Gaining from rational health planning: Spatial reallocation of top-tier general hospital beds in China

The inequity in spatial access to health care among regions remains one of the most persistent challenges faced by countries around the world. This study addressed the problem of maldistribution of top-tier healthcare resources in China via the adoption of rational health planning. We proposed an optimization model to maximize the equity in spatial access by reallocating beds among currently existing top-tier general hospitals in China. The two-step floating catchment area method was employed to measure the spatial accessibility, and quadratic programming with the objective of minimizing the demand-factor-weighted variance of spatial accessibility was used to obtain the optimal quantity of beds in each hospital. The results demonstrated that the reallocation of beds had substantially improved both equity and efficiency of spatial access. The optimized spatial reallocation of beds promoted equity in spatial access with a 52% reduction of the weighted standard deviation, from 1.03 to 0.49, as well as achieving enhanced efficiency represented by a 153% increase in the weighted median spatial access, from 0.15 to 0.38. Our findings are expected to provide implications on spatial allocation of China's healthcare resources, and the optimization method could be adopted in future evidence-based health planning procedures in order to improve the equitableness of healthcare delivery systems.