Examining the Urban and Rural Healthcare Progress in Big Cities of China: Analysis of Monitoring Data in Dalian from 2008 to 2017

Int J Environ Res Public Health. 2020 Feb 12;17(4):1148. doi: 10.3390/ijerph17041148.


How to effectively reduce the disparity between urban and rural medical healthcare has become a major global concern. In China, the government has issued a series of reform measures to address the gap between urban and rural medical care. To explore the impact of China's medical system reforms in improving health services in urban and rural areas and understand the factors promoting and hindering progress, we evaluated the healthcare system in Dalian City, China, from 2008 to 2017. The weighted TOPSIS (technique for order preference by similarity to ideal solution) model was used to assess the development of the healthcare system in the different districts and employed the obstacle model to identify and analyze indicators that hinder progress in health services. Using the local spatial clustering function, we categorized the districts in terms of the hindrance type that significantly hamper the growth of the healthcare system. Our results show the healthcare system in Dalian's urban areas has steadily increased, while development in rural areas has been erratic. Although the urban-rural healthcare disparity has narrowed distinctly, sustained progress is not guaranteed. Based on the location theory, residents in urban areas are more affected by economic factors, while those in rural areas are more influenced by time considerations. When initiating healthcare reforms in urban areas, the impact of varying land prices and per capita disposable income should be considered. For rural areas, constructing more medical institutions to reduce the impact of time costs should be considered. We also found different factors that hinder the growth of the healthcare system for urban and rural areas. To address these impediments to progress, urban areas should pay more attention to coordinated development, while rural areas should address specific concerns based on local needs and conditions. More research on the progress in medical reform is crucial to provide reference and policy-guidance for countries facing similar concerns.

Keywords: GIS; healthcare system; obstacle model; urban and rural disparity; weighted TOPSIS model.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Cities
  • Health Care Reform*
  • Humans
  • Income
  • Rural Health Services*
  • Rural Population
  • Urban Health Services*
  • Urban Population