# Spatio-temporal evolution of financial sustainability in Chinese public hospitals: evidence from provincial panel data (2010–2022)

## TL;DR

This study examines how financial sustainability in Chinese public hospitals changed from 2010 to 2022, revealing regional differences and key factors influencing it.

## Contribution

The paper introduces a multidimensional framework for evaluating financial sustainability and identifies spatial and temporal patterns and mechanisms.

## Key findings

- Financial sustainability showed fluctuating growth with increasing regional disparities over three distinct phases.
- A strong spatial pattern emerged with higher sustainability in eastern and southern provinces.
- Government fiscal investment had a significant total effect with spatial spillover impacts.

## Abstract

To analyze the spatio-temporal evolution patterns of financial sustainability in Chinese public hospitals and identify key driving mechanisms.

Using balanced panel data from 31 Chinese provinces (2010–2022), we constructed a theory-grounded multidimensional financial sustainability evaluation framework and employed spatial econometric models and convergence testing.

Financial sustainability exhibited “fluctuating rise with intensifying regional differentiation” characteristics, evolving through three phases: steady improvement (2010–2015), rapid growth (2016–2019), and stable development (2020–2022). Spatially, a significant “high east-low west, strong south-weak north” pattern emerged, with global Moran's I of 0.347 indicating strong spatial autocorrelation. Club convergence analysis identified three groups with annual convergence speed of 1.8%. Government fiscal investment demonstrated a total effect of 0.401, including significant spatial spillover effects (0.089).

Policy transmission occurs through policy learning, talent mobility, and technological diffusion mechanisms. The findings validate spatial spillover and policy diffusion theories while providing scientific evidence for establishing adaptive financial guarantee mechanisms and offering valuable reference for healthcare financing in developing countries.