https://doi.org/10.4081/gh.2022.1157
Impact of the presence of private hospitals on the spatial equality of healthcare accessibility in Beijing, China
Submitted: 27 September 2022
Accepted: 19 November 2022
Published: 29 November 2022
Accepted: 19 November 2022
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Providing equal geographical access to hospitals, either in the public or private healthcare sector, is vital and will benefit public health in general. Against the background of the partial privatization of the healthcare sector, the impact of private hospitals on equal healthcare access has been a highly neglected issue. We have applied an assessment methodology to study this situation by comparing the status quo scenario with one without private hospitals, based on accessibility analysis and spatial equality measurements. The case study of Beijing, China revealed a double-sided impact. With the presence of private hospitals, the Gini coefficient of spatial accessibility in urban districts was reduced from 0.03391 to 0.03211, while it increased from 0.1734 to 0.1914 in suburban districts. Thus, private hospitals improved spatial equality in urban districts in Beijing but jeopardized it in suburban districts. These research findings should enlighten policymakers to promote healthcare equality but would also need to be repeated in some other big cities.
Akin JS, Lance PM, Dow WH, Lance PM, Loh CA, 2005. Changes in access to health care in China, 1989–1997. Health Policy Plan 20:80-9.
DOI: https://doi.org/10.1093/heapol/czi010
Alkhamis AA, 2017. Critical analysis and review of the literature on healthcare privatization and its association with access to medical care in Saudi Arabia. J Infec Public Health 10:258-68.
DOI: https://doi.org/10.1016/j.jiph.2017.02.014
Benitez JA, E. Kathleen Adams EK, Seiber EE, 2018. Did Health Care Reform Help Kentucky Address Disparities in Coverage and Access to Care among the Poor? Health Serv Res 53:1387-1406
DOI: https://doi.org/10.1111/1475-6773.12699
Berens W, Körling FJ, 1985. Estimating road distances by mathematical functions. Eur J Oper Res 21:54-6.
DOI: https://doi.org/10.1016/0377-2217(85)90087-6
Blomqvist Å, 2009. Health system reform in China: What role for private insurance? China Econ Rev 20:605-12.
DOI: https://doi.org/10.1016/j.chieco.2009.07.001
BMBS, 2016. Data from the Beijing Municipal Bureau Statistics presented in the Beijing Statistical Yearbook 2016. Accessed 20 April 2020. http://nj.tjj.beijing.gov.cn/nj/main/2020-tjnj/zk/indexch.htm
BMHCIC, 2015. Data from Beijing Municipal Health Commission Information Center presented in the Statistics Communique on Health Development and Family Planning of Beijing in 2015. Accessed 20 April 2020. Available form: http://www.phic.org.cn/tjsj/wstjgb/201603/t20160325_255024.html
Brimberg J, Love RF, 1993. General considerations on the use of the weighted lp norm as an empirical distance measure. Transp Sci 27:341-9.
DOI: https://doi.org/10.1287/trsc.27.4.341
Brown L, Barnett JR, 2004. Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia. Soc Sci Med 58:427-44.
DOI: https://doi.org/10.1016/S0277-9536(03)00163-1
Cheng G, Zeng X, Duan L, Lu X, Sun H, Jiang T, Li Y, 2016. Spatial difference analysis for accessibility to high level hospitals based on travel time in Shenzhen, China. Habitat Int 53:485-94.
DOI: https://doi.org/10.1016/j.habitatint.2015.12.023
Davis P, Milne B, Parker K, Hider P, Lay-Yee R, Cumming J, Graham P, 2013. Efficiency, effectiveness, equity (E3). Evaluating hospital performance in three dimensions. Health Policy 112:19-27.
DOI: https://doi.org/10.1016/j.healthpol.2013.02.008
Delbosc A, Currie G, 2011. Using Lorenz curves to assess public transport equity. J Transp Geogr 19:1252-9.
DOI: https://doi.org/10.1016/j.jtrangeo.2011.02.008
Deng C, Li X, Pan J, 2018. Private hospital expansion in China: a global perspective. Glob Health J 2:33-46.
DOI: https://doi.org/10.1016/S2414-6447(19)30138-1
Ding J, Hu X, Zhang X, Shang L, Yu M, Chen H, 2018. Equity and efficiency of medical service systems at the provincial level of China’s mainland: a comparative study from 2009 to 2014. BMC Public Health 18:214.
DOI: https://doi.org/10.1186/s12889-018-5084-7
Evans L, Charns MP, Cabral HJ, Fabian MP, 2019. Change in geographic access to community health centers after Health Center Program expansion. Health Serv Res 54:860-9.
