Background: Spatial accessibility to healthcare facilities has drawn much attention in health geography. In China, central and local governments have aimed to develop a well-organized hierarchical system of healthcare facilities in recent years. However, few studies have focused on the measurement of healthcare accessibility in a hierarchical service delivery system, which is crucial for the assessment and implementation of such strategies. Methods: Based on recent improvements in 2SFCA (two-step floating catchment area) method, this study aims to propose a Hierarchical 2SFCA (H2SFCA) method for measuring spatial accessibility to hierarchical facilities. The method considers the varied catchment area sizes, distance decay effects, and transport modes for facilities at various levels. Moreover, both the relative and absolute distance effects are incorporated into the accessibility measurement. Results: The method is applied and tested in a case study of hierarchical healthcare facilities in Shenzhen, China. The results reveal that the general spatial accessibility to hierarchical healthcare facilities in Shenzhen is unevenly distributed and concentrated. The disparity of general accessibility is largely caused by the concentrated distribution of tertiary hospitals. For facilities at higher levels, average accessibility of demanders is higher, but there are also larger disparities in spatial accessibility. The comparison between H2SFCA and traditional methods reveals that traditional methods underestimate the spatial disparity of accessibility, which may lead to biased suggestions for policy making. Conclusions: The results suggest that the supply of healthcare resources at primary facilities is far from sufficient. To improve the spatial equity in spatial accessibility to hierarchical healthcare facilities, various actions are needed at different levels. The proposed H2SFCA method contributes to the modelling of spatial accessibility to hierarchical healthcare facilities in China and similar environments where the referral system has not been well designed. It can also act as the foundation for developing more comprehensive measures in future studies.

The residential care system is rapidly developing and plays an increasingly important role in care for the elderly in Beijing. A noticeable disparity in the accessibility to existing residential care facilities, however, is demonstrated in existing studies. The spatial optimization of residential care facility (RCF) locations is urgently needed to promote equal access to residential care resources among the elderly population. A two-step floating catchment area method with an additional distance-decay function is adopted to measure accessibility to residential care facilities. The spatial optimization model is developed to maximize equity in accessibility by minimizing the total square difference between the accessibility score of each demand location and the weighted average accessibility score. The Particle Swarm Optimization (PSO) method is implemented for the solution. The optimized RCF layouts improve equal spatial access to residential care resources with very low accessibility standard variation (0.0066). A relatively large number of beds (51% of the total beds) to be located in the suburban districts between the central and periphery districts of Beijing are optimized. A smaller number of beds to be located in the central and periphery districts (33% and 16% respectively) are optimized. The gaps between the existing and optimized layouts suggest that more RCF beds (5961 beds) are needed in suburban districts, while the RCF beds in some subdistricts located in the central and periphery districts are oversupplied (5253 and 1584 surplus beds respectively). The optimized results correspond to the municipal special plan proposed by the Beijing government. The optimization objective of this study is different from traditional facility location optimization models, and the method is efficient in maximizing equal access to residential care facilities. This method can support knowledge-based policy-making and planning of residential care facilities.

The two-step floating catchment area (2SFCA) method, which is one of the most widely used methods for measuring healthcare spatial accessibility, defines the catchment area of each facility as the area within a certain distance from the facility. However, in some cases, the service utilization behavior is constrained by administrative boundaries, therefore the definition of catchment area within a certain distance may be inappropriate. In this study, we aim to propose a modification of the 2SFCA method for measuring spatial accessibility to healthcare services in a system constrained by administrative boundaries. The proposed method defines the catchment areas of healthcare facilities within certain administrative units. The method is applied in a case study of the healthcare services in Yanqing District of Beijing, China. Three types of healthcare facilities, including general hospitals, community healthcare centers and stations, are included. Based on the sensitivity analysis of the distance-decay parameter β, result of the β = 1 scenario is relatively appropriate and is utilized for further analysis. The difference between spatial accessibility with or without constraint of administrative boundary is relatively significant. The results of the proposed model show that the village-level spatial accessibility to healthcare services shows a significant disparity, and the uneven distribution of general hospitals is the main cause. The constraint of administrative boundary has a significant impact on healthcare accessibility, which verifies the validity of the modification proposed by this study in empirical studies. The empirical results also lead to policy recommendations to improve healthcare equity in the study area. At the town-level, the improvement of equity in healthcare accessibility could be achieved in two ways. First, the sizes of community healthcare centers in towns with small accessibility scores should be expanded. Second, new general hospitals can be built in the eastern part of Yanqing District. Within each town, to improve the equity in healthcare accessibility, community healthcare stations should be expanded or newly built in the periphery villages.

Understanding the regional pattern of population aging in China enables rational policy making to address the challenges of inequity in social welfare and care resources among the east–central–west regions and rural–urban areas of China. This study uses census data in 2000 and 2010, and aging population ratios, annual increase rates, and spatial autocorrelation analysis to examine spatial disparities in population aging in China. The results show that the population is more aged and aging more rapidly in rural areas than in urban areas. Spatial clusters of population aging expanded from the east coastal region in 2000, to inland provinces such as Sichuan and Chongqing in 2010. The vulnerable regions in terms of population aging, health status of the elderly population, and economic level at the prefectural level were also identified.

As the population is ageing rapidly in Beijing, the residential care sector is in a fast expansion process with the support of the municipal government. Understanding spatial accessibility to residential care resources by older people supports the need for rational allocation of care resources in future planning. Based on population data and data on residential care resources, this study uses two Geographic Information System (GIS) based methods – shortest path analysis and a two-step floating catchment area (2SFCA) method to analyse spatial accessibility to residential care resources. Spatial accessibility varies as the methods and considered factors change. When only time distance is considered, residential care resources are more accessible in the central city than in suburban and exurban areas. If care resources are considered in addition to time distance, spatial accessibility is relatively poor in the central city compared to the northeast to southeast side of the suburban and exurban areas. The resources in the northwest to southwest side of the city are the least accessible, even though several hotspots of residential care resources are located in these areas. For policy making, it may require combining various methods for a comprehensive analysis. The methods used in this study provide tools for identifying underserved areas in order to improve equity in access to and efficiency in allocation of residential care resources in future planning.