# Spatial accessibility and equity of traditional Chinese medicine hospitals in Eastern China: application of improved two-step floating catchment area method

## TL;DR

This study evaluates the spatial accessibility and equity of traditional Chinese medicine hospitals in Zhejiang Province, China, using improved methods to identify disparities and suggest policy solutions.

## Contribution

The study introduces an improved two-step floating catchment area method with real-time travel times to assess TCM hospital accessibility and equity at high geographic resolution.

## Key findings

- 93.47% of residential points in Zhejiang are within 60 minutes of a TCM hospital, covering 97.21% of the population.
- Lishui municipality shows consistently poor equity across TCM resources, with Gini coefficients up to 0.505 for medical equipment.
- Spatial clustering of accessibility is influenced by topography and resource allocation disparities.

## Abstract

Despite the growing role of Traditional Chinese Medicine (TCM) in China, little is known about the spatial accessibility and equity of TCM hospital resources at high geographic resolution. This study quantifies the spatial accessibility (SA) of TCM hospitals and assess the equity in resource distribution across Zhejiang Province to identify distributional disparities and inform policy responses.

We applied a Two-Step Floating Catchment Area (2SFCA) framework augmented with navigation-derived travel times from a real-time route API to estimate SA for 99 public TCM hospitals and 25,601 residential demand points; equity was evaluated using Gini coefficients for four core resources (TCM physicians, TCM pharmacists, inpatient beds, and high-value TCM equipment), and spatial clustering was examined via Moran's I.

Among the 25,601 residential points analyzed, 93.47% were within a 60 min driving distance of a TCM hospital, covering 97.21% of the provincial population. However, accessibility varied considerably by municipality: Hangzhou exhibited the highest SA scores, while Lishui demonstrated consistently poor equity across all resource indicators. Gini coefficients ranged from 0.365 for TCM pharmacists (indicating proper equity) to 0.505 for medical equipment (indicating high inequity). Spatial autocorrelation analysis revealed distinct clustering patterns, with accessibility shaped by both topographical constraints and disparities in resource allocation.

While Zhejiang achieves high overall SA to TCM hospitals, substantial inequities in resource allocation remain. Policy implications include targeted redistribution of high-value assets (for example, regional equipment-sharing consortia), deployment of mobile diagnostic and treatment units for remote and insular areas, incentives to attract TCM practitioners to underserved localities, and strengthening county-level service capacity to reduce intra-municipal disparities. These measures would help translate broad coverage into more equitable access to TCM services.