Measuring spatial accessibility of residents' medical treatment under hierarchical diagnosis and treatment system: Multi-scenario simulation in China.

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.