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

Authors

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

Published in

Frontiers in public health. Volume 14. Pages 1970301. Epub Oct 16, 2026.

Abstract

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.
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.
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.
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.

PMID:
42964154
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.

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