1. Introduction
China has eliminated poverty, and people’s physical needs are basically met. According to Maslow’s hierarchy of needs, people’s safety needs, namely, people’s health, has become important. However, as urbanization accelerates, the imbalance between the growing demand for multi-level diversified medical and health services and the limited supply of medical and health resources has become more prominent [
1]. The division and cooperation mechanism among medical and health institutions is not wholesome and lacks connectivity and sharing. There is insufficient cooperation and synergy among all tiers and all types of healthcare institutions. It is difficult for the service system to effectively respond to the increasing incidence of chronic and high morbidity diseases, especially sudden public infectious diseases, which have a substantial impact on the medical system and occupy the diagnosis and treatment resources needed for other chronic diseases [
2].
Since 2020, COVID-19 has affected 215 countries around the world, with more than 6 million dead cases, and has posed substantial threats to healthy people globally. With China’s large population base and frequent mobility, the concealment of virus transmission has caused large-scale diffusion in 31 provinces nationwide, which has impacted health and social stability in China [
3]. During the COVID-19 pandemic, the tiered healthcare system plays an important role in ensuring the original treatment of chronic diseases while responding to the large number of confirmed patients and asymptomatically infected patients [
4]. Its implementation is conducive to ensuring that different tiers of medical and health resources undertake the treatment of different diseases, strengthening regional resource integration, avoiding resource squeezes, and maximizing resource benefits.
China has issued the Healthy China Strategy in the Report of the 19th CPC National Congress, and a series of development plans for the health service system by the State Council illustrates the increasing attention at the national level to the livelihood issue of basic medical and health services [
5]. However, medical and health resources are inadequately invested and unevenly allocated in China. It is a serious challenge for China to consolidate the victory against the epidemic and to universalize the Healthy China Strategy benefits. This requires regions to pay attention to the equilibrium allocation of medical and health resources [
6]. The equilibrium spatial allocation of two-tier medical and health resources is important because (1) it is conducive to improving the fairness and efficiency of resource allocation, and (2) it is conducive to ensuring the coverage of resources meets the medical needs of residents with different diseases.
The right to health is one of the basic tasks of modern countries and must be guaranteed. The right to health includes the requirement to ensure access to medical treatment and to guarantee healthcare for the population. Medical resources provide medical services, focusing on disease treatment [
7], while healthcare resources provide healthcare services, focusing on disease prevention [
8]. In China, medical and healthcare resources of all types mostly undertake the function of both disease treatment and disease prevention [
9]. In the actual research process, medical resources and healthcare resources are not strictly distinguished [
10]. Therefore, the medical and health resources mentioned in this paper refer to both medical resources and healthcare resources. During the COVID-19 pandemic, various medical and health resources not only provide treatment services, such as routine treatment and COVID-19 treatment, but also provide healthcare services, such as routine healthcare, nucleic acid detection, and vaccination. Healthcare is one of the basic tasks of modern countries. Scholars in Japan, Poland, Austria, and Brazil have investigated and analyzed the allocation of healthcare resources in their countries, and it is proposed that the quantity of healthcare resources is balanced and that healthcare resource utilization is optimized [
11,
12,
13,
14].
The unequal spatial distribution of medical and health resources is widespread in various countries, which is mainly manifested in the prominent imbalance between supply and demand [
15,
16] and with significant regional characteristics [
17]. Especially in rural areas [
18], remote areas [
19], and other areas with a low level of socio-economic development [
20,
21], resource allocation is seriously inadequate, so it is difficult and expensive to see a doctor. Coupled with the uneven distribution of medical and health resources, China has proposed a tiered healthcare system, which has promoted the good, tiered flow of medical and health resources to a certain extent. However, the primary care facilities still have a weak service capacity, and large hospitals are overcrowded. Chinese scholars have mainly conducted research on the spatial–temporal variation characteristics of resource allocation based on urban–rural and regional differences. There is a polarization in the allocation of rural and urban medical and health resources in China, with a lack of resources and insufficient health investments in rural areas [
1,
7]. The regional allocation of resources is poorly balanced, with a large number of high-quality medical resources concentrated in large cities and central areas [
22,
23,
24]. In recent years, some scholars have focused on the tiered differences in resource allocation, arguing that the polarization of medical resources between primary care facilities and hospitals is prominent and that medical resources are allocated in an inverted triangle among multi-tier healthcare institutions [
5,
25,
26]. However, most of them are based on a national scale and lack an in-depth analysis of tiered differences at the small regional scale.
