Accessibility and Spatial Equity of Hierarchical Healthcare Facilities: Evidence from Urban Shijiazhuang in the Beijing–Tianjin–Hebei Urban Agglomeration

Rapid metropolitan expansion and population redistribution have posed increasing challenges to the spatial coordination between healthcare supply and demand. This study examines urban Shijiazhuang, a rapidly urbanizing provincial capital in the Beijing–Tianjin–Hebei urban agglomeration (BTHUA), to investigate how accessibility and spatial equity vary between central and peripheral urban districts at each healthcare level. The Gaussian two-step floating catchment area (Ga2SFCA), Gini coefficient, and accessibility-based population location quotient (APLQ) were employed to identify spatial inequities in healthcare resource allocation. The results indicate that tertiary healthcare resources remain disproportionately concentrated in central urban districts, while their spatial expansion has lagged behind population growth in the peripheral urban districts. Secondary hospitals partially alleviate this imbalance by forming regional service nodes toward peripheral areas, whereas primary healthcare institutions provide broader coverage but cannot compensate for the insufficient supply of higher-level healthcare resources. Spatial equity is generally higher in the central than in the peripheral urban districts, indicating that healthcare disparities in Shijiazhuang exhibit a pronounced central–peripheral pattern rather than being explained solely by the conventional urban–rural divide. Localized supply–demand deficits are particularly evident in northern Zhengding County and parts of Gaocheng District. Accordingly, five functional healthcare zones were identified to guide differentiated planning and resource allocation, promoting healthcare equity and sustainability in rapidly urbanizing regions.