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Assessing the appropriateness of outpatient physician and inpatient bed allocation in China: evidence from national health statistics, 2013–2023

This study analyzes China's 2013–2023 health resource allocation and finds that while outpatient physician distribution has improved, it remains insufficient relative to demand, whereas inpatient beds are oversupplied, particularly in primary care, highlighting the need for demand-sensitive planning over aggregate expansion.

Original authors: Biao Wang, Lin Pan, Xin Jiang, Junyu Niu, Li Luo

Published 2026-06-29

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CC BY 4.0

Original authors: Biao Wang, Lin Pan, Xin Jiang, Junyu Niu, Li Luo

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine China's healthcare system as a massive, bustling city with two main types of service centers: Small Neighborhood Shops (Primary Medical Institutions) and Mega Department Stores (Hospitals).

For the last decade (2013–2023), the government has been building more shops and hiring more staff to help the city's growing population. But this study asks a simple question: Are they stocking the right things in the right places?

Here is what the researchers found, using a "supply-and-demand" checkup.

1. The "Cashier" Problem (Outpatient Physicians)

Think of outpatient physicians as the cashiers who check you in, diagnose minor issues, and send you on your way.

The Situation: The city is getting busier. More people are walking into both the Neighborhood Shops and the Mega Stores.
The Shortage: Even though the government hired more cashiers, they still aren't enough to handle the line. The demand for cashiers grew faster than the number of cashiers available.
The Result: The "matching score" (how well the staff fits the crowd) got a little better, especially in the Neighborhood Shops. But the lines are still too long. In fact, for every 1 cashier on duty, there are still nearly 2 people waiting in line (a ratio above 1.0).
The Takeaway: The system is still short on the people needed to see patients for daily check-ups and minor illnesses.

2. The "Empty Room" Problem (Inpatient Beds)

Now, think of inpatient beds as the sleeping rooms where patients stay overnight for serious treatment.

The Situation: The government built a lot of new sleeping rooms in both the Shops and the Mega Stores.
The Oversupply: While the number of rooms exploded, the number of people actually staying overnight didn't grow nearly as fast.
The Result: There are now many empty beds.
- In the Mega Stores, the rooms are mostly full, but there are still a few extra.
- In the Neighborhood Shops, the situation is worse. They built many rooms, but very few people are using them. The "matching score" actually got worse over time because they built so many rooms that the empty space became glaring.
The Takeaway: The system has built too many hospital beds, especially for small clinics, relative to how many people actually need to stay overnight.

3. The "Regional Weather" (Provincial Differences)

Just like weather, healthcare resources aren't the same everywhere.

Some provinces (mostly in the east) have high demand and better matching.
Other provinces (often in the west or northeast) have different patterns.
The Lesson: You can't fix the whole country with one rule. A "one-size-fits-all" plan doesn't work because the needs vary wildly from province to province.

The Big Picture: What's Wrong with the Plan?

The researchers argue that for the last ten years, China focused on quantity (building more things, hiring more people) rather than fit (making sure those things match what people actually need).

The Mistake: They kept hiring more doctors and building more beds without realizing they were building too many beds and not enough doctors.
The Reality: The "Neighborhood Shops" are struggling to get enough doctors to see patients, while they sit on a pile of unused beds. Meanwhile, the "Mega Stores" are also short on doctors but have plenty of beds.

The Proposed Fix

The paper suggests that the government needs to stop just counting heads and beds. Instead, they should:

Hire more doctors for the Neighborhood Shops to clear the lines.
Stop building so many new beds, especially in small clinics where they aren't being used.
Make the Neighborhood Shops more attractive so people trust them with their care, rather than rushing to the Mega Stores for everything.

In short: China has built a lot of "sleeping rooms" that are sitting empty, while the "cashier counters" are still overwhelmed. The solution isn't to build more of everything; it's to balance the team so the right people are in the right places.

Technical Summary: Assessing the Appropriateness of Outpatient Physician and Inpatient Bed Allocation in China (2013–2023)

Problem Statement

Since the 2009 health system reform, China has significantly expanded its health resources, including insurance coverage, public investment, and the supply of medical institutions, physicians, and beds. However, it remains unclear whether this aggregate expansion has resolved the structural imbalances between primary medical institutions and hospitals. Specifically, there is a lack of evidence regarding whether the allocation of outpatient physicians and inpatient beds aligns with realized service demand across different levels of the healthcare system. Existing studies have largely focused on resource density, spatial equity, or efficiency (using Gini coefficients or Theil indices) rather than directly matching resource supply to observed service utilization by institution type. This study addresses the gap by evaluating the appropriateness of resource allocation in China from 2013 to 2023, distinguishing between primary medical institutions and hospitals.

Methodology

The study employed a repeated cross-sectional descriptive design using aggregated national and provincial-level data from the China Health Statistical Yearbooks and official statistical sources for the years 2013, 2018, and 2023.

1. Data and Classification:

Institutions: Divided into "Primary medical institutions" (community health centers, township health centers, village clinics, etc.) and "Hospitals" (general, specialized, TCM, etc.).
Demand Definition: Demand was defined as realized demand, estimated from observed service utilization (outpatient visits and inpatient admissions) rather than latent health needs.

