ArticleFrontiers in public health2026
Does wealth hinder structural coordination? Fiscal capacity and the coordination of healthcare and older adult care in China.
Article in Frontiers in 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
Objective: While population aging intensifies the need for integrated health and older adult care, it remains unclear whether greater local fiscal capacity actually facilitates such coordination. This study examines the coupling coordination between healthcare resources and older adult care beds at the county level in Ningbo, Taizhou, and Wenzhou (Zhejiang, China) from 2022 to 2024, with a focus on the role of fiscal constraints. Methods: A panel of 31 county-level units ( Results: The mean CCD was 0.419 (SD = 0.166), indicating a state between "near disorder" and "barely coordinated," with no significant temporal trend. The aging rate was positively associated with CCD ( Conclusion: The negative within-county association between fiscal self-sufficiency and CCD reveals a "fiscal paradox": periods of higher fiscal autonomy are accompanied by a relative under-prioritization of older adult care beds, creating a structural imbalance, whereas greater reliance on conditional transfers is associated with more balanced resource allocation. These findings generate the hypothesis-meriting further testing with direct transfer data-that conditional intergovernmental transfers may help promote balanced resource allocation, and that coupling indicators embedded in transfer designs could warrant evaluation in future policy pilots.
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