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

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript is very interesting and I just have a few comments that, I hope, will improve it:

- abstract: the authors start by separating metropolitan cities from peripheral cities but after they use the concept first-tier and second-tier. better to use just one classification

-l.62: there are also many studies at national level regarding healthcare accessibility by municipality or other administrative delimitation and not focusing only on urban/rural disparities but also on boundary effect. the authors cannot just focus on studies based on cities

-l. 68: remove one "to" 

-l. 105: include number of inhabitants, area, density and a short description of the area you are studying. 

-l. 147: the authors could consider the Guagliardo classification. Moreover, these are not the only models to measure accessibility. You also have the distance/time to the service; the number of services within n meters or minutes; and the mean distance/time to the n closest services

- l. 254: it does not make sense the authors refer that their study area is Karamay when, in reality, is one district within Karamay. Moreover, if the 14 districts are continuous and all urban, why only studying one district and the one where the municipal administration is located. This doesn't make sense when authors want to evaluate accessibility on second-tier cities! In order to make this paper relevant, the authors should do the analysis to all the city of Karamay and even neighbourhood areas if their citizens also use the healthcare services located in Karamay.

- figure 1: this figure most be improved in order to communicate. scale and title is missing on the three maps. The map from chine should represent also population density or the first and second tier cities. the map from Kalamay should have the representation of population density and location of healthcare services. missing legend on the last map. it is impossible to read the names on the last map. the delimitation of the subdistricts should be on all the maps trough out the manuscript

- l. 272: the reference to the figure should be after the next sentance because the map only represents hospitals and PHC

- figure 2: don't understand the need for the entrances (yellow dots) on the map. remove. Hospital and PHC should have different collours. why the subdistrict line does not delimitate all communities within? it seams that the subdistrict is bigger than the communities being studied. missing legend to what means the grey scale. I hope it is number of inhabitants. The difference of the symbols on 2b should be higher

- l. 289: important to refer that the wrong administrative level leads to ecological fallacy issues

- l. 293: coomunities or compounds. on the figure, the authors use the first but one the text, they refer the second. better to put equal

- l. 301: include average size of compounds, as well as the range

- figure 3: remove the streets inside compounds. on 3B, this is not the adequate method to map as most of the graphs are to small. there are more points on 3a than 3b when their should be the same number. better to separate 3b on 3 different maps

- figure 4: the scale is on top of the green area. it shouldn't

- l. 384: the paragraph before is not formatted as text

- l. 424: part of the text in this section should be on discussion as the authors make assumption based on the evidence achieved

- l. 441: this should be on the methods section

- l. 446: this information should be on a figure

- figure 5: it would be better to represent on the opposite way: accessibility as polygons and population as points. the dots with colour makes difficult to see the location of hospitals and PHC

- figure 6: the same comments from figure 5. LISA must be represented as polygons. although ArcGIS prepresent the outliers with darker colour, Anselin represent it with lighter colour because the most relevant information is the clusters and not the outliers

- l. 500: where does the income distribution comes from? there is no information about it or how it was used. this needs to be clarified

- l. 518: why "While" is bold?

- table 4: include the average as you compare the results with the average on the text

- l 558: discussion is very small (it should never be smaller that the results section or even the methods section)

- l. 608: to do this, the authors should present proposals on how to improve access, e.g. since location os healthcare services is of major importance, where a new service should appear to improve accessibility by age group (the authors can use location-allocation tools from ArcGIS)

- l. 629: the authors should include a limitations section

- l. 640: I don't understand how this manuscript can be relevant for second-tier cities. there is no discussion on the difference on accessibility between first and second tier cities on the discussion, no comparison with other studies regarding health accessibility in first tier cities, and the results are from one part of a city  

- l.  647: limitations cannot be on the conclusions section

Author Response

Thank you very much for taking the time to review our manuscript The one-by-one response to the reviewers’ comments has been submitted by an independent response file. We sincerely hope that the revised version has been significantly improved. Please find enclosed a point-by-point response to each comment. Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The research topic is interesting and worth investigating. The authors investigated the healthcare accessibility in a small city (Karamay) and looked into the disparities of different age groups, which is quite interesting. I have the following concern/suggestions:

1. Karamay city is located in Xinjiang Uygur Autonomous Region in China. The uniqueness and representativeness of this city should be further discussed (e.g., the proportion of residents of ethnic minority). Can the findings be applied to other small scale cities?

2. What about the findings in cities of other coutries (say, with similar scale)? More in-depth discussions, especially implications, should be made.

3. Current discussions have been largely framed in the context of Karamay per se. Extensive discussions should be made.

Author Response

Thank you very much for taking the time to review our manuscript The one-by-one response to the reviewers’ comments has been submitted by an independent response file. We sincerely hope that the revised version has been significantly improved. Please find enclosed a point-by-point response to each comment. Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

In this study, a framework for assessing healthcare facility accessibility and equity across different age groups is proposed. It is a very interesting study and would be a good contribution to “Land”. Please find detailed comments and suggestions in the attached file.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Moderate editing of English language required

Author Response

Thank you very much for taking the time to review our manuscript The one-by-one response to the reviewers’ comments has been submitted by an independent response file. We sincerely hope that the revised version has been significantly improved. Please find enclosed a point-by-point response to each comment. Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors improved greatly the manuscript. I just have a few comments extra:

- figure 1b should be divided in three (one for child, other for adults and other for older). the authors can keep the graphs with the different age groups but the site of the pie must be different according to the amount of inhabitants

- it doesn't make sense to refer that the case study is Karamay City when actually is just one district. I suggest the authors to refer that the study area is the district and not the city because it creates confusion and misleading

- remove the water elements from figure 6 as it makes confusion with the clusters

- While is still bold

 

Author Response

Thank you very much. We have addressed all the points raised, and revised the manuscript accordingly. The one-by-one response to the reviewers’ comments has been submitted by an independent response file. We sincerely hope that the revised version has been significantly improved. 

Please see the attachment.

Author Response File: Author Response.pdf