Background: Access to healthcare is critical for the implementation of Universal Health Coverage (UHC). With the development of healthcare insurance systems around the world, spatial impedance to healthcare institutions has attracted increasing attention. However, most spatial accessibility methodologies having been developed in Western countries, whose healthcare systems are different from those in Low and Middle Income Countries (LMIC).
Methods: In this paper, Hainan Island was taken as an example to explore the utilization of modern spatial accessibility techniques under a specialized Three-Tier Health Care Delivery System in China. Healthcare institutions were first classified into the three tiers accordingly. Then shortest travel time was calculated for each institution tier, and overlapped to identify eight types of multilevel healthcare access zones. Spatial access to doctors based on the Enhanced Two-Step Floating Catchment Area Method (E2SFCA) was also calculated.
Results: On Hainan Island, about 90% of the population were within 60-minute service range of Tier 3 (hospitals) healthcare institutions, 80% were within 30 minutes of Tier 2 (health centers), and 75% were within 15 minutes of Tier1 (clinics). Based on local policy, 76.36% of population living in 48.52% of area were able to receive timely services at all tiers of healthcare institutions. The weighted average access to doctors was 2.31 per thousand residents, but reginal disparity was large, and 64.66% were contributed by Tier 3 healthcare institutions.
Conclusion: Spatial access to healthcare institutions on Hainan Island was generally good according to travel time and general abundance of doctors, but inequality among regions and irrationality among different tiers of healthcare institutions exist. Primary healthcare institutions, especially Tier 2 need strengthen.