Coupling analysis of public health resource allocation and economic growth with spatial-temporal variation: a case study in China 2017- 2021

Background: China currently faces a formidable challenge regarding the inadequate and uneven allocation of resources in the public health sector. The increasing impact of economic and health crises stemming from public health emergencies highlights the crucial relationship between public health resource allocation (PHRA) and economic growth (EG). This study sought to investigate the Coupling Coordination Degree (CCD) and the spatiotemporal variations between PHRA and EG, expecting to provide guidance for future public health and economic resource allocation and development planning. Methods: By establishing a comprehensive evaluation-indexing system, we applied the polar, entropy, and linear weighting methods to calculate the comprehensive indices of PHRA and EG from 2017 to 2021. Subsequently, we empirically evaluated the CCD using the CCM model. Trend surface analysis and exploratory spatial data analysis were employed to assess the spatiotemporal variations of the CCD. Results: The comprehensive indices for PHRA, EG, and the CCD exhibited a gradual upward trend from 2017 to 2021, although most provinces remained in the basically balanced or moderate unbalanced stage. In the eastern region, coordinated development was hindered primarily due to lagging HPAG, while the central and western regions faced challenges due to lower levels of EG. Furthermore, we observed significant spatial heterogeneity in the CCD, reflecting a stable pattern of "high in the East and low in the West, high in the South and low in the North", with a growing gap between southern and northern regions. Additionally, the CCD transitioned from a random distribution to spatial clustering, with hot and cold spot areas centered around the Yangtze Plain and the Qinghai-Tibet Plateau. Notably, areas with hotspots exhibited remarkable spatial diffusion effects. Conclusion: The PHRA and EG have not achieved a high-quality coordination stage and remain out of sync across provinces. Moreover, substantial disparities and reinforced spatial agglomeration patterns were observed in the CCD. Consequently, it is imperative to implement additional administrative measures to promote both PHRA and EG. Tailored policies considering regional characteristics should also be implemented to bridge development gaps between regions, considering the spatial differences and correlations among them to optimize the spatial linkage environment.