Political, economic, social, and other regional conditions will impact medical and health resource allocation. Exploring the factors of resource allocation is conducive to improving regional public service equalization. Therefore, scholars have specifically analyzed the influencing factors of the spatial distribution equilibrium of resources, the main methods including the fixed effect model [
1], the gray correlation model [
22], the Geodetector model [
25], the spatial regression model [
27], and the state space model [
28]. The quantitative analysis results confirm that the level of economic development is the most important factor. In addition, the social environment, demographic characteristics, government policies, differences in residents’ conditions, and health levels also have effects on resource allocation [
25,
27,
28,
29,
30,
31]. However, in the process of influencing factor analysis, there is a lack of comprehensive index system construction, and the mechanism of each factor has not been deeply explored.
Point of interest (POI) data have the advantages of being real time, high precision, with wide coverage and easy access. Based on this, a series of spatial analyses can be carried out, such as kernel density analysis, cluster analysis, buffer analysis, standard deviation ellipse analysis, location entropy analysis, and hot spot analysis, which can be applied to spatial pattern research, central hot spot identification, and urban functional planning [
32,
33,
34,
35,
36,
37,
38,
39]. Therefore, a series of spatial analyses can be carried out using the POIs of medical and health resources to evaluate the spatial allocation of medical and health resources in Taiyuan. Moreover, the research on the influencing factors of spatial pattern differences based on POI data mainly adopts qualitative analysis, which lacks a quantitative analysis of regional economic and social indicators and realistic spatial distribution.
2. Overview of the Study Area
Taiyuan is located in the center of the Shanxi Province and the north of Taiyuan Basin, with the geographical coordinates of 37°27′~38°25′ N and 111°30′~113°09′ E. It is surrounded by mountains on the east, west, and north sides, and the center and southern areas consist of Fenhe River valley plains. With larger relief, the terrain is high in the north and low in the south and is predominantly mountainous and hilly. As the capital of Shanxi, Taiyuan is the political, economic, cultural, and medical center. It covers six districts (Jiancaoping, Xinghualing, Wanbailin, Yingze, Xiaodian, and Jinyuan), three counties (Qingxu, Yangqu, and Loufan) and Gujiao city. Taiyuan covers a total area of 6988 square kilometers and has a permanent population of 5,304,061. In 2020, the GDP of Taiyuan was CNY 415.325 billion, and per capita GDP was CNY 90,698. The population density of Taiyuan was 549 people per square kilometer, but there were significant differences among districts and counties. The population density of Yingze, Xinghualing, and Xiaodian was high, with 4681, 3644, and 2353 people per square kilometer, respectively, while that of Gujiao, Loufan, and Yangqu was low, with 136, 98, and 74 people per square kilometer, respectively.
In 2019, Taiyuan had 10.4 health technicians and 7.8 medical beds per thousand people, which were 1.43 and 2.43 times the national average, respectively. There were 3898 health institutions in the city, including 158 hospitals, 3689 primary care institutions, 40 public health professional institutes, and 11 other health institutions. Because of the primacy distribution of the urban scale, Shanxi shows strong resource agglomeration. In particular, as it is the capital city of Shanxi, medical and health resources in Taiyuan are distributed in the central urban area, resulting in an uneven resource distribution. In addition, Taiyuan is a typical mountainous city, with the main urban area located in the basin and valley area and the surrounding areas mostly mountainous, which is in line with the site selection elements and topographical characteristics of many cities in China. The city has reference significance with respect to other mountainous cities for the study of resource layout characteristics, so Taiyuan was chosen as the study area.
