国谈抗肿瘤药配备机构的空间可达性评价研究——以武汉市为例

目的：本研究旨在评估武汉市中心城区国谈抗肿瘤药配备机构的空间可达性水平,为优化药物供应与配置提供经验证据。方法：以武汉市为例,采用基于高斯衰减函数的两步移动搜索法(2-Step Floating Catchment Area, 2SFCA)评估研究区域内各个需求单元在不同交通出行方式下的国谈抗肿瘤药配备机构的可达性,同时运用空间自相关分析和K-means聚类分析识别需求单元可达性的分布态势和分类模式。结果：在驾车或公交出行的情况下,武汉市中心城区各需求单元的配药定点机构的可达性呈现出明显的空间分异特征。江汉区、汉阳区等可达性水平较高且均衡,而青山区和洪山区可达性水平较低且内部存在明显分层。此外,各需求单元呈现显著正相关空间分布,区域内高值集聚与分区内部分化现象并存。结论：武汉市中心城区配药机构可达性整体较高,但存在从核心城区向边缘城区递减的趋势;多数辖区的可达性良好且较为均衡,但少数辖区的可达性较差且存在明显的内部等级分层。     

Relationship between accessibility and resources to treat acute ischemic stroke. Hokkaido,Japan: Analysis of inequality and coverage using geographic information systems

ObjectivesThis study aimed to clarify the relationship between the institution and resident with respect to accessibility to acute ischemic stroke (AIS) treatment in Hokkaido and to propose new methodology monitoring for accessibility to healthcare resources.MethodsThis study involves the use of geographic information system (GIS) network analysis. We established hospital/clinic with one of the following conditions as resources for AIS treatment: (1) medical facility practicing AIS treatment, (2) having computed tomography (CT) equipment, (3) having angiography equipment, and (4) having AIS specialists (neurosurgeons). We evaluated the coverage of population resources using transport time between ambulance departure and arrival at the healthcare facility. Furthermore, we compared the population coverage rate using available resources and calculated a Gini coefficient to analyze its relation with inequality. Empirical analysis was performed, and public database for data collection was utilized. We calculated the rate of population coverage with a transport time within 10 min as an indicator of accessibility to medical resources by GIS.ResultsThe Gini coefficients of practicable facilities, CT, angiography, and neurosurgeons are 0.35, 0.16, 0.18, and 0.30, respectively. The inequality of accessibility differs depending on the resources, and Gini coefficients indicate that hospital/clinic and neurosurgeons were considered to have higher allocation inequalities than CT and angiography.ConclusionsCombining Gini coefficient and GIS network analysis in accessibility can be useful in quantifying and monitoring variation by region. We propose this combination as a new method for helping the government to make evidence-based healthcare planning.     

Using Geographic Information Systems to investigate variations in accessibility to ‘extended hours’ primary healthcare provision

There are ongoing policy concerns surrounding the difficulty in obtaining timely appointments to primary healthcare services and the potential impact on, for example, attendance at accident and emergency services and potential health outcomes. Using the case study of potential access to primary healthcare services in Wales, Geographic Information System (GIS)‐based tools that permit a consideration of population‐to‐provider ratios over space are used to examine variations in geographical accessibility to general practitioner (GP) surgeries offering appointment times outside of ‘core’ operating hours. Correlation analysis is used to explore the association of accessibility scores with potential demand for such services using UK Population Census data. Unlike the situation in England, there is a tendency for accessibility to those surgeries offering ‘extended’ hours of appointment times to be better for more deprived census areas in Wales. However, accessibility to surgeries offering appointments in the evening was associated with lower levels of working age population classed as ‘economically active’; that is, those who could be targeted beneficiaries of policies geared towards ‘extended’ appointment hours provision. Such models have the potential to identify spatial mismatches of different facets of primary healthcare, such as ‘extended’ hours provision available at GP surgeries, and are worthy of further investigation, especially in relation to policies targeted at particular demographic groups.     

