Multi-scale inequalities in accessibility of hierarchical medical facilities in Chongqing, China: a comprehensive assessment of physician and bed resources

The accessibility of medical service is directly related to the quality of residents' lives and has attracted increasing concerns of both researchers and policymakers. However, previous studies have paid few attentions to the multi-scale inequalities in the accessibility of hierarchical medical facilities in megacities, and lacks comprehensive assessment of both physician and bed resources. Using Chongqing, China as the study area, this study applied the Gaussian-based two-step floating catchment area (G2SFCA) method to measure the accessibility of hierarchical medical facilities considering both physician and bed resources. The Dagum Gini coefficient was employed to decompose the inequality in medical accessibility across multiple scales (the three major divisions and urban-rural divisions). Results show that the average accessibility of tertiary hospitals is the highest and its distribution is the most equal, whereas the accessibility of primary hospitals has the lowest average value and the highest inequality. The bed-based and physician-based accessibility exhibit obvious differences. The Pearson correlation coefficients between two types of accessibility are 0.982, 0.913, and 0.62 for tertiary, secondary and primary hospitals, respectively. From the perspective of multi-scale inequalities, whether the urban-rural division or the three major regional partitions, the value of intra-group inequality exceeded the inter-group inequality across all hospital levels, which indicated that intra-group inequality are the main sources of overall disparities. This study can shed new lights on the compositions of the inequality in hierarchical medical accessibility, and highlights the necessity of comprehensively considering physician and bed resources in medical accessibility assessment.