Healthcare inequities in Chinese megacities: the older adult population’s accessibility to public hospitals in suburban Shanghai

Introduction: Due to the unbalanced spatial distribution of healthcare resources, the suburbanization of the older adult population may contribute to new health inequities. This study investigates public hospital accessibility of different regions and groups in Shanghai, exploring the equitability of resource distribution within the broader context of the city’s evolving spatial organization and political economy. Methods: Drawing on data from the 2000 and 2010 population censuses and the geographical distribution of hospitals, this study employs two complementary measures: the healthcare supply and demand matching index, and the average distance to the closest hospital, evaluating both the diversity of healthcare options and geographical convenience. Results: The findings reveal significant healthcare inequities in public hospital accessibility: (1) Continuous increase in the number of healthcare hospitals has brought about some improvements in supply levels, but in suburban Shanghai, the accessibility of public hospital is rather poor, and the average distance for all older adults to the closest hospitals has shown almost no improvement, increasing from 2.3 km in 2000 to 2.4 km in 2010; (2) older adults in suburban areas face greater distances to the closest hospital compared to their counterparts not in suburban areas. In 2010, the average distance was 4.4 km for older adults outside the outer-ring, compared to only 0.9 km within the inner-ring; and (3) there is a widening gap in health inequities among individuals from different socioeconomic strata between 2000 and 2010. The distance to the closest tertiary hospital increased by approximately 6 km for older adults in blue-collar communities, but only 1 km for those in white-collar and advanced white-collar communities. Conclusion: The study concludes that the inequitable accessibility to public hospitals for suburban older adults is a profound structural issue in Shanghai. Policy interventions must extend beyond simply increasing hospital numbers to address the root causes in healthcare governance and urban spatial planning to achieve health equity.