Time and distance barriers to mammography facilities in the Atlanta metropolitan area

To a great extent, research on geographic accessibility to mammography facilities has focused on urban–rural differences. Spatial accessibility within urban areas can nonetheless pose a challenge, especially for minorities and low-income urban residents who are more likely to depend on public transportation. To examine spatial and temporal accessibility to mammography facilities in the Atlanta metropolitan area by public and private transportation, we built a multimodal transportation network model including bus and rail routes, bus and rail stops, transfers, walk times, and wait times. Our analysis of travel times from the population-weighted centroids of the 282 census tracts in the 2-county area to the nearest facility found that the median public transportation time was almost 51 minutes. We further examined public transportation travel times by levels of household access to a private vehicle. Residents in tracts with the lowest household access to a private vehicle had the shortest travel times, suggesting that facilities were favorably located for women who have to use public transportation. However, census tracts with majority non-Hispanic black populations had the longest travel times for all levels of vehicle availability. Time to the nearest mammography facility would not pose a barrier to women who had access to a private vehicle. This study adds to the literature demonstrating differences in spatial accessibility to health services by race/ethnicity and socioeconomic characteristics. Ameliorating spatial inaccessibility represents an opportunity for intervention that operates at the population level.     

Does the edge effect impact on the measure of spatial accessibility to healthcare providers?

Background

Spatial accessibility indices are increasingly applied when investigating inequalities in health. Although most studies are making mentions of potential errors caused by the edge effect, many acknowledge having neglected to consider this concern by establishing spatial analyses within a finite region, settling for hypothesizing that accessibility to facilities will be under-reported. Our study seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application.

Methods

This study was carried out in the department of Nord, France. The statistical unit we use is the French census block known as ‘IRIS’ (Ilot Regroupé pour l’Information Statistique), defined by the National Institute of Statistics and Economic Studies. The geographical accessibility indicator used is the “Index of Spatial Accessibility” (ISA), based on the E2SFCA algorithm. We calculated ISA for the pregnant women population by selecting three types of healthcare providers: general practitioners, gynecologists and midwives. We compared ISA variation when accounting or not edge effect in urban and rural zones. The GIS method was then employed to determine global and local autocorrelation. Lastly, we compared the relationship between socioeconomic distress index and ISA, when accounting or not for the edge effect, to fully evaluate its impact.

Results

The results revealed that on average ISA when offer and demand beyond the boundary were included is slightly below ISA when not accounting for the edge effect, and we found that the IRIS value was more likely to deteriorate than improve. Moreover, edge effect impact can vary widely by health provider type. There is greater variability within the rural IRIS group than within the urban IRIS group. We found a positive correlation between socioeconomic distress variables and composite ISA. Spatial analysis results (such as Moran’s spatial autocorrelation index and local indicators of spatial autocorrelation) are not really impacted.

Conclusion

Our research has revealed minor accessibility variation when edge effect has been considered in a French context. No general statement can be set up because intensity of impact varies according to healthcare provider type, territorial organization and methodology used to measure the accessibility to healthcare. Additional researches are required in order to distinguish what findings are specific to a territory and others common to different countries. It constitute a promising direction to determine more precisely healthcare shortage areas and then to fight against social health inequalities.

     

Assessing spatial and nonspatial factors for healthcare access: towards an integrated approach to defining health professional shortage areas

This research considers both spatial and nonspatial factors in examining accessibility to primary healthcare in Illinois. Spatial access emphasizes the importance of geographic barrier between consumer and provider, and nonspatial factors include nongeographic barriers or facilitators such as age, sex, ethnicity, income, social class, education and language ability. The population and socioeconomic data are from the 2000 Census, and the primary care physician data for the same year are provided by the American Medical Association. First, a two-step floating catchment area method implemented in Geographic Information Systems is used to measure spatial accessibility based on travel time. Secondly, the factor analysis method is used to group various sociodemographic variables into three factors: (1) socioeconomic disadvantages, (2) sociocultural barriers and (3) high healthcare needs. Finally, spatial and nonspatial factors are integrated to identify areas with poor access to primary healthcare. The research is intended to develop an integrated approach for defining Health Professional Shortage Areas (HPSA) that may help the US Department of Health and Human Services and state health departments improve HPSA designation.     

