Hospital grade assignment.

In order to improve the operational efficiency of medical institutions and build a more complete and efficient medical system, the Chinese government is vigorously promoting the reform of hierarchical diagnosis and treatment. We constructed a multi-factor composite selection weight to characterize the residents’ medical treatment behavior in the context of hierarchical diagnosis and treatment. By combining the weight with the two-step floating catchment area method, we analyzed the spatial variation characteristics of residents’ accessibility to medical care under different scenarios. Results show that the referral rate between medical institutions increases gradually along with the occurrence of public health events. When there is a major public health event, the proportion of the population transferred from the primary medical institutions to the county hospitals and the county hospitals to the municipal hospitals exceeded 65%. In three scenarios, the spatial pattern of accessibility shows obvious consistency and local differences. Among the three-tier medical institutions in China, the service capacity of county hospitals is poor, and the contribution rate of accessibility is less than 20%. The results clearly show the spatial differences in the accessibility of Chinese residents in different scenarios and the impact of public health events on accessibility. This research can provide a reference for the layout optimization of medical resources in the future.

为提升医疗机构运行效率、构建更完善高效的医疗体系，中国政府正大力推进分级诊疗（hierarchical diagnosis and treatment）改革。本研究构建了多因素复合选择权重，以刻画分级诊疗背景下居民的就医行为特征。将该权重与两步移动搜索法（two-step floating catchment area method）相结合，分析了不同场景下居民医疗服务可达性的空间分异特征。研究结果显示，医疗机构间转诊率随公共卫生事件的发生逐步提升；当出现重大公共卫生事件时，基层医疗机构向县级医院、县级医院向市级医院的转诊人口占比均超过65%。三种场景下，医疗服务可达性的空间格局均呈现出显著的一致性与局部差异性。在中国三级医疗体系中，县级医院的服务能力相对薄弱，其可达性贡献占比不足20%。本研究清晰揭示了不同场景下中国居民医疗服务可达性的空间差异，以及公共卫生事件对可达性的影响，可为未来医疗资源布局优化提供参考依据。