Distribution dynamics and spatial dependence in healthcare resource allocation efficiency: evidence of path...

The operational efficiency of the healthcare system is directly linked to the accessibility of health resources, the equitable distribution of health services across regions, and the sustainable functioning of the public health system. In the context of rapid population aging and growing medical demand, the persistent existence of interprovincial efficiency disparities may further intensify resource allocation imbalances and regional fragmentation in health service provision. Against this backdrop, this study examines the dynamic evolution and spatial interdependence of provincial healthcare system efficiency in China, systematically characterizing its transformation patterns and stratified structure.

Using panel data from 31 Chinese provinces over the period 2001-2020, this study measures provincial healthcare system efficiency through an input-oriented Data Envelopment Analysis model under variable returns to scale. Pure technical efficiency is adopted as the core indicator, and efficiency states are categorized into low, medium, and high groups based on tercile thresholds. On this basis, Markov transition matrices and stationary distributions are constructed to capture efficiency mobility and long-term structural patterns. A spatial Markov framework is further employed to assess the influence of neighborhood efficiency contexts on state transitions. In addition, transition equations are estimated to identify structural factors associated with upward and downward efficiency movements.

During the sample period, the mean pure technical efficiency across provinces was 0.884, indicating the presence of residual input redundancy under the existing resource allocation structure. The Markov transition results reveal strong state persistence and limited cross-level mobility, reflecting pronounced path dependence. The stationary distribution further confirms the long-term coexistence of low-, medium-, and high-efficiency "clubs," with corresponding steady-state probabilities of 44.91, 30.84, and 24.24%, respectively, suggesting no evidence of natural convergence. Spatial Markov analysis indicates that provinces located within high-efficiency neighborhoods are more likely to experience upward mobility, whereas clusters of low-efficiency regions tend to reinforce state persistence.

China's provincial healthcare system efficiency exhibits structural stratification and spatial interdependence, and efficiency disparities do not diminish automatically over time. From a policy perspective, greater emphasis should be placed on cross-regional coordination and the optimization of resource allocation structures. By facilitating upward efficiency mobility and mitigating the persistence of low-efficiency states, policymakers can reduce the long-term risk of structural divergence.