Inequality in hospital bed supply and utilization across regions and departments: evidence from China

Abstract Background Adequate hospital bed capacity is fundamental to health-care accessibility. However, increasing beds per capita may mask inequalities across regions and departments, not only in supply but also in how available capacity and utilization patterns vary across regions and departments. This study examined spatiotemporal patterns and inequalities in hospital bed supply and utilization across regions and departments in China from 2009 to 2024 to inform more targeted bed planning and resource allocation. Methods Using data on hospital beds, inpatient discharges, and population for 15 hospital departments across 31 provincial-level regions in mainland China, we measured supply as beds per 10,000 population and utilization as the bed turnover rate. Spatial analysis, kernel density estimation, and Markov chains characterized distributional patterns and dynamics, while GE(1) measured interprovincial inequality within departments and interdepartmental inequality within provinces. Results National bed supply increased from 23.56 to 57.74 beds per 10,000 population, substantially outpacing growth in the bed turnover rate, which rose from 27.09 to 31.25. Markov analysis showed a clear upward shift in bed supply. Provinces in the lower-middle and upper-middle states moved to the next-higher state with probabilities of 0.71 and 0.51, respectively, while the high state had a persistence probability of 0.98. The low and high bed-turnover states were relatively stable, but no consistent upward shift emerged. GE(1) showed that interprovincial inequality in overall bed supply declined from 0.03 to 0.01, whereas inequality in bed turnover rates remained at approximately 0.01. However, bed-supply inequality increased in obstetrics and gynecology, infectious diseases, and traditional medicine. Within provinces, interdepartmental inequality in bed supply declined from 0.55 to 0.49 but remained substantially greater than that in bed turnover rates. Conclusions Expansion of total bed capacity and the narrowing of interprovincial disparities did not eliminate persistent disparities across departments. Hospital-bed planning should manage new capacity and reallocate existing beds based on region- and department-specific assessments of supply, utilization, and need.