DOI: https://doi.org/10.1111/1475-6773.13149
Gao J, Qian J, Tang S, Eriksson BO, Blas E, 2002. Health equity in transition from planned to market economy in China. Health Policy Plan 17:20-9.
DOI: https://doi.org/10.1093/heapol/17.suppl_1.20
Glorioso V, Subramanian SV, 2014. Equity in access to health care services in Italy. Health Serv Res 49:950-70.
DOI: https://doi.org/10.1111/1475-6773.12128
Haidich A-B, Ioannidis JPA, 2004. The Gini coefficient as a measure for understanding accrual inequalities in multicenter clinical studies. J Clin Epidemiol 57:341-8
DOI: https://doi.org/10.1016/j.jclinepi.2003.09.011
Hossler P, 2013. The privatization of the Milwaukee Clinical Campus: A case (study) for geographic approaches to medical services. Geoforum 49:81-90.
DOI: https://doi.org/10.1016/j.geoforum.2013.05.013
Hotelling H, 1929. Stability in competition. Econ J 39:41–57.
DOI: https://doi.org/10.2307/2224214
Hu P, Liu Z, Lan J, 2019. Equity and efficiency in spatial distribution of basic public health facilities: a case study from Nanjing Metropolitan Area. Urban Policy Res 37:43-66.
DOI: https://doi.org/10.1080/08111146.2018.1523055
Ilinca S, Di Giorgio L, Salari P, et al, 2019. Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey. Int J Equity Health 18:1-13.
DOI: https://doi.org/10.1186/s12939-019-1106-z
Jenkins SP, 1999. Analysis of income distributions. Stat Tech Bull 48:4–18.
Jin M, Liu L, Tong D, Gong Y, Liu Y, 2019. Evaluating the spatial accessibility and distribution balance of multi-level medical service facilities. Int J Environ Res Public Health 16:1150.
DOI: https://doi.org/10.3390/ijerph16071150
Khan AA, 1992. An integrated approach to measuring potential spatial access to health care services. Socio-Econ Plan Sci 26:275-87.
DOI: https://doi.org/10.1016/0038-0121(92)90004-O
Kunzmann KR, 1998. Planning for spatial equity in Europe. Int Plan Stud 3:101-120.
DOI: https://doi.org/10.1080/13563479808721701
Lee RC, 1991. Current approaches to shortage area designation. J Rural Health 7:437-50.
DOI: https://doi.org/10.1111/j.1748-0361.1991.tb01085.x
Levesque J, Harris MF, Russell G ,2013. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 12:18.
DOI: https://doi.org/10.1186/1475-9276-12-18
Li SK, He X, 2019. The impacts of marketization and subsidies on the treatment quality performance of the Chinese hospitals sector. China Econ Rev 54:41-50.
DOI: https://doi.org/10.1016/j.chieco.2018.10.007
Liu W, Liu Y, Twum P, Shixue L, 2016. National equity of health resource allocation in China: data from 2009 to 2013. Int J Equity Health 15:1-8.
DOI: https://doi.org/10.1186/s12939-016-0357-1
Love RF, Morris JG, 1979. Mathematical models of road travel distances. Manag Sci 25:130-39.
DOI: https://doi.org/10.1287/mnsc.25.2.130
Luo W, Wang F. Measures of Spatial Accessibility to Health Care in a GIS Environment: Synthesis and a Case Study in the Chicago Region, 2003. Environ Plann B: Plann Des 30:865-84.
DOI: https://doi.org/10.1068/b29120
Marsh MT, Schilling DA, 1994. Equity measurement in facility location analysis: A review and framework. Eur J Oper Res 74:1-17.
DOI: https://doi.org/10.1016/0377-2217(94)90200-3
McGrail MR, 2012. Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements. Int J Health Geogr 11:50.
DOI: https://doi.org/10.1186/1476-072X-11-50
Neutens T, 2015. Accessibility, equity and health care: review and research directions for transport geographers. J Transp Geogr 43:14-27.
DOI: https://doi.org/10.1016/j.jtrangeo.2014.12.006
Oliver A, Mossialos E, 2004. Equity of access to health care: outlining the foundations for action. J Epidemiol Comm Health 58:655-8.
DOI: https://doi.org/10.1136/jech.2003.017731
Pan J, Qin X, Li Q, Messina J P, Delamater PL, 2015. Does hospital competition improve health care delivery in China? China Econ Rev 33:179-99.
DOI: https://doi.org/10.1016/j.chieco.2015.02.002
Pan J, Zhao H, Wang X, Shi X, 2016. Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China. Soc Sci Med 170:35-45.
DOI: https://doi.org/10.1016/j.socscimed.2016.09.042
Pan X, Kwan M, Yang L, Zhou S, Zuo Z, Wan B, 2018. Evaluating the Accessibility of Healthcare Facilities Using an Integrated Catchment Area Approach. Int J Environ Res Public Health 15:2051.
