Regional disparities and multidimensional determinants of hospital bed allocation in China: spatial evidence for public health policymaking

Introduction Medical resource distribution in China exhibits marked spatial disparities, with hospital bed allocation demonstrating particularly pronounced regional inequalities. These imbalances may significantly impact healthcare accessibility and population health outcomes across different provinces. Methods This study employed a comprehensive analytical framework to examine hospital bed distribution across 31 provinces in China in 2022. We first conducted descriptive statistics and spatial autocorrelation analysis to identify distribution patterns. Subsequently, multiple linear regression (MLR) and spatial error model (SEM) were applied to evaluate the factors categorized into six dimensions: economic development, population structure, environmental conditions, education level, existing healthcare resources, and transportation infrastructure. Finally, the Geodetector method was systematically implemented to quantify individual factor contributions and their interaction effects based on spatial stratified heterogeneity principles. Results Our analysis revealed three key findings: ( 1 ) Significant regional disparities existed in hospital beds per 1,000 population, with global spatial autocorrelation confirming strong clustering patterns. Local indicators of spatial association (LISA) identified high-high clusters in southwestern regions and low-low clusters in southeastern provinces; ( 2 ) Both MLR and SEM analyses indicated a negative correlation between sex ratio and bed availability, with SEM demonstrating superior goodness-of-fit by effectively addressing spatial autocorrelation; ( 3 ) Geodetector results showed GDP per capita served as the primary driver of bed distribution, revealing a threshold effect where bed demand concentrated in low-GDP regions. Notably, significant interaction effects that substantially magnified individual factor impacts, with the synergistic effect between disposable income per capita and sex ratio emerging as the most pronounced. Conclusion This study reveals substantial spatial disparities in hospital bed distribution across China, highlighting the necessity of integrated regional policymaking that explicitly addresses multifactorial synergies to optimize equitable healthcare resource allocation.