Divergent distributions of physicians and healthcare beds in China: Changing patterns, driving forces, and policy implications

Abstract

The distributions of different healthcare resources are typically examined individually and separately, thus overlooking the fundamental fact that healthcare delivery hinges on the cofunction of different resources. Divergent distributions of physicians and healthcare beds are found to significantly affect healthcare quality and efficiency, while theoretical understanding and related empirical investigations are still lacking. This study disserts the divergent distributions as embedded in medicine (i.e., physician-to-bed ratio varies for the treatment of different diseases) and shaped largely by the healthcare delivery system that determines where different diseases to be treated. Gini coefficients and bivariate Moran's Index provide strong evidence for the increasing divergence in their distributions across prefecture-level cities in China between 2000 and 2018. Spatial regression models reveal a high physician-to-bed ratio in cities of a higher level, with high finance capacity, few primary care facilities, and advanced medical technologies. Meanwhile, less developed areas are multidimensionally disadvantaged in attracting physicians, as political, economic, and medical technological forces acted jointly to determine healthcare resource distribution. This study presents a novel approach to healthcare resource distribution by focusing on the colocation of different resources, and suggests that more comprehensive policymaking is required to coordinate and optimize healthcare resource allocation across the country.