility to parks on housing prices in Shenzhen, China.” Habitat Int. 63: 45–54. https://doi.org/10.1016/j.habitatint.2017.03.010.
Wu, H. C., and M. H. Tseng. 2018. “Evaluating disparities in elderly community care resources: Using a geographic accessibility and inequality index.” Int. J. Environ. Res. Public Health 15 (7): 1353. https://doi.org/10.3390/ijerph15071353.
Wu, Y., X. Yan, S. Zhao, J. Wang, J. Ran, D. Dong, M. Wang, H. Fung, E. K. Yeoh, and R. Y. N. Chung. 2020. “Association of time to diagnosis with socioeconomic position and geographical accessibility to healthcare among symptomatic COVID-19 patients: A retrospective study in Hong Kong.” Health Place 66: 102465. https://doi.org/10.1016/j.healthplace.2020.102465.
Xia, Y., H. Chen, C. Zuo, and N. Zhang. 2022. “The impact of traffic on equality of urban healthcare service accessibility: A case study in Wuhan, China.” Sustainable Cities Soc. 86: 104130. https://doi.org/10.1016/j.scs.2022.104130.
Yang, D. H., R. Goerge, and R. Mullner. 2006. “Comparing GIS-based methods of measuring spatial accessibility to health services.” J. Med. Syst. 30 (1): 23–32. https://doi.org/10.1007/s10916-006-7400-5.
Yang, J., and L. Mao. 2018. “Understanding temporal change of spatial accessibility to healthcare: An analytic framework for local factor impacts.” Health Place 51: 118–124. https://doi.org/10.1016/j.healthplace.2018.03.005.
Yang, S., D. Wang, C. Li, C. Wang, and M. Wang. 2021. “Medical treatment behaviour of the elderly population in Shanghai: Group features and influencing factor analysis.” Int. J. Environ. Res. Public Health 18 (8): 4108. https://doi.org/10.3390/ijerph18084108.
Yin, P. 2019. “Urban–rural inequalities in spatial accessibility to prenatal care: A GIS analysis of Georgia, USA, 2000–2010.” GeoJournal 84 (3): 671–683. https://doi.org/10.1007/s10708-018-9884-1.
Zainab, U. I., E. Kruger, and M. Tennant. 2015. “Major metropolis rail system access to dental care for the retired and elderly: A high-resolution geographic study of Sydney, Australia.” Gerodontology 32 (4): 302–308. https://doi.org/10.1111/ger.12157.
Zhang, S., X. Song, and J. Zhou. 2021. “An equity and efficiency integrated grid-to-level 2SFCA approach: Spatial accessibility of multilevel healthcare.” Int. J. Equity Health 20 (1): 1–14. https://doi.org/10.1186/s12939-021-01553-9.
Zhang, T., J. Liu, and C. Liu. 2019. “Changes in perceived accessibility to healthcare from the elderly between 2005 and 2014 in China: An Oaxaca-Blinder decomposition analysis.” Int. J. Environ. Res. Public Health 16 (20): 3824. https://doi.org/10.3390/ijerph16203824.
Zhang, W., Y. Gao, S. Li, W. Liu, C. Zeng, L. Gao, M. Li, and C. Peng. 2022. “Accessibility measurements for urban parks considering age-grouped walkers’ sectorial travel behavior and built environment.” Urban For. Urban Greening 76: 127715. https://doi.org/10.1016/j.ufug.2022.127715.
Zhang, Y., W. Li, H. Deng, and Y. Li. 2020. “Evaluation of public transport-based accessibility to health facilities considering spatial heterogeneity.” J. Adv. Transp. 2020: 7645153. https://doi.org/10.1155/2020/7645153.
Zhao, P., S. Li, and D. Liu. 2020a. “Unequable spatial accessibility to hospitals in developing megacities: New evidence from Beijing.” Health Place 65: 102406. https://doi.org/10.1016/j.healthplace.2020.102406.
Zhao, Y., Y. Hu, J. P. Smith, J. Strauss, and G. Yang. 2014. “Cohort profile: The China health and retirement longitudinal study (CHARLS).” Int. J. Epidemiol. 43 (1): 61–68. https://doi.org/10.1093/ije/dys203.
Zhao, Y., J. Strauss, X. Chen, Y. Wang, J. Gong, Q. Meng, G. Wang, and H. Wang. 2020b. China health and retirement longitudinal study wave 4 user’s guide, 5–6. Beijing: National School of Development, Peking University.
Zheng, J. T., and P. F. Wang. 2018. “Chronic diseases and comorbidity in the elderly in Beijing.” Chin. Gener. Pract. 21 (3): 265–268.
Zhong, S., X. Yang, and R. Chen. 2016. “The accessibility measurement of hierarchy public service facilities based on multi-mode network dataset and the two-step 2SFCA: A case study of Beijing’s medical facilities.” Geogr. Res. 35: 731–744.
Zou, Y., L. Jia, S. Chen, X. Deng, Z. Chen, Y. He, Q. Wang, D. Xing, and Y. Zhang. 2022. “Spatial accessibility of emergency medical services in Chongqing, Southwest China.” Front. Public Health 10: 959314.
Information & Authors
Information
Published In
Journal of Urban Planning and Development
Volume 149 • Issue 4 • December 2023
Copyright
© 2023 American Society of Civil Engineers.
History
Received: Sep 17, 2022
Accepted: May 8, 2023
Published online: Jul 25, 2023
Published in print: Dec 1, 2023
Discussion open until: Dec 25, 2023
ASCE Technical Topics:
- Age factors
- Business management
- Case studies
- Diseases
- Engineering fundamentals
- Health hazards
- Infrastructure
- Land use
- Methodology (by type)
- Population projection
- Practice and Profession
- Public administration
- Public health and safety
- Research methods (by type)
- Sustainable development
- Urban and regional development
- Urban areas
- Workplace diversity
Authors
Metrics & Citations
Metrics
Citations
Download citation
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.