Spatiotemporal evolution and determinants analysis of health resource supply-demand coupling coordination in China

BACKGROUND: The imbalance between supply and demand in China's healthcare sector has become increasingly pronounced. This study aims to quantitatively assess the coupling and coordination status of health resource supply and demand in China, reveal its determinants, with the goal of narrowing regional disparities and improving the overall coordination level. By analyzing the spatiotemporal evolution of health resource allocation from 2002 to 2021, we seek to provide evidence-based policy recommendations for addressing the imbalance in China's healthcare sector. METHODS: Using provincial panel data from 2002 to 2021, we constructed a comprehensive evaluation index system for the health resource supply-demand system. The entropy weight method and the Technique for Order Preference by Similarity to Ideal Solution were employed to quantify the comprehensive levels of supply and demand. The coupling coordination degree (CCD) and its types were assessed using a coupling coordination model. Finally, the geographically and temporally weighted regression (GTWR) model and Geodetector model was used to analyze the spatiotemporal evolution and determinants of CCD in 31 provinces of China from 2002 to 2021. RESULTS: From 2002 to 2021, the CCD of health resource supply-demand in China improved significantly, increasing from 0.400 to 0.804, reaching a good coupling coordination level. Although the regional coefficient of variation (CV) of CCD decreased from 0.225 to 0.206, regional heterogeneity persisted, with the eastern region exhibiting the highest coordination, followed by the central, western, and northeastern regions. Analysis using Geodetector and GTWR models identified key spatiotemporal determinants. Notably, education level emerged as the core factor explaining the spatial heterogeneity (q = 0.608), and its interaction with urbanization (q = 0.885) significantly amplified these spatial differences. Population density, government support, and transportation accessibility were also identified as important influencing factors. CONCLUSIONS: The current healthcare supply-demand conflict in China is characterized by insufficient supply, low quality, and an irrational structure and layout. Although coupling coordination has improved under recent reforms and policies, challenges such as poor coordination degrees and significant regional disparities persist. The Chinese government should strengthen supply-side healthcare reforms to address regional disparities and enhance the coupling coordination of health resource supply and demand.