Coupling coordination degree spatial analysis and driving factor of population and health care systems in China 2010–2021

Coupling coordination degree spatial analysis and driving factor of population and health care systems in China 2010–2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Coupling coordination degree spatial analysis and driving factor of population and health care systems in China 2010–2021 Linbin Luo, Ruibo He, Yiqing Xing, Weicun Ren, Liang Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6922885/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background Coordinating population and health service systems is essential for the modernization and sustainable development of health governance. This study investigates China’s population and health care systems from 2010 to 2021, aiming to explore the spatiotemporal evolution and key driving mechanisms of system coupling coordination. Methods Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook, covering 31 provinces from 2010 to 2021. An evaluation model was developed to assess the coupling coordination degree (CCD) between the population and health care systems. Spatial autocorrelation analysis was employed to examine spatial dependence, and a Spatial Durbin Model (SDM) was applied to identify key driving factors. Results From 2010 to 2021, the development indices of the population and health service systems increased from 0.213 to 0.686 and from 0.079 to 0.781, respectively, while the CCD rose from 0.361 to 0.855, reflecting a shift from imbalance to high-level coordination. Regionally, the pattern of “east–strong, central–rising, west–weak” persisted. A shift in developmental stages was observed, with nearly 60% of provinces health care–lagged in 2010, and about 53% population–lagged by 2021. Significant spatial clustering was observed (global Moran’s I: 0.379–0.473, P < 0.001), with high–high clusters concentrated in the Yangtze River Delta (Shanghai, Jiangsu, Zhejiang), Pearl River Delta (Guangdong), and Beijing–Tianjin–Hebei region, and low–low clusters in western and inland provinces. Key drivers such as government health expenditure, digital infrastructure, transport infrastructure, and health insurance coverage significantly promoted local coordination and exhibited notable spatial spillover effects, with digital infrastructure being the most influential. Population density facilitated neighboring coordination via service demand diffusion, while economic development had limited spatial spillovers. Conclusion The findings show sustained improvement in population–health system coordination, accompanied by persistent regional disparities and shifting constraint structures. Policy should focus on developing population–responsive health services, enhancing coordination capacity in less–developed regions through targeted fiscal support, and strengthening digital and transport infrastructure to promote regional synergy. population system health care systems coupling coordination degree spatiotemporal dynamic evolution Full Text Additional Declarations No competing interests reported. Tables 1 to 8 are available in the Supplementary Files section. Supplementary Files Tables.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 09 Sep, 2025 Reviews received at journal 04 Sep, 2025 Reviews received at journal 12 Aug, 2025 Reviewers agreed at journal 28 Jul, 2025 Reviews received at journal 25 Jul, 2025 Reviews received at journal 23 Jul, 2025 Reviews received at journal 22 Jul, 2025 Reviewers agreed at journal 21 Jul, 2025 Reviewers agreed at journal 19 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers agreed at journal 17 Jul, 2025 Reviewers agreed at journal 16 Jul, 2025 Reviewers invited by journal 16 Jul, 2025 Editor invited by journal 19 Jun, 2025 Editor assigned by journal 18 Jun, 2025 Submission checks completed at journal 18 Jun, 2025 First submitted to journal 18 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6922885","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486827178,"identity":"035130fe-8894-4a0a-bc29-6b5ddc3477eb","order_by":0,"name":"Linbin Luo","email":"","orcid":"","institution":"Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Linbin","middleName":"","lastName":"Luo","suffix":""},{"id":486827179,"identity":"cd9f7b02-3fb5-4e3e-bd57-017e0ed3a8bf","order_by":1,"name":"Ruibo He","email":"","orcid":"","institution":"Hubei University of 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2010–2021","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"population system, health care systems, coupling coordination degree, spatiotemporal dynamic evolution","lastPublishedDoi":"10.21203/rs.3.rs-6922885/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6922885/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCoordinating population and health service systems is essential for the modernization and sustainable development of health governance. This study investigates China\u0026rsquo;s population and health care systems from 2010 to 2021, aiming to explore the spatiotemporal evolution and key driving mechanisms of system coupling coordination.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eData were obtained from the China Statistical Yearbook and China Health Statistics Yearbook, covering 31 provinces from 2010 to 2021. An evaluation model was developed to assess the coupling coordination degree (CCD) between the population and health care systems. Spatial autocorrelation analysis was employed to examine spatial dependence, and a Spatial Durbin Model (SDM) was applied to identify key driving factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFrom 2010 to 2021, the development indices of the population and health service systems increased from 0.213 to 0.686 and from 0.079 to 0.781, respectively, while the CCD rose from 0.361 to 0.855, reflecting a shift from imbalance to high-level coordination. Regionally, the pattern of \u0026ldquo;east\u0026ndash;strong, central\u0026ndash;rising, west\u0026ndash;weak\u0026rdquo; persisted. A shift in developmental stages was observed, with nearly 60% of provinces health care\u0026ndash;lagged in 2010, and about 53% population\u0026ndash;lagged by 2021. Significant spatial clustering was observed (global Moran\u0026rsquo;s I: 0.379\u0026ndash;0.473, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with high\u0026ndash;high clusters concentrated in the Yangtze River Delta (Shanghai, Jiangsu, Zhejiang), Pearl River Delta (Guangdong), and Beijing\u0026ndash;Tianjin\u0026ndash;Hebei region, and low\u0026ndash;low clusters in western and inland provinces. Key drivers such as government health expenditure, digital infrastructure, transport infrastructure, and health insurance coverage significantly promoted local coordination and exhibited notable spatial spillover effects, with digital infrastructure being the most influential. Population density facilitated neighboring coordination via service demand diffusion, while economic development had limited spatial spillovers.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe findings show sustained improvement in population\u0026ndash;health system coordination, accompanied by persistent regional disparities and shifting constraint structures. Policy should focus on developing population\u0026ndash;responsive health services, enhancing coordination capacity in less\u0026ndash;developed regions through targeted fiscal support, and strengthening digital and transport infrastructure to promote regional synergy.\u003c/p\u003e","manuscriptTitle":"Coupling coordination degree spatial analysis and driving factor of population and health care systems in China 2010–2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-18 15:01:52","doi":"10.21203/rs.3.rs-6922885/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-09T11:56:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-04T14:40:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T03:09:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73468353972761684009809230484403379707","date":"2025-07-29T00:52:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T05:48:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-23T07:30:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-22T06:13:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"25189008855194752472985426675751935405","date":"2025-07-21T13:54:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"196127234408595978189502459187201511120","date":"2025-07-19T10:06:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277125780245082898168099611514569832875","date":"2025-07-19T02:22:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173939838337155862586383703592601003100","date":"2025-07-17T10:20:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"208776599466904332298634425034564382684","date":"2025-07-16T13:55:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-16T13:48:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-19T23:04:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-19T00:03:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-19T00:02:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-06-18T12:05:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c239820-4e30-4107-9fd5-8f5590260ff8","owner":[],"postedDate":"July 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T14:23:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-18 15:01:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6922885","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6922885","identity":"rs-6922885","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}