5. Discussion
We found that there were regional differences in the spatial allocation of medical and health resources in Taiyuan, with higher levels of resource allocation in central urban areas and areas along the high-traffic roads, while primary care facilities were poorly distributed. Correspondingly, more than half of the interviewees needed more than 15 min to reach the nearest medical and health institution. Among them, Interviewees 8 and 10, who were aged and needed long-term medication, said that access to medical and health services was inconvenient, and there was an urgent need for home doctor services or additional health centers. This was similar to the findings of Zhifei Ma and Xuchuan Sun [
11,
32] who showed that medical and health resources were clustered in large cities and central areas. Therefore, for the implementation of basic public health services, it is necessary to strengthen management and redeployment, optimize the spatial distribution of medical and health resources, increase resource supply in surrounding counties, such as Yangqu, Loufan, Gujiao, and Qingxu, and improve the construction of basic medical services in a 15 min radius. In addition, the findings of this paper showed that the quantity and the HRDI of primary care facilities were significantly higher than those of hospitals, and the spatial distribution equilibrium was also superior to that of hospitals, contrary to the findings of Junhao Wang and Xueqian Song et al., who found that primary institutions suffered from insufficient allocation [
17,
18]. Perhaps due to the typical primacy distribution of the urban scale in Shanxi, human, material, and financial resources within medical and health resources tend to be concentrated at hospitals, resulting in a low level of equilibrium with little disparity in human, material, and financial resources within primary medical and health resources. Most interviewees understood the tiered healthcare concept and were able to access different tiers of medical and health institutions according to the severity of their disease and the difficulty of treatment. Therefore, it is necessary to continuously improve the tiered healthcare system, to establish a scientific and effective medical order featuring primary treatments at primary institutions, two-way referral, tier linkage, and a separation of emergency and slow treatment, and to meet the different medical needs of residents.
The spatial distribution of medical and health resources is the result of a combination of factors, and the level of economic development is the most important factor. The results of the analysis of influencing factors in this paper are similar to those of others [
18,
20,
21,
22,
23,
24]. It is worth noting that this paper expands on the existing literature by adding the factor of the relief degree of land surface. The study showed that the relief degree of land surface had a significant influence on two-tier resource allocation. The main reason is that Taiyuan, as a mountainous city, has a large relief and elevation difference, and the mountainous and hilly terrain covers about four-fifths of the total area. The terrain conditions cannot be ignored when analyzing the factors influencing the spatial distribution of medical and health resources in Taiyuan. In addition, the interview results revealed that, in addition to the high expense, the relatively long distance, inaccessibility, and limited level of treatment were also the main reasons for the difficulty in accessing medical and health services. This was strongly related to the low level of local medical and health resource allocation and the predominantly mountainous topography, which is consistent with the analysis of the Geodetector results. Therefore, Taiyuan should focus on increasing resource supply in remote mountainous areas and rationally allocating resources considering the terrain and population. Terrain disadvantages can be compensated for through transport improvement, financial subsidies, talent support, information sharing, and so on. Efforts to promote economic development and industrial optimization, to increase household income, and to improve the medical security system must continue being made.
The widespread outbreak of COVID-19 increased the demand for medical and health resources, and the resource gap has expanded further. Most interviewees stated that medical treatment was more difficult after the COVID-19 outbreak. In order to ensure the needs for epidemic prevention, control, and isolation, as well as the routine diagnosis and treatment of chronic and acute diseases, epidemic prevention and control should not rely solely on conventional medical resources. Medical and health resources should be prepared for the emergency prevention and control of public infectious diseases. Large public places, such as stadiums and exhibition centers, should be selected for the reconstruction of cabin hospitals, so that emergency medical rescue tasks can be undertaken, and basic medical services can be provided.