Wu Baoling, Wu Wenbo, Wang Xi, Huang Weizhang, Luo Zhenni, Li Jifeng
The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
Faculty of Humanities and Social Sciences, Macau Polytechnic University, Macau, China.
Front Health Serv. 2025 Jun 12;5:1621018. doi: 10.3389/frhs.2025.1621018. eCollection 2025.
Secondary public hospitals play a pivotal role in China's hierarchical medical system, serving as a critical intermediary tier. However, in rapidly urbanizing cities such as Guangzhou, these hospitals face mounting challenges including widening efficiency disparities, imbalanced resource allocation, and weak governance structures. This study aims to systematically evaluate the evolution and spatial dynamics of service capacity among secondary general public hospitals in Guangzhou, offering empirical evidence to support capacity improvement and policy optimization.
A composite evaluation framework was constructed across three dimensions: medical quality, operational efficiency, and sustainability. Based on panel data from 12 secondary general public hospitals in Guangzhou between 2019 and 2023, we applied a combination of Entropy-TOPSIS model, Kernel Density Estimation (KDE), and the Dagum Gini Coefficient to assess overall service capacity levels, temporal trends, and spatial inequalities.
The findings indicate a general upward trend in service capacity; however, disparities among hospitals have intensified. While indicators of medical safety (e.g., mortality and complication rates) have steadily improved, there remains significant divergence in surgical ratios and pharmaceutical service coverage-particularly in peripheral areas. KDE analysis reveals a transition from unimodal to bimodal distribution, indicating stratification of service capacity. Decomposition of the Dagum Gini Coefficient shows that transvariation (inter-group overlaps) is the main source of inequality, underscoring increasing cross-regional capacity divergence.
Although Guangzhou's secondary public hospitals have shown overall improvement, challenges remain in terms of regional coordination and internal structural disparities. This study recommends differentiated interventions such as specialty alliances, performance-based resource allocation, and workforce optimization to enhance system resilience and equity. The proposed evaluation model demonstrates strong applicability and scalability, offering theoretical and empirical insights for healthcare system governance in other rapidly urbanizing regions.
二级公立医院在中国分级医疗体系中发挥着关键作用，是重要的中间层级。然而，在广州等快速城市化的城市中，这些医院面临着越来越多的挑战，包括效率差距不断扩大、资源分配不均衡以及治理结构薄弱。本研究旨在系统评估广州二级综合公立医院服务能力的演变和空间动态，为支持能力提升和政策优化提供实证依据。
构建了一个涵盖医疗质量、运营效率和可持续性三个维度的综合评估框架。基于2019年至2023年广州12家二级综合公立医院的面板数据，我们应用熵权法-TOPSIS模型、核密度估计（KDE）和达古姆基尼系数相结合的方法，来评估整体服务能力水平、时间趋势和空间不平等。
研究结果表明服务能力总体呈上升趋势；然而，医院之间的差距却在加剧。虽然医疗安全指标（如死亡率和并发症发生率）稳步改善，但手术比例和药学服务覆盖范围仍存在显著差异，尤其是在周边地区。KDE分析显示从单峰分布向双峰分布转变，表明服务能力出现分层。达古姆基尼系数分解表明，组间重叠是不平等的主要来源，凸显了跨区域能力差距的扩大。
尽管广州的二级公立医院总体有所改善，但在区域协调和内部结构差异方面仍存在挑战。本研究建议采取差异化干预措施，如专科联盟、基于绩效的资源分配和劳动力优化，以增强系统弹性和公平性。所提出的评估模型具有很强的适用性和可扩展性，为其他快速城市化地区的医疗系统治理提供了理论和实证见解。
