{
  "abstract": "Background\n\nHealth service supply capacity depends not only on medical resource stocks but also on urban eco-sanitation conditions and resource-allocation mechanisms. Existing studies focus mainly on environmental exposure and health outcomes, with limited attention to whether eco-sanitation improvements can be converted into health service supply capacity.Methods\n\nThis study constructed a panel of Chinese prefecture-level and above cities for 2002-2024, using the health service supply capacity index as the dependent variable and the eco-sanitation environment index as the core explanatory variable. Two-way fixed effects models, dimension-specific analysis, mechanism tests, heterogeneity analysis, robustness checks, and interpretable machine learning identified mismatch mechanisms and boundary conditions. The mechanism analysis was extended to two- and three-year ESE lags and one- and two-year lagged investment variables. Carbon-emission comparability was reassessed on exact CEADs-matched samples for 2002-2019. Hu Huanyong line subgroup models were additionally estimated with city and province-year fixed effects.Results\n\nThe eco-sanitation environment, green infrastructure, and municipal sanitation facilities improved continuously, whereas health service supply capacity increased more slowly. The baseline model does not support a stable positive conversion from eco-sanitation improvement to stronger supply capacity. Dimension-specific results reveal differentiated roles. The positive PPI coefficient must not be read as a pollution benefit; it is consistent with a demand-induced or compensatory resource-allocation response. Neither two- to three-year ESE lags nor one- to two-year lagged investment variables produced a stable urban construction investment transmission chain. The positive CEADs interaction was confirmed only within the 2002-2019 matched sample and therefore represents pre-pandemic evidence. The southeastern Hu-line coefficient attenuated and lost conventional significance after province-year policy shocks were absorbed. Machine learning indicates the relationship is shaped by development stage, population size, fiscal capacity, and nonlinear boundaries.Conclusions\n\nEco-sanitation improvement is not a sufficient condition for enhancing health service supply capacity. Healthy city development should integrate eco-sanitation governance, infrastructure investment, workforce allocation, and fiscal arrangements into a unified governance framework. Because HSC is a supply-side proxy based on resource counts, these implications concern resource availability and network density rather than quality of care, realized utilization, accessibility, or overall health-system performance.",
  "abstract_shown": true,
  "affiliations": [
    "School of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, 266033, China. pengzhen@qut.edu.cn.",
    "School of Architecture and Urban Planning, Qingdao University of Technology, Qingdao, 266033, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Zhen Peng"
    },
    {
      "affs": [
        1
      ],
      "name": "Lin Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/4gdmsgah3pbpz.bib",
  "cited_by": 0,
  "doi": "10.1186/s12913-026-15444-8",
  "fulltext_url": "https://europepmc.org/articles/PMC13670610",
  "id": "4gdmsgah3pbpz",
  "issns": [
    "1472-6963"
  ],
  "landing_url": "https://europepmc.org/article/MED/42875776",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2307|Public Health and Environmental Issues"
    ]
  ],
  "openalex": "W7167080768",
  "pdf_url": "https://europepmc.org/articles/PMC13670610?pdf=render",
  "pmcid": "PMC13670610",
  "pmid": "42875776",
  "published": "2026-08-25",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/4gdmsgah3pbpz.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:18Z",
      "native_id": "MED:42875776",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42875776"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2307|Public Health and Environmental Issues",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Mismatch between urban eco-sanitation improvement and health service supply capacity: evidence from Chinese city panel data and interpretable machine learning.",
  "title_text": "Mismatch between urban eco-sanitation improvement and health service supply capacity: evidence from Chinese city panel data and interpretable machine learning.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:18Z",
  "url": "https://research.draconitic.com/paper/4gdmsgah3pbpz",
  "venue": "BMC health services research",
  "versions": []
}