Racial disparities in travel time to radiotherapy facilities in the Atlanta metropolitan area

Low-income women with breast cancer who rely on public transportation may have difficulty in completing recommended radiation therapy due to inadequate access to radiation facilities. Using a geographic information system (GIS) and network analysis we quantified spatial accessibility to radiation treatment facilities in the Atlanta, Georgia metropolitan area. We built a transportation network model that included all bus and rail routes and stops, system transfers and walk and wait times experienced by public transportation system travelers. We also built a private transportation network to model travel times by automobile. We calculated travel times to radiation therapy facilities via public and private transportation from a population-weighted center of each census tract located within the study area. We broadly grouped the tracts by low, medium and high household access to a private vehicle and by race. Facility service areas were created using the network model to map the extent of areal coverage at specified travel times (30, 45 and 60 min) for both public and private modes of transportation. The median public transportation travel time to the nearest radiotherapy facility was 56 min vs. approximately 8 min by private vehicle. We found that majority black census tracts had longer public transportation travel times than white tracts across all categories of vehicle access and that 39% of women in the study area had longer than 1 h of public transportation travel time to the nearest facility. In addition, service area analyses identified locations where the travel time barriers are the greatest. Spatial inaccessibility, especially for women who must use public transportation, is one of the barriers they face in receiving optimal treatment.     

A flow-based statistical model integrating spatial and nonspatial dimensions to measure healthcare access

Assessing access to healthcare for an entire healthcare system involves accounting for demand, supply, and geographic variation. In order to capture the interaction between healthcare services and populations, various measures of healthcare access have been utilized, including the popular two-step floating catchment area (2SFCA) method. However, despite the many advantages of 2SFCA, the problems, such as inappropriate assumption of healthcare demand and failure to capture cascading effects across the system have not been satisfactorily addressed. In this paper, a statistical model for evaluating flows of individuals was added to the 2SFCA method (hereafter we refer to it as F2SFCA) in order to overcome limitations associated with its current restriction. The proposed F2SFCA model can incorporate both spatial and nonspatial dimensions and thus synthesizes them into one framework. Moreover, the proposed F2SFCA model can be easily adapted to measure access for different types of individuals, over different service provider types, or with capacity constraints in a healthcare system. We implemented the proposed model in a case study assessing access to healthcare for the elderly in Taipei City, Taiwan, and compared the weaknesses and strengths to the 2SFCA method and its variations.     

中国县级医疗卫生服务地理可及性的公平性分析

目的：建立中国县级层面的地区贫困指数以分析中国医疗卫生服务地理可及性的公平性。方法：采用主成分分析方法提取县级不同维度贫困指标的第一主成分得分,对其标准化后作为县级地区贫困指数。采用最小二乘法分析地区贫困和医疗卫生服务地理可及性的关系。结果：按照地区贫困指数分组,居住在最贫困20%地区的居民平均到最近医疗点的距离和时间分别是居住在最不贫困20%地区居民的2.60倍和2.25倍,存在显著的不公平性。回归分析结果显示,地区贫困指数每增加一个单位,到最近医疗点距离和时间分别增加22.1%和16.6%。结论：中国县级医疗卫生服务地理可及性随着地区贫困程度加深而恶化。     

National and subnational estimates of coverage and travel time to emergency obstetric care in Afghanistan: Modeling of spatial accessibility

In Afghanistan, the risk of maternal death is among the highest in the world, with wide variation across the country. One explanation may be wide geographic disparities in access and use of maternal health care services. This study describes the spatial distribution of public facilities providing maternal health care in Afghanistan, specifically emergency obstetric care (EmOC), and the differences in travel time estimates using different transportation modes from 2010 to 2015 at the national and subnational levels. We conducted mapping and spatial analyses to measure the proportion of pregnant women able to access any EmOC health facility within 2 h by foot, animal, motor vehicle and a combination of transport modes. In 2015, adequate coverage of active public health facilities within 2 h of travel time was 36.6% by foot and 71.2% by a combination of transport modes. We found an 8.3% and 63.2% increase in access to EmOC facilities within 2 h of travel time by a combination of transport modes and by foot only, respectively, by 2015. Access to a combination of transportation options such as motor vehicles and animals may benefit pregnant women in reaching health facilities efficiently. Afghanistan made impressive gains in maternal healthcare access; despite these improvements, large disparities remain in geographic access by province and overall access to facilities is still poor.     

