Examining the spatial and social heterogeneities of accessing hierarchical healthcare services through the lens of equity: A case study of the central urban area in Shanghai, China

Achieving equal access to healthcare is an essential goal of the Sustainable Development Goals and a key criterion for building healthy communities. In this study, we examine the spatial and social heterogeneities of accessing hierarchical healthcare services through the lens of equity in the central urban area of Shanghai. The BFCA method is applied to analyze the accessibility to healthcare with various levels of services and via travel modes from communities and identify communities with a spatial mismatch. The relationship between factors, including socio-economic factors, health status, medical choice, and accessing healthcare services are examined using a multi-nominal logistic model. The results show that 1) Accessing healthcare performs a spatial mismatch and core-periphery disparity in the central urban area. 2) The lacking the accessibility to high-tier healthcare and a walkable environment are two main spatial equity issues, especially the latter one. 3) The inequities of access to healthcare facilities are systematic differences in factors including age, family income, family expenditure, medical choice, and health status. The results highlight the geographic and demographic disparities in healthcare services through the lens of equity and provide suggestions to improve the healthcare coverage and develop a sustainable and healthy-oriented city.