China has achieved notable progress in economic and social development over the past decade. However, regional disparities—especially in Health Service Development Level (HSDL)—remain significant, challenging national health goals and public health sustainability. This study evaluates China’s HSDL, explores causes of regional inequality, and proposes policy recommendations to optimize resource allocation and address health disparities. We used panel data from 31 provinces (2012–2021) to build a composite HSDL index via the CRITIC weighting method. Dagum’s Gini coefficient measured regional disparities, and kernel density estimation analyzed distribution patterns. Moran’s I index assessed spatial autocorrelation. Traditional and spatial Markov chain models examined dynamic transitions, while spatial econometric models (SDM, SEM, SAR) explored spatiotemporal evolution and convergence. From 2012 to 2021, China’s HSDL rose steadily, peaking in 2020, mainly due to coordinated health policies and COVID-19 responses. Eastern provinces maintained high HSDL, while western regions improved significantly through health poverty alleviation efforts, narrowing interregional gaps. In 2021, a slight decline was observed, likely due to reduced public health investment and shifting policy priorities post-pandemic. Spatial analysis showed clustering of high HSDL in the east, with notable internal disparities in the west. Markov model comparisons revealed strong transition inertia and lock-in effects, especially in low-HSDL regions. Spatial econometric models confirmed a trend of spatial convergence, with shrinking gaps among eastern, central, and western areas. Despite national progress in HSDL, regional imbalances and unequal resource distribution persist, particularly in western provinces. Future strategies should focus on balanced development by improving basic healthcare services, promoting equitable resource allocation, and enhancing targeted policy support for underserved regions.
Shao et al. (2026) studied this question.