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Int. J. Environ. Res. Public Health 2019, 16(4), 582; https://doi.org/10.3390/ijerph16040582

Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources

1
School of Management, Chengdu University of Information Technology, Chengdu 610225, China
2
School of Earth and Environmental Sciences, The University of Queensland, Brisbane, QLD 4067, Australia
3
Research Center for Mountain Development, Institute of Mountain Hazards and Environment, Chinese Academy of Sciences, Chengdu 610041, China
4
College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
5
Department of Urban and Rural Planning, School of Architecture and Urban-Rural Planning, Sichuan Agricultural University, Chengdu 610041, China
*
Authors to whom correspondence should be addressed.
Received: 6 December 2018 / Revised: 22 January 2019 / Accepted: 14 February 2019 / Published: 17 February 2019
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Abstract

In China, upper-level healthcare (ULHC) and lower-level healthcare (LLHC) provide different public medical and health services. Only when these two levels of healthcare resources are distributed equally and synergistically can the public’s demands for healthcare be met fairly. Despite a number of previous studies having analysed the spatial distribution of healthcare and its determinants, few have evaluated the differences in spatial equity between ULHC and LLHC and investigated their institutional, geographical and socioeconomic influences and spillover effects. This study aims to bridge this gap by analysing panel data on the two levels of healthcare resources in 31 Chinese provinces covering the period 2003–2015 using Moran’s I models and dynamic spatial Durbin panel models (DSDMs). The results indicate that, over the study period, although both levels of healthcare resources improved considerably in all regions, spatial disparities were large. The spatio-temporal characteristics of ULHC and LLHC differed, although both levels were relatively low to the north-west of the Hu Huanyong Line. DSDM analysis revealed direct and indirect effects at both short-and long-term scales for both levels of healthcare resources. Meanwhile, the influencing factors had different impacts on the different levels of healthcare resources. In general, long-term effects were greater for ULHC and short-term effects were greater for LLHC. The spillover effects of ULHC were more significant than those of LLHC. More specifically, industrial structure, traffic accessibility, government expenditure and family healthcare expenditure were the main determinants of ULHC, while industrial structure, urbanisation, topography, traffic accessibility, government expenditure and family healthcare expenditure were the main determinants of LLHC. These findings have important implications for policymakers seeking to optimize the availability of the two levels of healthcare resources. View Full-Text
Keywords: two levels of healthcare resources; spatial spillover effects; spatial equity; dynamic spatial Durbin panel model two levels of healthcare resources; spatial spillover effects; spatial equity; dynamic spatial Durbin panel model
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Song, X.; Wei, Y.; Deng, W.; Zhang, S.; Zhou, P.; Liu, Y.; Wan, J. Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources. Int. J. Environ. Res. Public Health 2019, 16, 582.

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