Bursa'da sağlık tesislerinin mekânsal dağılımı ve erişim özellikleri
Spatial distribution and access properties of the health facilities in Bursa
Yazar: SEDA IŞIK
Danışman: PROF. DR. TURGAY KEREM KORAMAZ
İstanbul Teknik Üniversitesi / Fen Bilimleri Enstitüsü / Şehir Planlama Ana Bilim Dalı / Şehir Planlama Bilim Dalı
Derece: Yüksek Lisans, 2020
Konu: Şehircilik ve Bölge Planlama = Urban and Regional Planning

Özet:
Kentsel fonksiyonların kent içindeki dağılımı, planlama çalışmaları için kritik bir öneme sahiptir. Çeşitli fonksiyonların kentteki ihtiyaçlara ve taleplere uygun şekilde yerleşimi, kentsel çevrenin ve yaşamın kalitesinin artmasında büyük rol oynamaktadır. Bu bağlamda, kentsel fonksiyon ve donatılar için uygun yer seçimi geçmişten beri tartışılan konulardan biri olmuştur.
Kentsel fonksiyonların uygun yer seçimine yönelik kuramsal çalışmalar öncelikle tarım, sanayi gibi ekonomik faaliyetlerin yer seçimi hakkında gerçekleştirilmiştir. Zaman içerisinde sektörlerin çeşitlenmesi ve uzmanlaşmaların artmasıyla birlikte farklı kentsel fonksiyonların kentteki dağılımı hakkında yapılan çalışmalar da artmıştır. Çeşitli tesis ve hizmetlerin dağılımında ortaya çıkan modeller, yer seçiminde belirli faktörlerin göz önünde bulundurulması gerektiği fikrini ortaya çıkarmıştır. Her fonksiyon için o fonksiyona özgü kriterler göz önünde bulundurularak uygun yer seçimi kararlarının verilmesi, kentsel yerleşimin ve dolayısıyla kent yaşamının ve niteliğinin gelişmesini sağlamaktadır.
Her kamusal hizmet için olduğu gibi sağlık hizmetlerinde de tesislerin konumu, sağladığı etkin hizmet düzeyi ve kentte yaşayan her bireyin sunulan kamu hizmetlerinden yararlanabilmesi oldukça önemlidir. Yaşanan acil sağlık sorunlarının çözülebilmesi için, sağlık tesisine ulaşım mesafesi oldukça önemli bir faktördür. Bunun yanı sıra başvurulan sağlık tesisinde yeterli yatak kapasitesi, teknik donanım ve sağlık personelinin bulunması da sağlık tesisine erişilebilirliğin ölçülmesinde kullanılan kriterlerdir.
Bu çalışmada, sağlık tesisleri yer seçiminin anlaşılabilmesi adına öncelikle yer seçim kavramı ve bu kavramın gelişim süreci incelenmiştir. Kamu tesislerinin yer seçim özellikleri irdelendikten sonra sağlık tesislerinin yer seçiminde göz önünde bulundurulan faktörlere ilişkin gerçekleştirilen çalışmalar araştırılmıştır. 
Çalışma kapsamında sağlık tesisleri yer seçimine yönelik kullanılan kriterler için Bursa il genelinde ilçe düzeyinde, sonrasında Bursa il merkezinde mahalle düzeyinde veri değerleri elde edilerek mekânsal dağılım ve erişim özellikleri incelenmiş; Bursa ilinde sağlık tesislerine olan erişim ve gereksinim düzeyine ilişkin uygunluk analizi gerçekleştirilmiştir. Böylelikle sağlık tesisleri gereksinimi ve erişim düzeyinin Bursa il genelinde hangi ilçelerde, Bursa il merkezinde ise hangi mahallelerde artıp azaldığına dair çıkarımlarda bulunulmuştur. Gerçekleştirilen analizler sonucunda il geneli ve il merkezine yönelik birbirinden farklı sonuçlar elde edilmiştir. Bu sayede, sağlık tesisleri yer seçiminde fiziksel erişilebilirliğe ilişkin faktörlerin, sağlık tesislerine olan erişim ve gereksinim düzeyinin değişmesinde önemi bir rol oynadığı görülmüştür.

Abstract:
The distribution of urban functions in the city is critical for urban planning. Suitable allocation of the needs and demands of various functions, have a major role for increase of the urban environment and quality of life. In this context, choosing a suitable location for urban functions and equipment has been one of the issues discussed since the past.
Theoretical studies on the selection of suitable location of urban functions were carried out primarily on the location selection of economic activities such as agriculture and industry. Over time, studies on the distribution of different urban functions in the city have increased with the diversification of sectors and specialization. Models emerging in the distribution of various facilities and services have brought up the idea that certain factors should be taken into account in the selection of location. For each urban service, making the appropriate location selection by considering the criteria specific to that function provides that the urban settlement and hence the city life becomes better quality. 
As in any public service, it is very important that the location of the health facilities, the level of effective health service and that everyone living in the city can benefit from the public services provided in the health services.The distance to the health facility is a very important factor in order to solve the emergency health problems. In addition, the availability of sufficient bed capacity, technical health equipment and health personnel in the health facility applied for are the criteria used in measuring accessibility to the health facility. It has been emphasized that access to healthcare facilities and the service capacity of healthcare facilities are very important in the current epidemic process.
