Towards an infrastructure approach: The interactive relationship between spatial distribution of hospitals and urbanization in Chinese major cities

Abstract The uneven distribution of healthcare resources has emerged as a prominent concern in healthy city development globally. However, extant research mainly follows an amenity approach that merely regards hospitals as passive spatial carriers of healthcare services and rarely considers them as an integral part of the urbanization processes, overlooking the interactive relation between hospitals and urbanization and their implications for the supply-side healthcare inequalities. This study introduces a hospital-city nexus framework highlighting hospitals as crucial infrastructure for urban development, and incorporates open big data and statistical data to examine the interactive relationship between hospital clustering and urban structures across 36 major Chinese cities. The study identifies prevalent hospital clustering in China, characterized by specific morphology, land use, and institutional composition. Higher hospital clustering occurs in cities with low financial capacity, low per capita income, and advanced medical technologies. Land use and locational attributes are key factors in hospital clustering, while transport services play a lesser role. Hospital clustering is positively associated with nearby housing values, but the relationship with population density and aging are diverse. Highlighting the hospital-city nexus, this study enhances the supply-side understanding of the uneven spatial distribution of hospitals, informing relevant healthcare policy and urban planning. • Hospital distribution should be understood as an integral part of urbanization process. • AOI serves as a useful open big data source in examining healthcare inequalities. • Urban hospitals seem to cluster in certain urban areas in Chinese cities. • City characteristics have a deeper impact on the distribution of hospitals at the intra-city scale. • Hospital clustering heterogeneously interacted with urban structures across urban contexts.