Work

Hospital and health-center bed expansion and persistent relative mismatch across geometry-stable non-district Chinese counties, 2015–2023

Year: 2026

Type: article

Abstract: Introduction: Territorial health equity depends not only on expanding health resources but also on aligning local capacity with territorial planning contexts. We examined whether changes in hospital and health-center bed allocation were associated more strongly with territorial planning context or local fiscal-economic capacity. Methods: We analyzed a 2015-2023 panel of 1,787 geometry-stable non-district counties in China. The analysis combined county and province-by-year fixed effects, long-difference models, block-level Shapley decomposition, high-mismatch-state transitions, spatial diagnostics, discrete-time exit models, and adjacent-county pair comparisons. Results: Median beds per 10,000 registered residents increased from 35.1 in 2015 to 54.0 in 2023, whereas the distribution of relative planning-supply mismatch changed little. Planning-context and capacity blocks explained similarly small shares of annual variation in total beds. For bed density, the larger baseline planning-context share was driven primarily by the negative population coefficient and did not indicate allocation aligned with observed healthcare need. Higher initial capacity was associated with greater cumulative bed-density growth, lower relative mismatch, and a higher probability of exiting the high-mismatch state. Among county-years previously classified as high-mismatch, 84.0% remained in that state in the following year. Relative mismatch remained spatially clustered, but prefecture boundaries did not significantly amplify capacity-related bed-density gaps. Discussion: Aggregate expansion, relative territorial alignment, and recovery from persistent high mismatch represent distinct health-system outcomes. The findings support context-sensitive allocation, capacity-sensitive financing, and duration-sensitive monitoring, while remaining associational rather than causal.

Source: Frontiers in Public Health

DOI: 10.3389/fpubh.2026.1970301

Authors: Kai Dai, Ziao Chen, Ling Wang, Zihao Lin, Yiqiang Feng

Institutions: Sichuan Agricultural University, Central China Normal University, Chinese Academy of Medical Sciences & Peking Union Medical College

Language: English

Topic: Healthcare Systems and Reforms

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,801