[Regional distribution differences and influencing factors of primary healthcare institutions in China]

China has achieved certain progress in expanding the coverage of primary healthcare institutions (PHCI), promoting equitable access to essential medical and health resources, and advancing universal health coverage. However, disparities in equitable access among different regions and income groups remain substantial. This study aims to analyze regional differences in the distribution of PHCI after the new healthcare reform and to explore the main factors influencing their distribution, so as to provide references for optimizing the allocation of primary healthcare resources.

Data on the number of PHCI and factors influencing regional distribution differences from 2009 to 2022 were collected for 31 provincial-level administrative regions (hereinafter referred to as "administrative regions"). The Gini coefficient, Theil index, and the PHCI health resources density index (PHRDI) were used to evaluate the equity of PHCI distribution from 2009 to 2022 based on population, geographic area, and health level. PHRDI and each influencing factor were classified into 5 levels using the natural breaks method, and statistical maps of annual PHRDI distribution for each administrative region were drawn accordingly. Taking the number of PHCI in 2022 as the dependent variable, 15 indicators were selected as independent variables, and a geodetector was used to analyze the key factors influencing PHCI distribution.

In 2022, the number of PHCI in China was 979 768, representing an increase of 11.07% compared with 2009. The distribution of PHCI in 2022 by year-end permanent resident population (Gini coefficient 0.178, Theil index 0.051) was absolutely equitable; distribution by the number of women receiving systematic maternal management (Gini coefficient 0.227, Theil index 0.084)/the number of low-birth-weight infants (Gini coefficient 0.335, Theil index 0.179) was relatively even/comparatively appropriate; distribution by geographic area (Gini coefficient 0.628, Theil index 0.701) was highly inequitable, with inter-regional and intra-regional differences contributing 58.45% and 41.55%, respectively, to the overall inequity by geographic area. Over the years, PHRDI consistently showed a gradual decline from eastern to western regions. Compared with 2009, 10 administrative regions achieved an upgrade in PHRDI level by 2022, with the largest number in the eastern region (5 administrative regions). Year-end permanent resident population, number of PHCI health personnel, number of women receiving systematic maternal management, geographic area, local health expenditure, regional GDP, and total dependency ratio were the main factors influencing regional differences in PHCI distribution (all P<0.05). The individual explanatory powers of these indicators were 75.6%, 69.3%, 68.0%, 47.3%, 44.9%, 44.0%, and 41.5%, respectively, and there were enhanced interaction effects among the influencing factors.

The total number of PHCI in China has increased, but the growth rate is relatively slow and human resources remain relatively insufficient. There are regional differences in PHCI distribution, with PHRDI showing a gradual decrease from east to west. The establishment of PHCI should not only consider regional population size, but also comprehensively take into account factors such as local health personnel, economic development, health level, age structure, and geographic area.