Regional integration and public healthcare environment: Evidence from China

Abstract

Introduction: Existing studies have focused on the impact of economic development and urban expansion on public healthcare environment but has ignored the importance of regional integration. Regional integration reflects the spatial distribution of the labor force, which significantly affects healthcare workforce and healthcare infrastructure development.

Methods: Based on panel nested data for 137 cities in 16 major city clusters in China from 2001 to 2019, this paper assesses the impact of regional integration on the public healthcare environment through a hierarchical linear model (HLM).

Results: Our findings indicate that a 1% increase in regional integration leads to a 6.6 and 1.9% improvement in healthcare workforce and healthcare infrastructure. The results of the mechanism analysis indicate that regional integration affects the public healthcare environment through improving transportation infrastructure and industrial upgrading. In addition, regional integration has a stronger effect on cities with lower levels of economic development and healthcare environments. Finally, the endogeneity test based on the difference-in-difference (DID) model and the robustness test based on high-dimensional fixed effects model conduct the consistent conclusions.

Discussion: Policies to improve the public healthcare environment through promoting regional integration are proposed. Government should develop a more comprehensive regional cooperation plan to improve the public healthcare environment. Also, financial spending on improving the healthcare environment in peripheral cities should be increased. In addition, regional integration policy development needs to consider differences across regions.

Keywords: heterogeneity analysis; hierarchical linear model; public healthcare environment; regional integration; spatial core-peripheral cities.