Hospital Distribution Shows Moderate Inequality and Four Underserved Subdistricts

General Background: Equitable hospital distribution is essential for healthcare accessibility, yet aggregate health infrastructure statistics may conceal disparities across smaller administrative areas. Specific Background: Hospital availability in periurban regions may differ considerably between subdistricts despite seemingly sufficient regional healthcare resources. Knowledge Gap: Existing Indonesian healthcare distribution studies predominantly examine district or provincial disparities, leaving subdistrict-level inequalities insufficiently explored. Aims: This ecological cross-sectional study assessed hospital distribution, population-adjusted inequality, and differences in hospital availability across population density groups. Administrative data covering 18 subdistricts in 2025 were analyzed using hospital-to-population ratios, Lorenz curves, Gini coefficients, and population density tertiles. Results: Thirty-three hospitals and 3,771 beds served 2,041,260 residents, equivalent to 1.85 beds per 1,000 population. Hospital availability ranged from zero to 3.46 facilities per 100,000 residents. Four subdistricts, representing approximately 317,600 residents (15.6%), had no hospitals. The population-based Gini coefficient was 0.37, indicating moderate inequality, while the area-based coefficient reached 0.54. The highest population density tertile contained 54.5% of hospitals and five of seven specialty facilities. Novelty: This study quantifies fine-scale healthcare infrastructure disparities through integrated population-based and spatial inequality measures within a periurban administrative setting. Implications: Healthcare infrastructure planning should incorporate subdistrict-level distribution indicators rather than relying exclusively on aggregate regional hospital and bed statistics. Highlights: Approximately 15.6% of residents lived in areas without a local hospital. Population-adjusted and land-area concentration coefficients reached 0.37 and 0.54, respectively. The most densely populated tertile contained 54.5% of all facilities and five of seven specialty centers.