ICU bed distribution in China: progress, disparities, and policy implications

Intensive Care Unit (ICU) bed allocation is a vital measure of healthcare system maturity and equity; however, challenges remain in addressing regional disparities and optimizing resource distribution in China. This study employed the Gini coefficient, Lorenz curve, and health resource agglomeration degree (HRAD) as analytical tools to evaluate equity and distribution patterns of 31 mainland provinces in China from 2013 to 2022. This study also examined HRAD differences between regions using the Kruskal-Wallis test and influencing factors by multiple linear regression analysis. Between 2013 and 2022, China experienced a 2.63-fold increase in ICU bed capacity, corresponding to an average annual growth rate of 11.3%. However, substantial regional disparities remained evident. The number of ICU beds per 10,000 square kilometers in Shanghai is 1,800 times that of Tibet. The geographical distribution of ICU beds exhibited marked inequity, as indicated by a Gini coefficient of 0.69, while population-based allocation demonstrated greater equity with a coefficient of 0.13. Analysis of the health resource agglomeration degree (HRAD) revealed a distinct geographical pattern: the eastern region had a significantly higher HRAD compared to the western region. In the regression results, the bed utilization rate and nurses per 100,000 population are positively correlated with the HRAD, while the nurse-to-doctor ratio is negatively correlated. The distribution framework, although achieving relative equity in densely populated urban areas, falls short of meeting critical care demands in remote regions with sparse populations and constrained infrastructure. To bridge this gap, policymakers must prioritize geographical accessibility and economic feasibility through targeted strategies.