Efficiency, equity, and future trajectories of healthcare resource allocation in China: a multi-method provincial panel analysis, 2003–2022

This study aims to systematically evaluate the evolutionary characteristics of healthcare resource allocation in China from 2003 to 2022, measuring allocation efficiency and equity concurrently but independently against the dual background of deepening healthcare system reforms and public health emergency shocks, thereby providing empirical evidence for optimizing healthcare resource layout in developing countries. Retrospective longitudinal analysis using provincial panel data from China’s 31 provinces (2003–2022). A comprehensive framework utilizing the DEA-Malmquist Index model, the Dagum Gini coefficient, and the GM(1,1) grey prediction model was employed to empirically measure and simulate the dynamic evolution of efficiency, the sources of spatial inequality, and the future trajectories of supply and demand for healthcare resource allocation, respectively. The empirical results indicate that: (1) Regarding efficiency, the Total Factor Productivity (TFP) of China’s healthcare resource allocation exhibits a fluctuating downward trend. The mean TFP remained consistently below 1 from 2018 to 2022, with the decline in the technological progress index (Techch = 0.929) closely associated with this trend. Regional heterogeneity characterized by “high in the East, low in the West” was observed and is statistically distinguishable for technological change between the East and the other two regions (province-level bootstrap); the concentration of decreasing returns to scale in the richer regions suggests that scale expansion has reached diminishing returns. (2) Regarding equity, the Dagum Gini coefficient of allocation efficiency (provincial TFPch) fluctuates markedly. Trans-variation density has long dominated (contribution rate of 52.96% in 2022), which may reflect overlap between regional distributions, although this is only one of several possible sources. The Eastern-Western gradient gap is the root cause of overall inequality. (3) Regarding prediction, healthcare resource supply is projected to continue expanding, but average hospitalization cost per visit would reach approximately 15,587 CNY in nominal terms by 2029 on an illustrative extrapolation of the 2003–2022 trend, pointing to a risk of rigid growth in government health expenditure. This descriptive assessment shows that healthcare resource allocation in China over 2003–2022 was characterised by stagnating technological progress, a persistent East-versus-rest gradient in productivity change, and rising nominal costs. Frontier shift was concentrated in resource-dense provinces and slower where resource stocks expanded fastest, while inequality in physical resources per head declined and inequality in productivity change did not. Frontier-expanding investment, scale consolidation in provinces operating under decreasing returns, cross-regional coordination, and value-based payment reform are the directions indicated by these patterns; the study does not identify causal effects.