Keeping Pace with Urban Growth? Long-Term Spatial Alignment of Tertiary Grade-A Healthcare Resources in Four Southwestern Chinese Cities

Rapid urban growth continues to reshape land development and the spatial distribution of population, yet the long-term and multiscale alignment of high-tier healthcare resources with this process remains insufficiently understood. This study examines Chengdu, Chongqing, Kunming, and Guiyang and reconstructs changes in built-up areas, population distribution, and tertiary Grade-A hospital campuses from 2010 to 2025. Urban growth–healthcare alignment is assessed through stage-wise change, citywide spatial shifts, and local spatial association. The results reveal clear asynchrony among land expansion, population growth, and healthcare-resource expansion. Built-up area expansion peaked during 2015–2018, whereas population growth was concentrated in 2010–2015. Of the 78 newly added hospital campuses, 66 (84.6%) were located on land built up before 2010, exceeding an area-proportional expectation of 67.9% (p < 0.001). By contrast, the 6.4% located on same-period newly built-up land did not differ significantly from its area-based expectation (9.8%). The results therefore indicate locational persistence within established urban space rather than a demonstrable uniform stage-based development lag. Population-related variables generally showed higher point estimates of spatial association with tertiary Grade-A healthcare-resource change than built-up area expansion alone, although bootstrap comparisons indicated that these differences were not consistently robust across cities. All four cities showed significant positive citywide associations between urban growth and healthcare-resource change, and these associations remained robust across alternative KDE bandwidths and healthcare-capacity specifications; however, local associations remained spatially heterogeneous, and the extent of significant mismatch areas was sensitive to FDR correction. The four cities nevertheless followed distinct spatial pathways, reflecting context-dependent patterns of healthcare-resource adjustment. These findings show that high-tier healthcare resources exhibit selective alignment and locational persistence rather than simply expanding with outward urban growth. Planning should therefore consider actual population concentration and local spatial mismatch in addition to aggregate citywide resource growth.