ArticleBMC public health2026
Regional differences, evolutionary trends, and influencing factors of the level of medical assistance protection across Chinese provinces.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSince the launch of China's new round of health system reform in 2009, substantial progress has been made in expanding medical security coverage and strengthening assistance for vulnerable populations. However, provincial disparities in medical assistance protection remain insufficiently understood, which may challenge the equity and sustainability of the medical security system. This study assessed the level of medical assistance protection across Chinese provinces, examined its regional differences and evolutionary trends, and identified influencing factors.
methodsPanel data from 31 Chinese provinces from 2019 to 2023 were used. The entropy-weighted TOPSIS method was applied to construct a comprehensive index of medical assistance protection. Dagum's Gini coefficient decomposition and kernel density estimation were used to examine regional differences and evolutionary trends. Interrupted time series analysis was employed to assess pandemic-related changes, and a panel Tobit model was used to identify influencing factors of medical assistance protection.
resultsMedical assistance protection declined sharply in 2020 and then gradually recovered through 2023. The western region consistently showed higher protection levels than the eastern and central regions. Overall, interregional, and intraregional disparities declined during the study period, while the dominant source of disparity shifted from interregional differences to hyper-variable density, and intraregional disparities became more important than interregional disparities by 2023. Kernel density estimation indicated divergent polarization patterns, with intensification in the eastern region, gradual weakening in the central region, and no clear polarization in the western region. Fiscal investment and hospitalization rates were positively associated with protection levels. Economic development and education levels were negatively associated with protection intensity, suggesting a possible welfare paradox.
conclusionThe findings reveal an atypical regional pattern in which economically less-developed western provinces showed higher medical assistance protection levels than more developed eastern provinces. This pattern suggests that targeted fiscal transfers and policy support may play a more direct role than economic growth alone in strengthening medical assistance protection. Region-specific strategies are needed to optimize fiscal investment, improve service utilization, and strengthen primary healthcare capacity, thereby promoting a more equitable and sustainable medical assistance system.
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