Spatiotemporal evolution and spatial benefit analysis of the coupling coordination of China’s three medical systems

Objective: The harmonious development of healthcare, medical insurance, and pharmaceutical systems is crucial for advancing healthcare reform in China. This study evaluates the coordination level of China's three medical systems and examines their dynamic evolution trajectories and spatial effects from 2013 to 2023. Methods: Data from 31 provinces were analyzed using a coupling coordination degree (CCD) model to assess spatiotemporal evolution. Kernel density estimation and Markov chain models were applied to explore dynamic characteristics, while spatial Durbin models were employed to evaluate interregional spillover effects and influencing factors. Results: From 2013 to 2023, the CCD of China's three medical systems exhibited a steady upward trend. Eastern regions consistently sustained higher levels of coordination, while central and western regions achieved notable improvements. Some provinces transitioned from disequilibrium to preliminary coordination; Dynamic evolution revealed diminishing absolute disparities but widening relative differences, with intensified multipolarization in eastern and western regions and significant internal variation in central provinces; Spatial analysis identified pronounced spatial autocorrelation and spillover effects, with high-high clustering zones expanding into the Yangtze River Delta, while low-low clustering zones remained concentrated in the northwest. Economic development, urbanization, and human capital contributed significantly to coordination, while government healthcare expenditure exerted a negative impact, and aging effect exhibits a significant threshold effect. Conclusion: The level of coordination among China's three major medical systems show sustained improvement, yet significant regional disparities persist, primarily due to uneven pharmaceutical development. Coordination follows a path-dependent trajectory, limiting rapid advancement. Positive spatial spillover effects generate economic influence on neighboring regions. Policies should focus on balancing regional coordination with differentiated strategies, enhancing interdepartmental and interregional mechanisms, and optimizing resource allocation.