Impact of provincial economic development levels on public-private hospital co-development in China: an empirical analysis.

Introduction: The co-development of public-private hospitals in China's healthcare system significantly influences the system's service utilisation, but the public-private hospital interaction is poorly understood. Bridging this knowledge gap is crucial for informed policy-making and promoting a more balanced healthcare system. This study measures China's public-private hospital co-development and the impact of provincial and regional economic development levels on public-private hospital co-development.

Methods: We use service utilisation, a comprehensive measure of resource allocation, service capacity and service efficiency, to assess the co-development of China's public and private hospitals. Using the coupling coordination degree model, a novel approach borrowed from physics, we measured the degree of interaction between the public and private pillars of China's hospital system. Second, we measured the relationship between the degree of private-public hospital interaction and the level of provincial-regional economic development, including provincial direct and spillover effects. Data were collected on 2011-2021 service utilisation across 31 Chinese provinces. Fixed-effect models and the spatial Durbin model estimated the direct and spillover effects between the coupling coordination degree and the level of provincial economic development.

Results: We found that national, regional and provincial service utilisation in private hospitals expanded, while service utilisation remained constant in public hospitals. China's private-public hospital co-development improved from the 'barely co-developed' (0.696 in 2011) to the 'partially co-developed' level (0.752 in 2021) in the public-private transitional co-development stage. We identified significant regional heterogeneity, with the eastern region co-development slightly better than the central region and both substantially better than the western region. There was also significant provincial heterogeneity. Increases in regional and provincial economic development promoted the service utilisation of private hospitals, improving the balanced co-development of public-private hospitals in the home and adjacent provinces (p<0.05).

Conclusions: To improve the co-development of public-private hospitals and avoid regional imbalances, regional and provincial hospital policies and regulations should be coordinated and equitable; private hospitals should cooperate with public hospitals through their professional management teams and medical equipment sharing to equalise medical resource allocations; and regional economic disparities should be addressed.