Assessing Accessibility and Social Equity of Tertiary Hospitals for Older Adults: A City-Wide Study of Tianjin, China

Building age-friendly cities with good accessibility and social equity can help improve older adults' well-being and quality of life. However, current accessibility analysis of service facilities tends to target most general users, while few studies have been conducted regarding hospitals from an age-friendly perspective. This study aims to measure accessibility to tertiary hospitals and conduct its equity analysis for older adults aged 65 years or over. First, the gravity-based model and geographic information system are utilized to measure accessibility to tertiary hospitals within regions and across regions, and the overall accessibility of a region. Second, coefficient of variation and global Moran's I are adopted to investigate differences in accessibility to tertiary hospitals by type among regions. Third, Lorenz curves and Gini coefficients are employed to analyze social equity of access to medical services for the elderly. Taking Tianjin, China as the case study, the results show that there exist spatial clusters in terms of accessibility to tertiary hospitals within districts, across districts, and of the whole district. Most districts in the city center have better access to these hospitals than the peripheral and suburban districts. The social equity of accessibility to tertiary hospitals is slightly better in the senior population than in the total population. This study can help the governments improve the spatial distribution and allocation of urban health care resources in a more equitable manner and promote the development of age-friendly cities in future.