DOI: https://doi.org/10.3390/ijerph15092051
Penchansky R, Thomas JW, 1981. The concept of access: definition and relationship to consumer satisfaction. Med Care 127-40.
DOI: https://doi.org/10.1097/00005650-198102000-00001
Reshadat S, Zangeneh A, Saeidi S, et al, 2019. Measures of spatial accessibility to health centers: investigating urban and rural disparities in Kermanshah, Iran. J Public Health 27:519-529.
DOI: https://doi.org/10.1007/s10389-018-0966-9
Sharma G, Patil G R, 2021. Public transit accessibility approach to understand the equity for public healthcare services: A case study of Greater Mumbai. J Transport Geogr 94:103123.
DOI: https://doi.org/10.1016/j.jtrangeo.2021.103123
Shen Y, Eggleston K, Lau J, Schmid CH, 2007. Hospital Ownership and Financial Performance: What Explains the Different Findings in the Empirical Literature? Inq 44:41-68.
DOI: https://doi.org/10.5034/inquiryjrnl_44.1.41
Talen E, Anselin L, 1998. Assessing Spatial Equity: An Evaluation of Measures of Accessibility to Public Playgrounds. Environ Plann 30:595-613.
DOI: https://doi.org/10.1068/a300595
Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M, 2008. Tackling the challenges to health equity in China. Lancet 372:1493-501.
DOI: https://doi.org/10.1016/S0140-6736(08)61364-1
Tiemann O, Schreyögg J, 2012. Changes in hospital efficiency after privatization. Health Care Manag Scie 15:310-26.
DOI: https://doi.org/10.1007/s10729-012-9193-z
Wang F, 2012. Measurement, optimization, and impact of health care accessibility: a methodological review. Ann Am Assoc Geogr 102:1104-12.
DOI: https://doi.org/10.1080/00045608.2012.657146
Wang X, Yang H, Duan Z, Pan J, 2018. Spatial accessibility of primary health care in China: A case study in Sichuan Province. Soc Sci Med 209:14-24.
DOI: https://doi.org/10.1016/j.socscimed.2018.05.023
Weich S, Lewis G, Jenkins SP, 2001. Income inequality and the prevalence of common disorders in Britain. Br J Psychiatry 178:222–7.
DOI: https://doi.org/10.1192/bjp.178.3.222
Whitehead JL, Pearson A, Lawrenson R, Atatoa-Carr P, 2019. How can the spatial equity of health services be defined and measured? A systematic review of spatial equity definitions and methods. J Health Serv Res Policy 24:270-8.
DOI: https://doi.org/10.1177/1355819619837292
Xu W, Zhang F, Zeng B, Yang T, Wang H, 2019. spatial access to medical services in the underdeveloped region of Northwestern China: A case study in Lanzhou City. Sustainability 11: 6786.
DOI: https://doi.org/10.3390/su11236786
Yang N, Chen S, Hu W, Wu Z, Chao Y, 2016. Spatial Distribution Balance Analysis of Hospitals in Wuhan. Int J Environ Res Public Health 13:971.
DOI: https://doi.org/10.3390/ijerph13100971
Yin C, He Q, Liu Y, Chen W, Gao Y,2018. Inequality of public health and its role in spatial accessibility to medical facilities in China. Appl Geogr 92:50-62.
DOI: https://doi.org/10.1016/j.apgeog.2018.01.011
Zhang S, Song X, Wei Y, Deng W, 2019. Spatial equity of multilevel healthcare in the metropolis of Chengdu, China: A new assessment approach. Int Journal Environ Res Public Health 16:493.
DOI: https://doi.org/10.3390/ijerph16030493
Zhang T, Xu Y, Ren J, Sun L, Liu C, 2017. Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. Int J Equity Health 16:42.
DOI: https://doi.org/10.1186/s12939-017-0543-9
Zhao M, Liu S, Qi W, 2018. Spatial differentiation and influencing mechanism of medical care accessibility in Beijing: A migrant equality perspective. Chin Geogr Sci 28:353-62.
DOI: https://doi.org/10.1007/s11769-018-0950-x
Zhu L, Zhong S, Tu W, Zheng J, He S, Bao J, Huang C, 2019. Assessing spatial accessibility to medical resources at the community level in Shenzhen, China. Int J Equity Health 16:242.
DOI: https://doi.org/10.3390/ijerph16020242
How to Cite
Dai, T., Guo, K., Zhao, J., & Lu, W. (2022). Impact of the presence of private hospitals on the spatial equality of healthcare accessibility in Beijing, China. Geospatial Health, 17(2). https://doi.org/10.4081/gh.2022.1157
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