Evaluating and enhancing the service capacity of secondary public hospitals in urban China: a multi-method empirical analysis based on Guangzhou (2019-2023).

Background: Secondary public hospitals play a pivotal role in China's hierarchical medical system, serving as a critical intermediary tier. However, in rapidly urbanizing cities such as Guangzhou, these hospitals face mounting challenges including widening efficiency disparities, imbalanced resource allocation, and weak governance structures. This study aims to systematically evaluate the evolution and spatial dynamics of service capacity among secondary general public hospitals in Guangzhou, offering empirical evidence to support capacity improvement and policy optimization. Methods: A composite evaluation framework was constructed across three dimensions: medical quality, operational efficiency, and sustainability. Based on panel data from 12 secondary general public hospitals in Guangzhou between 2019 and 2023, we applied a combination of Entropy-TOPSIS model, Kernel Density Estimation (KDE), and the Dagum Gini Coefficient to assess overall service capacity levels, temporal trends, and spatial inequalities. Results: The findings indicate a general upward trend in service capacity; however, disparities among hospitals have intensified. While indicators of medical safety (e.g., mortality and complication rates) have steadily improved, there remains significant divergence in surgical ratios and pharmaceutical service coverage-particularly in peripheral areas. KDE analysis reveals a transition from unimodal to bimodal distribution, indicating stratification of service capacity. Decomposition of the Dagum Gini Coefficient shows that transvariation (inter-group overlaps) is the main source of inequality, underscoring increasing cross-regional capacity divergence. Conclusions: Although Guangzhou's secondary public hospitals have shown overall improvement, challenges remain in terms of regional coordination and internal structural disparities. This study recommends differentiated interventions such as specialty alliances, performance-based resource allocation, and workforce optimization to enhance system resilience and equity. The proposed evaluation model demonstrates strong applicability and scalability, offering theoretical and empirical insights for healthcare system governance in other rapidly urbanizing regions.