Measurement of the Spatiotemporal Disparities in the Equalization Level of Basic Medical and Health Services in China: An Empirical Study Based on Provincial Panel

Abstract

Objective This study aims to explore the spatiotemporal disparities in the equalization of basic medical and health services in China, in order to provide reference and guidance for promoting the equalization process of basic medical and health services and ensuring the fair enjoyment of citizens' right to life and health. Methods Based on the theory of Structure-Process-Outcome(SPO), a comprehensive evaluation index system of equalization level was constructed with 22 core indicators of basic medical and health services, from the three dimensions of medical and health investment, health service utilization, and medical service effectiveness. The Generalized Principal Component Analysis (GPCA) model was used to calculate the equalization level of basic medical and health services in 31 provinces, municipalities, and autonomous regions from 2011 to 2021. Furthermore, the kernel density estimation and Moran’s I model was employed to analyze the correlation and disparity at the spatial level. Results 1. From a national perspective, the level of equalization of basic medical and health services in China has significantly improved from 2011 to 2021. The mean score of national equalization level increased from -0.605 to 0.174, with an increase of 128.75%. 2. From the perspective of spatiotemporal disparities between regions, the level of equalization shows a spatial distribution pattern of "higher in the east and lower in the west", decreasing from coastal areas to inland and from the east to the west. 3. From the perspective of spatiotemporal disparities within regions, from 2011 to 2021, there has been a certain improvement in the intraregional disparity in the Eastern and Western parts, while the intraregional disparity in the Central and Northeastern parts has further intensified. 4. From the perspective of spatial interconnection among provinces, there is a strong spatial correlation in the level of equalization of basic medical and health services in China. However, the spatial distribution of agglomeration centers and isolated points shows an east-west differentiation trend. Conclusion From 2011 to 2021, the level of equalization of basic medical and health services in China has significantly improved, but the disparities among regions have become more evident. Disparities among regions have replaced inter-provincial disparities as the main factor influencing the level of equalization of basic medical and health services in China. It is recommended to enhance the spatial balance of the level of equalization of basic medical services in China, based on the fully utilization of spatial correlation and agglomeration among provinces.