Measuring geographic access to health care: raster and network-based methods

ABSTRACT: BACKGROUND: Inequalities in geographic access to health care result from the configuration of facilities, population distribution, and the transportation infrastructure. In recent accessibility studies, the traditional distance measure (Euclidean) has been replaced with more plausible measures such as travel distance or time. Both network and raster-based methods are often utilized for estimating travel time in a Geographic Information System. Therefore, exploring the differences in the underlying data models and associated methods and their impact on geographic accessibility estimates is warranted. METHODS: We examine the assumptions present in population-based travel time models. Conceptual and practical differences between raster and network data models are reviewed, along with methodological implications for service area estimates. Our case study investigates Limited Access Areas defined by Michigan's Certificate of Need (CON) Program. Geographic accessibility is calculated by identifying the number of people residing more than 30 minutes from an acute care hospital. Both network and raster-based methods are implemented and their results are compared. We also examine sensitivity to changes in travel speed settings and population assignment. RESULTS: In both methods, the areas identified as having limited accessibility were similar in their location, configuration, and shape. However, the number of people identified as having limited accessibility varied substantially between methods. Over all permutations, the raster-based method identified more area and people with limited accessibility. The raster-based method was more sensitive to travel speed settings, while the network-based method was more sensitive to the specific population assignment method employed in Michigan. CONCLUSIONS: Differences between the underlying data models help to explain the variation in results between raster and network-based methods. Considering that the choice of data model/method may substantially alter the outcomes of a geographic accessibility analysis, we advise researchers to use caution in model selection. For policy, we recommend that Michigan adopt the network-based method or reevaluate the travel speed assignment rule in the raster-based method. Additionally, we recommend that the state revisit the population assignment method.     

Accessibility and accommodations for patients with mobility disabilities in a large healthcare system: How are we doing?

BackgroundPeople with disabilities continue to experience health disparities resulting from inaccessibility of healthcare practices and medical diagnostic equipment (MDE).ObjectiveThe purpose of this study was to evaluate the accessibility of and accommodations for patients with mobility disabilities in clinics of a large healthcare system in the South Atlantic division of the U.S., to determine if accessibility was different based on clinic type, and to identify areas for improvement to increase accessibility.MethodsThis was a cross-sectional study of 214 healthcare professionals conducted between March and June of 2018. Chi square tests and ANOVA were used to compare accessibility between primary care, hospital based, and private diagnostic clinics.ResultsA relatively high proportions of respondents reported that their clinic had implemented many accessible features. However, significant differences were found by clinic type with primary care clinics having better access to MDE including height adjustable exam tables, scales with handrails, wheelchair accessible scales, or padded leg supports. However, primary care clinics were less likely to have lifts for transferring patients. The percent of clinics with MDE was higher than that reported in previous studies which may be due to the safe patient handling and mobility program implemented at the healthcare system. Accommodations for patients when a barrier to care is encountered remain an area for improvement.ConclusionWhile accessibility for people with disabilities was greater in this healthcare system, areas for improvement were identified to help healthcare professional care for their patients with disabilities.     

Mobility challenges and perceptions of autonomous vehicles for individuals with physical disabilities

BackgroundIndividuals with physical disabilities face many challenges, especially with mobility. Transportation plays a key role in an individual's health as it provides the access to critical services such as medical visits. Autonomous vehicles (AVs) can be one possible solution to increase transportation accessibility. However, there is currently limited information detailing the obstacles individuals with disabilities face when it comes to mobility, or research regarding perceptions of this population toward autonomous vehicles.ObjectiveThe goals of this study were twofold: 1) to identify the accessibility needs associated with transportation for individuals with a physical disability and 2) to understand the initial perceptions of this population towards autonomous vehicles to meet these needs.MethodsA survey with multiple choice and short-answer questions was developed to gather data on transportation issues and experiences from individuals with physical disabilities. This survey was distributed to disability networks.ResultsOur results illustrate the many challenges that individuals with physical disabilities experience related to transportation, such as cost, time for planning, and convenience of use. We also found that individuals with physical disabilities had an overall positive attitude towards AVs and would be willing to pay the same price as private transportation or possibly more to use AVs if it had the proper accessibility and safety features.ConclusionsOverall, this work can be used to inform decisions surrounding accessibility of current transportation as well as guide the planning and design of autonomous vehicles for a population with physical disabilities.     

Normative models and healthcare planning: network-based simulations within a geographic information system environment.

