Objective:To analyze essential health care equity in cities and counties of Hainan in order to provide the basis for its development. Methods:Based on health statistics of Hainan, China and OECD countries, indicators of essential health care equity in cities and counties were analyzed. Results:Equity in distribution of resources, the hospi-tal geographical distance is large difference, physician-to-nurse ratio is 1:1. 2, and the Gini coefficient is more than 0. 3. Equity in financing, health care spending per capita is less than the national level. Cities and counties with high government budgets for health are located in regional centers. The hospitalization costs compensation with new rural co-operative medical scheme is about 50%. Equity in service supply, bed occupancy rate below 90% and drugs accounted for 30% ~40% in most cities and counties. Regional differences in maternal and child health management are small, but below the national level. Conclusions:The situation of essential health care resources is related to the political and economic climate. Financing mechanisms for essential health care are imperfect;and a low supply of basic medical and public health services reduced the quality of essential health care. Suggestions:Rational distribution of essential health care resources should be promoted;essential health care financing should be increased;and the capability of essential health care supply should be improved.

Spinal metastases may cause pain,pathological fracture and/or neurological symptoms.The most common treatment of spinal metastases is conservative therapy.Surgical intervention is necessary when there are pathological and/or neurological deficits.Total en bloc spondylectomy (TES) has lower local recurrence rate and may be applicable to a patient with single metastatic tumor and a long survival expectancy,While debulking surgery is less risky and higher recurrence rate.Conventional radiotherapy is a kind of effective supplement to reduce the local recurrence rate in spinal metastases.However,the local dose is often failed to reach the effective dose because of the close connection of tumor and spinal cord and it is less effective for relatively radioresistant histologies.With the development of radiotherapy technology,spinal radiotherapy has become increasingly accurate to avoid of spinal cord injury.In addition,conventional radioresistant tumors has become treatable with high-dose stereotactic body radiotherapy (SBRT).At the same time,SBRT is also an important basis for the implementation of separation surgery of spinal metastases.Separation surgery is to separate the tumor and dura and achieve circumferential decompression and stabilization through posterior approach.As a result,a high-dose SBRT can be performed because of the small interspace to protect the spinal cord,which greatly reduces the local recurrence rate.Compared with TES,separation surgery combined with high-dose radiotherapy not only reduces the difficulty of surgery,but also has a good local control rate,which is a relatively "minimally invasive" strategy.Separation surgery is particularly suitable for patients with high-grade epidural spinal cord compression and moderately sensitive or insensitive to radiotherapy.Although the concept of separation surgery has been proposed for several years,only a few applications have been reported in foreign literature and fewer in domestic literature.This article aims to summarize the relevant concepts and clinical applications of separation surgery in spine metastases and to provide a reference for the treatment of spinal metastases.