Spatial disparities and dynamic evolution of health human resources in primary healthcare institutions in China: a study from the perspective of aggregation degree

As a critical component of universal health coverage, the spatial distribution of human resources in primary healthcare has attracted sustained policy attention worldwide. As the world’s largest developing country, China’s experience provides an important setting for examining the spatial distribution and dynamic evolution of the primary healthcare workforce. To examine the spatial distribution and dynamic evolution of health technical human resources in China’s primary healthcare institutions using the Health Resource Aggregation Degree (HRAD) framework. Data on health technical personnel in China’s primary healthcare institutions from 2013 to 2022 were obtained from the China Health Statistics Yearbook and the China Statistical Yearbook. HRAD, Population Aggregation Degree (PAD), kernel density estimation, Dagum Gini coefficient decomposition, and global Moran’s I were used to assess the distribution and temporal evolution of primary healthcare human resources across 31 provinces in China from 2013 to 2022. The number of health technicians in primary healthcare institutions increased across all regions of China from 2013 to 2022, but substantial regional disparities persisted. The HRAD/PAD ratio showed different temporal patterns across regions. Overall inequality changed little, with the Gini coefficient shifting from 0.382 in 2013 to 0.378 in 2022, and the 2022 global Moran’s I was not statistically significant (I = -0.0868, p = 0.4808). The observed pattern was characterized by persistent regional disparities, geographic-population mismatch, and increasing cross-regional distributional overlap. Despite sustained growth in the primary healthcare workforce, substantial spatial disparities persisted. Future policy should focus on improving targeted allocation mechanisms and strengthening the geographic accessibility of primary healthcare services, particularly in underserved areas.