Can cross-sector governance improve urban health resource supply? Evidence from China's Healthy City pilot policy.

Background: China launched the national Healthy City pilot program in 2016 to translate Health in All Policies into municipal governance. The policy differs from sector-specific health interventions because it embeds health goals into urban planning, fiscal allocation, interdepartmental coordination, and accountability routines. Whether this cross-sector governance approach increases urban health resource supply remains empirically unresolved. Methods: This study constructs a city-year panel of 293 prefecture-level cities from 2007 to 2022. It applies a two-way fixed effects difference-in-differences (DID) design to estimate the effect of the Healthy City pilot on three health resource outcomes: hospitals and health centers, hospital beds, and licensed physicians. Event-study estimates, per-capita specifications with socioeconomic controls, six robustness checks, and a placebo test assess the credibility of the estimates. Results: The baseline DID estimates show that the pilot increased the log number of hospitals and health centers by 0.248 (SE = 0.061, Conclusions: Cross-sector governance can expand urban health resource supply by aligning fiscal priorities and administrative coordination around health goals. The largest effect appears for institutional capacity, while the smaller physician effect suggests that workforce supply requires complementary policies. Resource-scarce cities gain more from the pilot, indicating that governance-oriented health policy can support more equitable health system strengthening.