Coupling coordination degree spatial analysis and driving factor of population and health care systems in China 2010–2021

Abstract Background Coordinating population and health service systems is essential for the modernization and sustainable development of health governance. This study investigates China’s population and health care systems from 2010 to 2021, aiming to explore the spatiotemporal evolution and key driving mechanisms of system coupling coordination. Methods Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook, covering 31 provinces from 2010 to 2021. An evaluation model was developed to assess the coupling coordination degree (CCD) between the population and health care systems. Spatial autocorrelation analysis was employed to examine spatial dependence, and a Spatial Durbin Model (SDM) was applied to identify key driving factors. Results From 2010 to 2021, the development indices of the population and health service systems increased from 0.213 to 0.686 and from 0.079 to 0.781, respectively, while the CCD rose from 0.361 to 0.855, reflecting a shift from imbalance to high-level coordination. Regionally, the pattern of “east–strong, central–rising, west–weak” persisted. A shift in developmental stages was observed, with nearly 60% of provinces health care–lagged in 2010, and about 53% population–lagged by 2021. Significant spatial clustering was observed (global Moran’s I: 0.379–0.473, P < 0.001), with high–high clusters concentrated in the Yangtze River Delta (Shanghai, Jiangsu, Zhejiang), Pearl River Delta (Guangdong), and Beijing–Tianjin–Hebei region, and low–low clusters in western and inland provinces. Key drivers such as government health expenditure, digital infrastructure, transport infrastructure, and health insurance coverage significantly promoted local coordination and exhibited notable spatial spillover effects, with digital infrastructure being the most influential. Population density facilitated neighboring coordination via service demand diffusion, while economic development had limited spatial spillovers. Conclusion The findings show sustained improvement in population–health system coordination, accompanied by persistent regional disparities and shifting constraint structures. Policy should focus on developing population–responsive health services, enhancing coordination capacity in less–developed regions through targeted fiscal support, and strengthening digital and transport infrastructure to promote regional synergy.