An Equity Evaluation of Healthcare Accessibility across Age Strata Using the G2SFCA Method: A Case Study in Karamay District, China

Equitable access to healthcare services is essential for residents' well-being and social equity, requiring the rational spatial distribution of healthcare facilities in urban planning. Compared with major studies on the spatial accessibility and equity of healthcare services in first-tier cities, second-tier cities, which form the foundational structure of the global urban system, have not be given sufficient attention. Therefore, this study takes Karamay District in Karamay as a case study to analyze the spatial equity of healthcare services using place-based accessibility measures. For accessibility calculations, we employ the Gaussian two-step floating catchment area method to separately analyze the accessibility to hospitals and primary healthcare (PHC) institutions, considering factors such as the number of facilities, population, distance, and transportation modes. Second, we utilize global and local Moran's I for spatial analysis to identify areas with varying levels of accessibility. Furthermore, considering the spatial equity for different social groups, this study innovatively proposes an analytical framework for assessing healthcare accessibility and equity across age groups using residential-level data and an adjusted search radius in second-tier cities, typically those with small-scale urban areas. The results reveal significant spatial clustering in healthcare accessibility, similar to that observed in most first-tier cities, as well as notable differences in the spatial distribution between hospital accessibility and PHC accessibility. Regarding age strata, results show that the elderly have lower access to hospitals but higher access to PHC institutions, which is opposite to the situation observed for children. Overall, second-tier cities demonstrate better equity in healthcare accessibility compared to first-tier cities, particularly regarding hospital accessibility. However, there are minor inequities in PHC accessibility for children aged 0-12 years. Our findings may provide valuable insights and essential data support for healthcare resource allocation and land use planning in second-tier cities.