School of Public Policy & Management, Tsinghua University, Beijing, China.
School of Economics and Management, Tsinghua University, Beijing, China.
Front Public Health. 2024 Jul 8;12:1330921. doi: 10.3389/fpubh.2024.1330921. eCollection 2024.
The equity of public resources triggered by city shrinkage is a global challenge. Significantly, the impact of city shrinkage on the allocation of health service resources needs to be better understood. This study explores the impact of population change on government investment and health service delivery in shrinking cities.
Using data from China's Urban Statistical Yearbook (2010-2020), we employ regression discontinuity (RD) and fixed-effect models to examine the causal relationship between city shrinkage and health service provision.
Shrinking cities show significant disparities in health resources, particularly in bed numbers (-1,167.58, < 0.05) and doctor availability (-538.54, < 0.05). Economic development ( < 0.01) and financial autonomy ( < 0.01) influence hospital bed distribution. Investments in public services (primary schools and teachers, < 0.01) affect health resource delivery. Robustness tests support our results.
This study reveals how city shrinkage disrupts health service provision and equity, establishing a causal relationship between city shrinkage/expansion and health resource allocation, emphasizing the imbalance caused by urban population changes. City expansion intensifies competition for health resources, while shrinking cities struggle to provide adequate resources due to government reluctance. Policymakers should adapt health resource allocation strategies to meet patient demands in changing urban landscapes.
城市收缩所引发的公共资源公平性问题是一个全球性挑战。值得注意的是，城市收缩对卫生服务资源配置的影响需要得到更好的理解。本研究旨在探讨人口变化对收缩城市政府投资和卫生服务提供的影响。
利用中国城市统计年鉴（2010-2020 年）的数据，我们采用回归不连续（RD）和固定效应模型来检验城市收缩与卫生服务提供之间的因果关系。
收缩城市在卫生资源方面存在显著差异，特别是床位数量（-1,167.58，<0.05）和医生可及性（-538.54，<0.05）。经济发展（<0.01）和财政自主权（<0.01）影响医院床位分配。公共服务投资（小学和教师，<0.01）影响卫生资源的提供。稳健性检验支持了我们的结果。
本研究揭示了城市收缩如何扰乱卫生服务的提供和公平性，建立了城市收缩/扩张与卫生资源配置之间的因果关系，强调了城市人口变化所导致的不平衡。城市扩张加剧了卫生资源的竞争，而收缩城市由于政府的不情愿，难以提供足够的资源。政策制定者应调整卫生资源配置策略，以满足不断变化的城市环境中的患者需求。
