Spatial Equity and Influencing Factors of Coupling Coordination Degree of Healthcare Resources Allocation and Service Utilization in China
Authors: jianpeng lin 
Published: July 2020

Abstract
Background: The COVID-19 epidemic in early 2020 has made the contradiction between allocation and utilization of healthcare resources in China more prominent. However, there is still no conclusion about the coordination degree of healthcare resources and service utilization in China, especially in the context of hierarchical diagnosis and treatment. Based on the hierarchical analysis framework for healthcare institutions, this paper mainly analyzes the coordination level of healthcare resources of primary healthcare institutions and hospital in China's provincial scale from 2010 to 2018.Method: In this paper, the entropy-weighted TOPSIS evaluation method is used to calculate the healthcare resourcesallocation and service utilization index, the coupled coordination model is used to evaluate the coordination relationship between healthcare resource allocation and service utilization, and the exploratory spatial data analysis method is used to evaluate the spatial distribution characteristics of the coordination level and detect its impact on the surrounding spatial units and the geographic detector is used to analyze the driving factors that affect the spatial inequity of the coordination level. Results: The coupling coordination degree of primary healthcare institutions and hospitals increased from 0.448 and 0.418 in 2010 to 0.519 and 0.534 in 2018, respectively, while the relative development degree increased from 0.469 and 0.466 in 2010 to 0.767 and 0.578 in 2018, respectively. The coupling coordination type has shifted from sligth imbalance to general coordination. The lagging situation of healthcare resources allocation has gradually improved. The coupling coordination degree basically shows the spatial distribution characteristics of higher in the eastern area, central in the central area, and lower in the border areas in the northwest, northeast, and southwest. At the same time, the spatial inequity is more obvious.The coupling coordination degree between China's healthcare resources allocation and service utilization has spatial autocorrelation, and formed hotspot and coldspot areas centered on the middle and lower reaches of the Yangtze River and the Tibetan Plateau respectively. The lag of healthcare resources allocation is the main reason for lowering the degree of coupling coordination between healthcare resources and service utilization in China. The spatial differentiation of coupling coordination degree is influenced by population distribution and structure, economic development level and topographical condition factors, and has obvious spatial and temporal heterogeneity. These results have similarities and differences at the level of hospitals and primary medical institutions.Conclusions: From 2010 to 2018, China's healthcare resources allocation and service utilization coupling coordination system changed from slight imbalance to general coordination. This kind of transformation is more obvious in hospitals than primary healthcare institutions. Whether it is hospitals or primary healthcare institutions, the coordination level has obvious spatial distribution characteristics and spatial inequity. The lag of healthcare resources allocation is the main reason for lowering the level of coupling coordination. This spatial inequity is affected by the distribution and structure of economic population, the level of economic development, and topographical conditions. These conclusions have similarities and differences at the level of hospitals and primary healthcare institutions.