In this study, firstly the concept of location selection and the development process of this concept are examined in order to understand the location of health facilities. It has been observed that the elements taken into account in the studies on location selection change over time. In early work on location theory, the researchers focused on choosing a location for economic activity in the city. After the industrial revolution, the location of the industrial facilities was studied. Afterwards, various urban models were created by taking into account the varying sizes of the settlements and population characteristics. Finally, various urban models have been created with the effect of globalization and the displacement of economic activities within the city. After examining the development of the concept of location selection, researches on location selection of public facilities were conducted. The principles of equality and efficiency that form the basis of public services have been examined. After examining the location selection features of public facilities, studies about the factors considered in the selection of health facilities were investigated.
Location selection of the health facilities were examined in 3 different aspects: location selection criteria, spatial features and access features. The factors taken into account when creating location selection criteria were examined. Demographic features, socio-economic features, health service demand, access features of health facilities are among these factors. The distance between health facilities and users is evaluated from different perspectives in terms of spatial features. It is very important for users-especially for people -with low socioeconomic status.to provide access to health facilities by public transportation. The distance between the health facility and the settlements can be evaluated as Euclidean distance, as well as travel distance with the effect of topography. Transport services directly affect access to healthcare facilities. Access features to healthcare facilities are divided into two categories as spatial and non-spatial access. Population, income level, health insurance, education level, age distribution are non-spatial access features. Spatial access features are the distribution of healthcare facilities, geographical features, transportation characteristics, and distance of patients from hospitals. In line with all these features, the most suitable location for health facilities is selected.
Within the scope of the study, spatial distribution and access characteristics were examined by obtaining data values at the district level in Bursa province and then at the neighborhood level in Bursa urban center for the criteria used for location selection of health facilities. Demographic data related to the criteria used in the analysis were obtained from TUIK. The data on the number of beds per 10,000 people and the number of beds per 1,000 people were taken from the 2019 Health Statistics Yearbook published by the Ministry of Health. The land values were obtained from the street-based land value table published by the Revenue Administration. The CAD files of the main transportation arteries, neighborhood and district borders, and residential areas were obtained from Bursa Metropolitan Municipality. 
In the analysis carried out throughout the province, factors such as population, population density, population growth rate, illiterate rate, dependent age rate, mortality rate, birth rate, land value, number of doctors per 1,000 people, number of beds per 10,000 people were used. The values of each district for each criterion are normalized. The health facility requirement index table in Bursa was created using the weighted overlay method with the factor weights and normalized values obtained from the analytical hierarchy process. These index values are divided into 5 ranges. It has been determined how the need for health facilities has changed on the basis of districts in Bursa. By adding index value ranges to the map, the distribution of health facility needs throughout the province has been analyzed. According to the results obtained in the province of Bursa, the district with the lowest health facility requirement is Nilüfer and the district with the highest is Orhaneli.
The analysis carried out in the urban center of Bursa was carried out for the districts of Nilüfer, Yıldırım, Osmangazi, Mudanya, Kestel and Gürsu, which are defined as the central region of Bursa. In this analysis, factors such as population, population density, population growth rate, illiterate rate, dependent age rate, mortality rate, birth rate, land value, number of doctors per 1,000 people, number of beds per 10,000 people, as well as distance to main transportation services, distance to the rail public transportation stops and the distance to district centers are used. The value of each neighborhood for each criterion is normalized. The health facility requirement index table in Bursa urban center was created using the weighted overlay method with the factor weights and normalized values obtained from the analytical hierarchy process. Index values are divided into 5 ranges. By adding index value ranges to the map, the distribution of the health facility requirement in the urban center was examined. It was observed in which neighborhoods the need for health facilities increased or decreased.
As a result of the analysis, inferences are made on districts in Bursa province and neighborhoods in Bursa urban center about level need and access of health facilities. As a result of the analysis, different results have been obtained for the province and the city center. Thus, it has been observed that the factors related to physical accessibility in the selection of health facilities are important in changing the level of access and needs to health facilities.
Transport features are a factor that directly affects access to healthcare facilities. It is very critical that health facilities can be easily reached in case of emergency. Apart from emergencies, public transportation systems are great importance for those who need to go to the hospital regularly. It is seen that transportation planning in Bursa is problematic in this respect. Access to healthcare facilities is very difficult for rural and distal settlements. This affects the quality of healthcare. As Bursa spreads as a multi-centered city, the distribution of health facilities should be planned accordingly. In places where the need for health facilities is high, new health facilities can be opened or access opportunities to existing health facilities can be improved. In addition, the improvement of existing health facilities in terms of quality and quantity meets the need for health facilities. In this respect, the closure of four hospitals in the center after Bursa City Hospital is established should be questioned in terms of providing health services. Bursa City Hospital is located in a problematic location in terms of transportation connections in line with the analysis made within the scope of the study. 
In conclusion, in line with the findings obtained from the analysis conducted within the scope of the study, effective transportation planning aimed at improving the transportation features in Bursa, developing various solutions in order to increase the access of distal areas to health facilities, existing health facilities need to be improved and regulated in terms of quality and quantity.