Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China

BMC Health Serv Res. 2016 Aug 17;16(1):399. doi: 10.1186/s12913-016-1643-8.


Background: There is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future.

Methods: Sichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment.

Results: In Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region.

Conclusions: The combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

Keywords: China; Enhanced two-step floating catchment area method; Ethnic minority region; Hospital care; Planning; Spatial accessibility.

MeSH terms

  • Catchment Area, Health
  • China / ethnology
  • Ethnic Groups / statistics & numerical data
  • Health Services Accessibility / standards*
  • Health Services Accessibility / statistics & numerical data
  • Healthcare Disparities / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Hospitals, Private / standards
  • Hospitals, Public / standards
  • Humans
  • Minority Groups / statistics & numerical data
  • Rural Health / standards
  • Socioeconomic Factors