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Peer-reviewedCC BY 4.0Frontiers in Public Health

Equity and spatial effects of hospital accessibility in Sichuan Province: evidence from GA2SFCA-based data

  • Qianwen Song1
  • Chengzhi Ge2
  • Jing Deng3
  1. 1Procurement Section of Shuangliu Maternal and Child Health Hospital, Chengdu, China
  2. 2Hefei Orthopaedics Hospital, Hefei, China
  3. 3Medical Equipment Department, West China Airport Hospital, Sichuan University (The First Peoples Hospital of Shuangliu District Chengdu), Chengdu, China
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Abstract

Introduction: Healthcare accessibility lies at the core of health equity; however, provincial-scale evidence on its spatial inequality and cross-county interactions remains limited, particularly in western China.

Methods: We used a 2020 national 1 km grid accessibility dataset and aggregated scores to 183 county-level units. Equity was assessed using the coefficient of variation and Palma ratio across prefecture, county, and grid scales. Subsequently, we analyzed the spatial effects of accessibility using Moran’s index and a Spatial Durbin Model (SDM).

Results: Accessibility exhibited a significant east-high, west-low gradient distribution. Inequality intensified with finer spatial units: the coefficient of variation increased from 42.16% at the prefecture level to 77.23% at the county level, and reached 148.28% at the grid level. Significant positive spatial autocorrelation confirmed clustering patterns, and the SDM spatial lag parameter was significantly positive. Direct effects showed that GDP and road density enhanced county-level accessibility, while fiscal expenditure and altitude exerted negative effects; population size had no significant direct effect. Indirect effects presented a different picture: population size had a negative spillover on neighboring areas, whereas fiscal expenditure generated positive cross-county spillovers.

Conclusion: These findings indicate that healthcare planning in western China cannot rely solely on administrative boundaries. To reduce accessibility disparities, policies should prioritize differentiated resource allocation, coordinate transport and medical infrastructure planning, and refine fiscal transfer mechanisms to leverage positive spatial spillovers.

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Cite

BibTeXRIS
BibTeX
@article{song2026equity,
  title = {{Equity and spatial effects of hospital accessibility in Sichuan Province: evidence from GA2SFCA-based data}},
  author = {Qianwen Song and Chengzhi Ge and Jing Deng},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1950200},
  url = {https://doi.org/10.3389/fpubh.2026.1950200},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Equity and spatial effects of hospital accessibility in Sichuan Province: evidence from GA2SFCA-based data
AU  - Qianwen Song
AU  - Chengzhi Ge
AU  - Jing Deng
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1950200
UR  - https://doi.org/10.3389/fpubh.2026.1950200
AB  - Introduction: Healthcare accessibility lies at the core of health equity; however, provincial-scale evidence on its spatial inequality and cross-county interactions remains limited, particularly in western China.  Methods: We used a 2020 national 1 km grid accessibility dataset and aggregated scores to 183 county-level units. Equity was assessed using the coefficient of variation and Palma ratio across prefecture, county, and grid scales. Subsequently, we analyzed the spatial effects of accessibility using Moran’s index and a Spatial Durbin Model (SDM).  Results: Accessibility exhibited a significant east-high, west-low gradient distribution. Inequality intensified with finer spatial units: the coefficient of variation increased from 42.16% at the prefecture level to 77.23% at the county level, and reached 148.28% at the grid level. Significant positive spatial autocorrelation confirmed clustering patterns, and the SDM spatial lag parameter was significantly positive. Direct effects showed that GDP and road density enhanced county-level accessibility, while fiscal expenditure and altitude exerted negative effects; population size had no significant direct effect. Indirect effects presented a different picture: population size had a negative spillover on neighboring areas, whereas fiscal expenditure generated positive cross-county spillovers.  Conclusion: These findings indicate that healthcare planning in western China cannot rely solely on administrative boundaries. To reduce accessibility disparities, policies should prioritize differentiated resource allocation, coordinate transport and medical infrastructure planning, and refine fiscal transfer mechanisms to leverage positive spatial spillovers.
SN  - 2296-2565
ER  -