Spatiotemporal coupling coordination between population aging and healthcare resource capacity in China: a...

China is experiencing rapid population aging with marked regional disparities, posing sustained challenges for healthcare provision. This study examines the spatiotemporal coupling coordination of two provincial composite indices, one summarizing population aging characteristics and one summarizing healthcare resource capacity, across 31 provincial-level regions, 2000-2023 (713 valid province-year observations).

Aging was measured by five demographic and health indicators, capacity by six supply-side indicators covering hospitals and primary healthcare institutions; principal component analysis and the entropy method were applied in parallel and cross-validated (Pearson r = 0.94) before entering a coupling coordination degree model. The coupling coordination degree quantifies the statistical correspondence between the two composite indices. It does not measure whether the healthcare needs of older adults are met by services supplied, and supports no causal interpretation; because provincially consistent data specific to older adults (geriatric beds, long-term care facilities, geriatricians) were unavailable for 2000-2023, the index reflects general healthcare capacity rather than provision specific to older adults.

China's aging coefficient rose from 7.0% (2000) to 14.9% (2023), following an acceleration-stabilization pattern with marked spatial heterogeneity. Hospital beds reached 9.10 million (≈6.4 per 1,000 population) and licensed physicians 4.28 million by 2023, up 77.6% since 2010, while the normalized healthcare composite rose from 0.02 to 0.91. National coordination improved across the period, moving from the lower to the upper bound of the pooled min-max normalization; these bounds denote the sample minimum and maximum rather than absent or perfect coordination. Regional disparities nevertheless persisted: Shandong and Jiangsu recorded values in the highest class of the classification adopted here (D ≥ 0.60), whereas Tibet and Qinghai remained in the lowest (D < 0.20), and the coefficient of variation of provincial aging coefficients declined only from 0.41 to 0.38.

The study contributes a 24-year, all-province series built on one fixed indicator framework spanning the reforms of 2003, 2009 and 2016, and a rule-based provincial typology, summarized as a Four-Dimensional Collaborative Development Framework, that identifies where demographic structure and healthcare capacity correspond least closely. The findings are an input to regional healthcare planning; whether the measures they suggest improve the care older adults receive lies beyond this design.