Measurement, source decomposition, and formation mechanism of differences in the development of China’s health services

In China, the issue of unbalanced development is rather prominent. This paper conducts research on the differences in China's health service development, aiming to provide references for promoting health equity through the equalization of health services. A series of quantitative methods are applied in this study, including the two-stage entropy method, spatial kernel density estimation, Theil index, variance decomposition method, and quadratic assignment procedure (QAP). Based on publicly-available macro data such as the China Health Statistics Yearbook, the two-stage entropy method is employed to comprehensively measure the health service levels of 31 provinces in China from 2005 to 2019. Then, spatial density estimation is used to examine the distribution characteristics of China's health services. The Theil index and variance decomposition methods are utilized to explore the sources and magnitudes of the differences in the development of health services from both spatial and structural perspectives. Additionally, the QAP is used to examine the driving factors of the differences in the development of health services across the country as well as in the eastern, central, and western regions. The research findings are as follows: (1) The development levels of health services in the whole country and the three major regions show an upward trend. However, there are significant imbalances among the three regions, with the development level of health services in the eastern region consistently higher than that in the other two regions. (2) Concerning spatial differences, the intra-regional differences are the main source of the overall differences. Among them, the internal differences in the eastern region are the largest, followed by those in the western region. (3) In terms of structural differences, the differences in curative ability are the main source of the overall differences. The contributions of differences in personnel, service utilization, and primary services to the overall differences decrease in sequence. (4) Facilities in the eastern region have the greatest impact on overall differences, while differences in personnel in the central and western regions have the greatest impact on overall differences.