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Abstract The expansion of rural primary health resources and the balanced distribution of regional layout are the essential requirements of a healthy rural construction. However, for a long time, China’s rural areas have been faced with problems like the shortage of primary health resources and insufficient health service capacity, resulting in a low utilization rate of outpatient and inpatient services as well as difficulties in effectively guaranteeing health rights of rural residents. With the accelerating process of population aging and the structural adjustment of disease spectrum, it has become an urgent task to rationally allocate rural primary health resources and realize balanced development of health services among regions.
This study adopts the entropy weight method and coupling coordination degree model to measure the coupling coordination relationship between rural primary health resource allocation and service utilization of 29 provinces (autonomous regions and municipalities) in China from 2007 to 2021, and employs spatial autocorrelation analysis and spatial econometric model to explore the spatial deductive characteristics, evolution trends, and driving mechanisms of coupling coordination in rural primary health resource allocation and service utilization.
It is found that: (1) since 2007, the coupling coordination relationship between rural primary health resource allocation and service utilization in China has been steadily improved. Overall, it has entered a barely coordinated stage from the initial near-disorder stage. As for regional distribution, it has a pattern of central>eastern>western>northeast. (2) Spatial correlation analysis shows that the coupling coordination relationship exhibits positive spatial association characteristics with significant spatial agglomeration effects. In terms of spatial distribution, it shows characteristics of high-high value agglomeration and low-low value agglomeration, among which high-high value agglomeration areas are mainly distributed in the eastern and central regions, while low-low value agglomeration areas are mainly in the western and northeastern regions, showing the phenomenon of significant imbalance in regional development. (3) Mechanism analysis proves that rural social security fiscal expenditure and digitization level have played a significant role in promoting the coupling coordination level of rural primary health resource allocation and service utilization in China, while the fiscal decentralization and rural transportation infrastructure have an inhibitory effect.
Based on the above empirical analysis, the following policy recommendations are put forward: (1) Optimize the allocation structure of primary health resources in rural areas. Achieve a shift from emphasizing material input to focusing on technological elements and the cultivation of talents, and from extensive to intensive management of primary health resources. (2) Promote the flow of health resources and service collaboration across regions at the rural grassroots level. Relying on national medical centers, national regional medical centers and other platforms, deepen health service cooperation among different regions. Strengthen policy learning and experience sharing among regions. (3) Improve the multiple mechanisms of action of coupling and coordination between the allocation of rural primary health resources and service utilization, including adjusting the fiscal investment mechanism for rural medical security; rationally dividing the financial and administrative power between the central and local governments in rural health services provision, expanding the autonomy of local governments in managing rural medical security affairs; achieving effective empowerment of digital technology for the rural health service system construction; and enhancing rural transportation infrastructure conditions. By conducting this study, it is expected to provide empirical evidence to promote the rational allocation of rural health resources, promote the accessibility, fairness and equalization of rural primary health services.
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Published: 20 January 2025
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