Assessing the spatiotemporal heterogeneity of resource allocation effects on patient flow in shanxi’s County hospitals, China

China's healthcare system faces significant challenges in resource distribution, with urban tertiary hospitals receiving disproportionate allocations. This imbalance has led to a substantial bypassing of county-level hospitals by rural patients seeking care at centralized urban facilities. This study examines the spatiotemporal effects of resource allocation in county-level hospitals on patient flow distribution between county and urban tertiary hospitals. We analyzed hospital-level data from 2013 to 2019, encompassing 41 tertiary and 189 county hospitals in Shanxi Province. Spatial autocorrelation was assessed using Moran's I, while Geographically and Temporally Weighted Regression models were employed to examine the relationship between resource allocation (including physicians, beds, medical equipment, and hospital assets) and patient volumes at both hospital levels. Our analysis reveals a positive correlation between increased resource allocation in county hospitals and their patient volumes, coupled with a corresponding decrease in urban tertiary hospital utilization. Temporal analysis shows intensifying benefits for county hospitals and more pronounced adverse effects on tertiary hospitals over time. Spatial patterns indicate stronger positive impacts in northern and southern Shanxi, where tertiary hospitals are less concentrated. Conversely, in areas with dense tertiary hospital presence, increased county hospital resources paradoxically lead to higher service volumes at tertiary institutions. Strategic enhancement of county hospital resources can effectively redistribute patient flows and alleviate overcrowding in tertiary hospitals, particularly in regions with limited tertiary facilities. However, healthcare resource reallocation strategies must account for regional disparities to avoid unintended consequences, such as increased patient migration from county to urban tertiary hospitals. These findings underscore the importance of context-specific resource allocation policies in China's multi-tiered healthcare system.