Geographic variations, temporal trends, and equity in healthcare resource allocation in China, 2010-21

Inequity in healthcare resources has been identified as a global public health priority, yet the geographic variations and temporal trends in distribution and inequity in China remain unclear. We aimed to investigate these variations and temporal trends in healthcare resources and evaluate inequity in healthcare resource allocation in China.

In this nationwide descriptive study, we used provincial-level data on healthcare infrastructure, human, and service resources from 31 provinces of mainland China, publicly released by the National Health Commission of China between 2010-21. We assessed the spatial autocorrelation of healthcare infrastructure, human, and service resources using Moran's I index, and identified spatial clusters of resource allocation. We evaluated the equity in healthcare resource allocation using the Lorenz curve, Gini coefficient, and Theil index by population and geographic dimensions.

Between 2010-21, the density of healthcare infrastructure and human resources in China increased, with the average stay decreasing from 10.5 to 9.2 days. There were substantial regional disparities, with higher resource density exhibited in eastern regions compared to western regions. Spatial autocorrelation was more pronounced for the density of practising (assistant) physicians (Moran's I = 0.465; P < 0.001), practising physicians (Moran's I = 0.351; P < 0.001), and bed occupancy rate (Moran's I = 0.256; P < 0.001), with significant geographic clusters of resource allocation. Lorenz curves showed that healthcare resource allocation was closer to the absolute equity by population but not geographic dimension, with Gini coefficients indicating severe inequity (>0.6) by geographic dimension compared to perfect equity (<0.2) by population dimension. Intraregional Theil index by population was higher than the inter-regional index, with contribution rates exceeding 60%.

Per capita access to healthcare resources in China has improved, but significant geographic variations and clustering exist, particularly with higher resource density in eastern regions. While resource allocation by population showed better equity than by geographic area, substantial intra-regional disparities highlight the need for targeted strategies to enhance equitable distribution, particularly in the western regions.