Provincial resource gaps were extreme in China’s community health centers
China’s community health service centers sit at the point where hospital care meets home-based care, and this analysis shows that their distribution is anything but even. Using official national data from 2015 to 2024, investigators examined whether community health service resources matched the permanent resident population across 31 provincial-level regions and whether those resources were being used efficiently.
The imbalance was striking. Density of community health service resources in eastern provinces was far higher than in central and western regions, and the gap between the highest and lowest HRAD values exceeded 10,000-fold. In practical terms, the map of community care capacity does not resemble the map of population need. It resembles a system shaped far more by regional development differences than by a unified primary care strategy.
Efficiency fell after adjustment for external operating pressures
The study used a three-stage DEA model to estimate static allocation efficiency and then applied the Malmquist index to track total factor productivity over time. After adjustment, overall technical efficiency fell from 0.635 to 0.624. Pure technical efficiency rose slightly, while scale efficiency declined. The pattern points to a system where management or operational technique is not the only problem; the size and structure of resource deployment are also working against performance.
One sentence captures the central problem: more resources alone did not restore efficiency.
The adjusted results matter because they separate internal performance from external environmental pressures. Once those pressures were accounted for, the weaker role of scale efficiency became visible, suggesting that some provinces may have built systems that are too large, too fragmented, or too poorly matched to local demand to operate effectively. In a home-based care context, that can translate into slower outreach, weaker continuity, and a reduced ability to absorb aging-related demand at the community level.
Technological progress lagged behind every other efficiency signal
The total factor productivity result was 0.942, equal to an annual decline of 5.8%. Across the province-level analysis, five provinces improved, one remained stable, and 25 showed a downward trend. The most important driver of that decline was lagging technological progress.
This is the part of the analysis that reaches beyond administrative accounting. Community health centers are not only service points; they are operational systems that depend on referral pathways, digital coordination, staff workflow, and the capacity to extend care into homes. When technological progress slows, even a well-funded network can underperform because the delivery model stays locked in older routines. In a country facing rapid population aging, that gap is likely to compound over time rather than resolve on its own.
The data do not suggest that the sector lacks need. They suggest that the sector has outgrown the pace at which its tools, workflows, and regional service models are evolving.
Why eastern provinces pull ahead while central and western regions fall behind
The east-central-west gradient was consistent and large. Eastern provinces carried a much higher density of community health resources, while central and western regions remained relatively under-resourced. The result is a mismatch between population alignment and service capacity that is especially problematic for home-based care, where geographic proximity, staffing continuity, and local coordination determine whether care can be delivered early or only after deterioration.
Resource-population misalignment creates a double burden. Regions with higher demand but lower service density face access strain, while regions with greater density may still fail to convert that capacity into efficient performance if the system is oversized or poorly adapted. The study’s findings support a view of primary care as both a distribution problem and an execution problem. Infrastructure matters, but so does the ability to use it well.
Home-based care amplifies both sides of that equation. Older adults with chronic disease, mobility limits, or functional decline need services that are local, fast, and integrated. When community centers are unevenly distributed, those patients are more likely to depend on hospital-based care for problems that could have been handled earlier in the community. That increases pressure on tertiary facilities and weakens the role of primary care as the system’s first line of response.
Policy choices now hinge on redistribution and service redesign
The investigators call for higher total investment in community health resources, but not as a stand-alone fix. They also recommend technology transfer, service model innovation in central and western regions, and differentiated regional allocation strategies. That combination reflects the structure of the problem seen in the data: distribution gaps are large, efficiency is uneven, and technological stagnation is reducing the return on existing investment.
For policymakers, the implication is direct. Expanding headcount or infrastructure without redesigning service delivery will not solve provincial inefficiency, and may even preserve the same imbalances at a larger scale. A better approach would align staffing, digital tools, and service pathways with the actual burden of aging and home-based care needs in each region.
The study does not measure patient outcomes directly, so it cannot show how much morbidity or avoidable hospitalization is driven by these disparities. It does, however, establish a clear systems-level warning: the current pattern of community health resource allocation in China is uneven, and its efficiency is slipping. The remaining question is not whether local capacity matters. It is how quickly provincial systems can shift from uneven expansion to genuinely population-aligned care delivery.