Spatiotemporal Patterns and Drivers of County-Level Health Resource Allocation in Hunan Province, China: A Health Equity Perspective

Vollständiger Abstract

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The equitable allocation of health resources is fundamental to building healthy cities and advancing sustainable regional development. Using panel data for 122 county-level units in Hunan Province, China, from 2011 to 2022, this study constructs an evaluation index system for healthcare resource allocation and applies trend surface analysis, spatial autocorrelation, the Dagum Gini coefficient, and geographically and temporally weighted regression (GTWR) to examine the spatiotemporal evolution, equity, and driving factors of health resource allocation. The results show the following. (1) The level of health resource allocation in Hunan Province rose steadily, with the composite score increasing by 74%, yet a persistent spatial pattern of higher allocation in the east and north than in the west and south remained; hot spots clustered in Changsha, while cold spots concentrated in parts of Southern Hunan and Western Hunan. (2) Regional disparities narrowed gradually, and the Dagum decomposition identified transvariation density as the dominant source of inequality, with an average contribution of 53.58%, exceeding intra-group and inter-group differences. (3) The effects of the drivers exhibited marked spatiotemporal heterogeneity. Per capita GDP promoted health resource allocation mainly in developed regions, while urbanization exerted stronger positive effects in less-developed regions. The positive effect of per capita disposable income gradually shifted from less-developed to developed regions over time, and population density generally showed a positive effect, with stronger influences concentrated in the Greater Western Hunan region. This study contributes to a deeper understanding of how regional disparities and heterogeneous driving mechanisms shape health resource allocation, providing evidence for more adaptive and equitable healthcare governance.