Three-medical linkage in China: trend evolution and obstacle identification

BACKGROUND: "Three-medical linkage" is a key concern of the healthcare system reform deepening in China, while it has not achieved the expected outcomes yet. The issues of "no-linkage" or "linkage without moving" have increasingly become a major challenge. METHODS: Data was obtained from various Yearbooks in China. Coupling coordination degree and gravity models were employed to analyze the spatio-temporal evolution pattern of the "three-medical linkage" in 31 provinces. The combination forecasting method was used to forecast the development trend of the "three-medical linkage." We constructed the obstacle degree model to identify the main obstacles to coordinated development. RESULTS: The overall development of the three systems exhibited a continuous upward trend. The coupling coordination grade of the "three-medical linkage" system has progressed from the disorderly development stage to the transitional stage in most provinces. The Beijing-Tianjin-Hebei and Yangtze River Delta regions are the most closely connected. Regional disparities in the degree of coupling coordination will widen in the future. The number of people benefiting from maternity insurance, per capita total health expenditure, and new drug research and development (R&D) costs hindered the coordinated development of the three systems. DISCUSSION: Highlighting the improvement of the "three-medical linkage" is essential. Under the goals of Healthy China and SDG3 (Good Health and Well-being), further efforts are needed to address systemic barriers and institutional deficiencies. The Chinese government should increase capital input to overcome major obstacles and carefully evaluate the imbalance in regional development.