Assessing the appropriateness of outpatient physician and inpatient bed allocation: evidence from three cross-sectional surveys in Shanghai (2013–2023)

BACKGROUND: There is a structural imbalance in the distribution of medical resources across different types of medical institutions in China. This study aims to evaluate the appropriateness of outpatient physician and inpatient bed allocation between primary care institutions and hospitals. METHODS: This study utilized data from the Shanghai Health Services Survey and medical resource allocation data for Shanghai from 2013 to 2023. The volume of demand for medical resources was estimated using the health service demand method. By integrating geometric analysis techniques with trigonometric modeling, both the quantity of resource allocation and the quantity of resource demand were represented as vectors, and cosine similarity was applied to evaluate the appropriateness of outpatient physician and inpatient bed allocation. RESULTS: From 2013 to 2023, the allocation quantities of outpatient physicians and inpatient beds in primary care institutions consistently showed a supply-deficit pattern. In 2018, the appropriateness of allocation reached its lowest levels, with scores of 0.5400 for outpatient physicians and 0.9599 for inpatient beds. Over the same period, the allocation of inpatient beds in hospitals exhibited an over-supply pattern. In 2013, the appropriateness of allocation for hospital inpatient beds reached its lowest score of 0.5720. CONCLUSIONS: A structural mismatch exists in the allocation of medical resources between primary care institutions and hospitals in Shanghai. Outpatient physicians and inpatient beds in primary care institutions are consistently under-allocated, whereas inpatient beds in hospitals are persistently over-allocated. Addressing this imbalance requires a multifaceted approach, including strengthening the allocation of healthcare personnel in primary care, enhancing the development of outpatient services integrated with general practice specialties, and appropriately expanding inpatient bed capacity in primary care institutions.