Hospital and health-center bed expansion and persistent relative mismatch across geometry-stable non-district Chinese counties, 2015–2023
4 affiliations
- 1School of Law, Central China Normal University
- 2School of Marxism, Sichuan Agricultural University
- 3Institute of Medical Information & Library, Chinese Academy of Medical Sciences and Peking Union Medical College
- 4College of Law, Sichuan Agricultural University
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.
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BibTeX
@article{dai2026hospital,
title = {{Hospital and health-center bed expansion and persistent relative mismatch across geometry-stable non-district Chinese counties, 2015–2023}},
author = {Kai Dai and Ziao Chen and Ling Wang and Zihao Lin and Yiqiang Feng},
journal = {Frontiers in Public Health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1970301},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1970301/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Hospital and health-center bed expansion and persistent relative mismatch across geometry-stable non-district Chinese counties, 2015–2023
AU - Kai Dai
AU - Ziao Chen
AU - Ling Wang
AU - Zihao Lin
AU - Yiqiang Feng
PY - 2026
DA - 2026/10/16
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1970301
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1970301/full
AB - 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.
SN - 2296-2565
ER -