OBJECTIVES: Network analysis to integrate patient, transportation and hospital characteristics for healthcare planning in order to assess the role of geographic information systems (GIS). A normative model of base-level responses of patient flows to hospitals, based on estimated travel times, was developed for this purpose. DATA SOURCES/STUDY SETTING: A GIS database developed to include patient discharge data, locations of hospitals, US TIGER/Line files of the transportation network, enhanced address-range data, and U.S. Census variables. The study area included a 16-county region centered on the city of Charlotte and Mecklenburg County, North Carolina, and contained 25 hospitals serving nearly 2 million people over a geographic area of nearly 9,000 square miles. STUDY DESIGN: Normative models as a tool for healthcare planning were derived through a spatial Network analysis and a distance optimization model that was implemented within a GIS. Scenarios were developed and tested that involved patient discharge data geocoded to the five-digit zip code, hospital locations geocoded to their individual addresses, and a transportation network of varying road types and corresponding estimated travel speeds to examine both patient discharge levels and a doubling of discharge levels associated with total discharges and DRG 391 (Normal Newborns). The Network analysis used location/allocation modeling to optimize for travel time and integrated measures of supply, demand, and impedance. DATA COLLECTION/EXTRACTION METHODS: Patient discharge data from the North Carolina Medical Database Commission, address-ranges from the North Carolina Institute for Transportation Research and Education, and U.S. Census TIGER/Line files were entered-into the ARC/INFO GIS software system for analysis. A relational database structure was used to organize the information and to link spatial features to their attributes. PRINCIPAL FINDINGS: Advances in healthcare planning can be achieved by examining baseline responses of patient flows to distance optimization simulations and healthcare scenarios conducted within a spatial context that uses a normative model to integrate characteristics of population, patients, hospitals, and transportation networks. Model runs for the defined scenarios indicated that a doubling of the 1991 patient discharge levels resulted in an areal constriction of the service areas to those zip codes immediately adjacent to the hospitals, thereby leaving substantial areas unassigned to hospitals during the allocation process, but that doubling the demand for obstetrics care (DRG 391) resulted in little change in the pattern of accessibility to care as indicated by the size, orientation, and pattern of the service areas. CONCLUSIONS: The GIS-Network system supported "what if" simulations, portrayed service areas within a spatial context, integrated disparate data in the execution of the location/allocation model, and used estimated travel time along a transportation network instead of Euclidean distance for calculating accessibility. The results of the simulations suggest that the GIS-Network system is an effective approach for exploring a variety of healthcare scenarios where changes in the supply, demand, and impedance variables can be examined within a spatial context and where variations in system trajectories can be simulated and observed.     

中国老年人就医行为及其影响因素研究

目的了解我国老年人就医行为及其影响因素。方法基于安德森医疗服务利用模型框架,利用中国健康与养老追踪调查(CHARLS)2015年数据建立Heckman样本选择模型和Probit模型,从倾向特征、使能资源、医疗需要等方面分析老年人就医行为影响因素。结果共调查老年人10172例,其门诊、住院比例分别为32.41%、17.68%;门诊、住院中选择公立医疗机构的比例分别为72.93%、92.18%,选择基层医疗机构比例分别为57.63%、17.00%。女性、低龄、城镇、中西部地区、有医保、自评健康不好和ADL受损的老人的门诊和住院服务利用较高,女性、高龄、居住在农村、自评健康不好、ADL受损的老人更依赖于民营或基层医疗机构。安德森模型中倾向特征、使能资源和医疗需要对老年人的就医行为解释较好,交通方式、医疗费用及自付比例、疾病的紧急程度等也与医疗机构的选择相关。当前的基本医疗保险制度提高了老年人的就诊率,但对就诊机构选择影响不明显。结论老年人门诊、住院时选择公立医疗机构较多,选择民营机构较少,门诊时在基层医疗机构略多,住院机构选择集中于高级别医疗机构。其就医行为出发于医疗需要,也受到使能资源的制约和倾向特征的影响。应致力于提高老年人的医疗可及性和公平性,在进一步完善现有高等级、公立医疗机构建设的同时,还应充分发挥基层及民营医疗机构的作用,满足不同老年群体的医疗需求。     

A multi-modal relative spatial access assessment approach to measure spatial accessibility to primary care providers

