Disparities in gynecological care capacity in China: a national assessment using the structure-process-outcome framework.

BACKGROUND: Regional and hierarchical disparities in gynecological care may compromise equity and quality in China. Assessing structural resources, clinical processes, and outcomes is critical to guide system improvement. METHODS: We conducted a nationwide cross-sectional survey of 376 public hospitals across 31 provinces, stratified by region (Eastern, Central, and Western) and hospital level (county vs. non-county). Participants included 3,094 gynecological physicians and 24,126 patients. Indicators were defined according to the Structure-Process-Outcome model: staff, equipment, service volume, and surgical capacity (structure); clinical pathway implementation and guideline awareness (process); and patient health status and satisfaction (outcome). RESULTS: Significant disparities were identified across regions and hospital levels. Eastern hospitals had larger gynecological teams (median 32 vs. 25 Central, 24 Western; p < 0.001) and more physicians with master’s degrees (21.1% vs. 8.0%; p < 0.001). Non-county hospitals showed greater structural capacity, with higher ultrasonography availability (82.1% vs. 62.6%; p < 0.001) and more Grade IV surgeries (15.4% vs. 8.7%; p < 0.01). Process indicators followed similar trends: cervical-cancer pathway use (43.9% vs. 20.7%; p < 0.001) and guideline awareness (28.7% vs. 18.3%; p < 0.05) were higher in better-resourced settings. Outcome disparities persisted, with inpatient deterioration more frequent in Western hospitals (14.0% vs. 10.9%; p < 0.001). Despite uniformly high satisfaction (74.5% outpatients, 79.3% inpatients), no association with objective outcomes was observed, highlighting a disconnect between perceived and actual quality of care. CONCLUSIONS: Gynecological healthcare in China shows substantial regional and hierarchical inequities, largely driven by structural resources. High satisfaction scores obscure disparities in objective outcomes. Policies aiming at redistributing resources, expanding guideline implementation, and strengthening provider training are needed to improve care equity and quality.