2. Estimation of Allocation and Demand:

Outpatient Physician Allocation ( $Q_{op}$ ): Since yearbooks do not directly report physicians dedicated solely to outpatient work, the study used a workload decomposition approach. Total practicing and assistant physicians ( $P$ $P$ ) were converted to equivalent outpatient physicians based on the share of workload devoted to outpatient services ( $s_{op}$ $s_{o p}$ ).
- Formula: $s_{op} = v / (v + 8b)$ , where $v$ is average daily outpatient visits per physician and $b$ is average inpatient bed-days managed per physician. One inpatient bed-day was assumed equivalent to eight outpatient visits.
- $Q_{op} = P \times s_{op}$ .
Outpatient Physician Demand ( $D_{op}$ ): Calculated by converting annual outpatient visits ( $V$ $V$ ) into required physician capacity, accounting for standard working days ( $H=250$ $H = 250$ ), standard consultations per day ( $W=15$ $W = 15$ ), and non-clinical time ( $R=10\%$ $R = 10%$ ).
- Formula: $D_{op} = V \times (1+R) / (H \times W)$ .
Inpatient Bed Demand ( $D_{bed}$ ): Estimated from annual admissions ( $A$ $A$ ), standard length of stay ( $L=7$ $L = 7$ days), and standard occupancy rate ( $U=85\%$ $U = 85%$ ).
- Formula: $D_{bed} = A \times L / (360 \times U)$ .
Inpatient Bed Allocation ( $Q_{bed}$ ): Obtained directly from official statistics.

3. Matching Framework:

Appropriateness Score ( $\lambda^*$ ): A geometric analysis based on rescaled cosine similarity was used to quantify the alignment between supply ( $Q$ ) and demand ( $D$ ). The angle ( $\theta$ ) between the observed allocation-demand vector and the 45-degree perfect-matching line was calculated. The score was rescaled to a 0–1 interval, where 1 indicates perfect matching.
Direction of Mismatch: The Demand-to-Supply Ratio (D/S) was used to identify the direction of the mismatch. $D/S > 1$ indicates undersupply; $D/S < 1$ indicates oversupply.

Key Contributions

Methodological Extension: The study extends a supply-demand suitability framework, previously applied only to Shanghai, to the national and provincial levels of China.
Differentiated Analysis: It uniquely distinguishes between primary medical institutions and hospitals, revealing that resource mismatches differ significantly by institution type and resource category (physicians vs. beds).
Dual Metric Approach: By combining a geometric appropriateness score (degree of match) with the D/S ratio (direction of mismatch), the study provides a nuanced view of resource allocation that goes beyond simple equity measures.
Realized Demand Focus: The study explicitly interprets demand based on observed utilization, offering a practical assessment of current system performance while acknowledging that low utilization may reflect suppressed demand due to capacity or trust issues.

Results

1. Outpatient Physicians:

Demand: Estimated demand for outpatient physicians increased in both sectors. In primary institutions, it rose from 1.27 million (0.93/1,000 pop) in 2013 to 1.45 million (1.03/1,000 pop) in 2023. In hospitals, it increased more sharply from 0.80 million (0.59/1,000 pop) to 1.25 million (0.89/1,000 pop).
Allocation: The equivalent number of outpatient physicians increased in both sectors but remained below demand.
Matching: The appropriateness score improved (Primary: 0.8257 $\to$ 0.9538; Hospitals: 0.8118 $\to$ 0.8621). However, D/S ratios remained above 1.0 for all years in both sectors, indicating a persistent undersupply of outpatient physicians relative to realized demand.

2. Inpatient Beds:

Demand: Primary care bed demand remained relatively stable (0.72 $\to$ 0.74 per 1,000 pop), while hospital bed demand rose significantly (3.21 $\to$ 3.98 per 1,000 pop).
Allocation: Bed supply expanded rapidly, particularly in hospitals (3.35 $\to$ 5.68 per 1,000 pop).
Matching: The appropriateness score for primary care beds declined (0.9588 $\to$ 0.8795), while hospital scores remained high but decreased (0.9993 $\to$ 0.9481). Crucially, D/S ratios were consistently below 1.0, indicating a systemic oversupply of inpatient beds relative to realized demand, a trend that worsened over time, especially in primary institutions.

3. Regional Heterogeneity:

Provincial heatmaps revealed substantial variation. While national averages showed trends, specific provinces exhibited distinct patterns of undersupply or oversupply, indicating that national-level planning may mask critical local disparities.

Significance and Claims

The paper claims that China's health resource allocation exhibits a differentiated structural pattern:

Physician Shortage: There is a persistent shortage of outpatient physicians relative to realized demand in both primary care and hospitals. This suggests that workforce planning has not kept pace with service utilization, even as total headcounts have grown.
Bed Oversupply: Conversely, inpatient beds are oversupplied relative to utilization, particularly in primary medical institutions. This indicates a misalignment where capacity expansion (especially in beds) has outpaced actual service needs.
Policy Shift: The authors argue that health resource planning must move beyond aggregate expansion and simple population-ratio targets (e.g., beds per 1,000 people). Instead, planning should be demand-sensitive, focusing on:
- Strengthening outpatient physician capacity and optimizing their workload.
- Improving primary care quality and trust to realize its gatekeeping function.
- Restraining inefficient bed expansion and focusing on functional adjustments (e.g., rehabilitation, long-term care) rather than acute inpatient capacity.
- Addressing regional heterogeneity with differentiated policies.

The study concludes that while the degree of mismatch has improved in some areas, the structural imbalance between physician shortages and bed oversupply remains a critical challenge for building a coordinated hierarchical medical system in China.