Two-step floating catchment area (2SFCA) methods that account for multiple transportation modes provide more realistic accessibility representation than single-mode methods. However, the use of the impedance coefficient in an impedance function (e.g., Gaussian function) introduces uncertainty to 2SFCA results. This paper proposes an enhancement to the multi-modal 2SFCA methods through incorporating the concept of a spatial access ratio (SPAR) for spatial access measurement. SPAR is the ratio of a given place’s access score to the mean of all access scores in the study area. An empirical study on spatial access to primary care physicians (PCPs) in the city of Albuquerque, NM, USA was conducted to evaluate the effectiveness of SPAR in addressing uncertainty introduced by the choice of the impedance coefficient in the classic Gaussian impedance function. We used ESRI StreetMap Premium and General Transit Specification Feed (GTFS) data to calculate the travel time to PCPs by car and bus. We first generated two spatial access scores—using different catchment sizes for car and bus, respectively—for each demanding population location: an accessibility score for car drivers and an accessibility score for bus riders. We then computed three corresponding spatial access ratios of the above scores for each population location. Sensitivity analysis results suggest that the spatial access scores vary significantly when using different impedance coefficients (p?<?0.05); while SPAR remains stable (p?=?1). Results from this paper suggest that a spatial access ratio can significantly reduce impedance coefficient-related uncertainties in multi-modal 2SFCA methods.     

Traveling Towards Disease: Transportation Barriers to Health Care Access

Transportation barriers are often cited as barriers to healthcare access. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. However, the significance of these barriers is uncertain based on existing literature due to wide variability in both study populations and transportation barrier measures. The authors sought to synthesize the literature on the prevalence of transportation barriers to health care access. A systematic literature search of peer-reviewed studies on transportation barriers to healthcare access was performed. Inclusion criteria were as follows: (1) study addressed access barriers for ongoing primary care or chronic disease care; (2) study included assessment of transportation barriers; and (3) study was completed in the United States. In total, 61 studies were reviewed. Overall, the evidence supports that transportation barriers are an important barrier to healthcare access, particularly for those with lower incomes or the under/uninsured. Additional research needs to (1) clarify which aspects of transportation limit health care access (2) measure the impact of transportation barriers on clinically meaningful outcomes and (3) measure the impact of transportation barrier interventions and transportation policy changes.     

安全套推广干预措施在流动人口中的可及性调查研究

目的 调查安全套推广使用过程中干预措施在流动人口中的可及性,并确定流动人口偏好的干预措施,为制定性传播疾病干预政策提供依据。 方法 采用便利抽样方法,抽取深圳市364名流动人口与44名卫生保健工作者,采用问卷调查方式,了解安全套使用推广提供与利用情况,评价各项干预措施在流动人口中的可及性及偏好。 结果 安全套使用推广干预措施的提供率与流动人口的偏好顺序较为一致,干预措施可及性介于17.6%~55.0%。 结论 在推广安全套使用过程中应重点强调干预措施在流动人口中的可及性,建议推行可及性良好并易被接受的干预措施。     

Comment améliorer les mesures d’accessibilité aux soins pour mieux cibler les zones sous-denses ?

Introduction

Compared to the other countries of the Organization for Economic Cooperation and Development (OECD), France now enjoys an average level of medical staffing. Yet accessibility to healthcare is a major public policy issue because of the unequal distribution of health professionals throughout the French territories; the authorities are trying to fight the problem by deploying a set of measures favoring the installation and maintenance of healthcare services in areas identified as underserved.

广州市城镇人口医药卫生服务可及性调查报告

采用分层随机抽样的方法对广州市常住人口医药卫生可及性进行了电话调查。目前,广州城镇人口大多数自付过医药费用,相当一部分城镇人口自付的医药费用比例过高,药品费用在城镇人口自付的医疗费用项目中居首位,城镇人口自付医药费用的主要原因是没有其他选择。城镇人口医疗保障覆盖面还不高,30%的城镇人口没有参加任何一种医疗保障项目。城镇人口在就医时倾向于选择大医院。完善基本医疗保障制度,引导患者就医行为,推进医药分家体制改革,转变基本医疗保障费用支付方式和加大公共卫生投入改革有助于提高广州市目前城镇人口医疗卫生服务可及性。