The Spatial Network Structure and Dynamic Changes of Health Services: Under the Flow of Patients and Resources Behind the Ongoing Inequality

Abstract

Background Health services inequities are often investigated empirically as associations between socioeconomic characteristics and differences between health service resource utilization and needs-based utilization. However, the static analysis of unfair healthcare services overlooks the structural changes in health service resources or patients in different regions. In China, large-scale patient mobility can easily lead to the gradual concentration of health service resources. Method This study explores the spatial network structure of health services and its influencing factors using data collected from 31 Chinese provinces from 2010 to 2018, including per capita GDP, health expenses, hospitals, geographical distance, etc. We spatialize different networks of health service and examine the impact of spatial network effects. We use social network analysis (SNA) and compare the structure of health service networks in different years, visualize them, and use CONCOR analysis to construct block models to explore the spatial structure of health service networks. We also use the QAP regression method to explore the factors that affect the structure of the health service network. Results Findings showed that China's health service network has significant spatial agglomeration and spillover effects that lead to spatial inequality in health services, accelerate the flow of health service resources, and increase the cost for patients seeking high-quality healthcare. From CONCOR analysis results, we found that the spatial and geographical gap in health services is gradually shifting from an east-west to a north-south gap. Additionally, we found that the differences in transfer payments enhance the spatial gravitational of health service networks (0.115, P < 0.001), accelerating the flow of service resources and patients. Conclusion Our exploratory study underlines the crucial role of equitable resource distribution in addressing the current irrational network structure of health services. The observed concentration of resources in developed provinces and the corresponding patient migration highlight the pressing need for a decentralized approach to health service allocation. Recognizing the dynamic nature of health service equity, our findings emphasize the necessity of recalibrating central-to-local transfer payments to mitigate regional disparities and foster a more balanced health service network. Identifying the spatial structure of health services is critical to enhancing our understanding of the spatial context of regional health governance and further distilling the spatial correlation characteristics of health services within an equitable health framework.