ORIGINAL RESEARCH article
Front. Public Health
Sec. Aging and Public Health
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 106 articles
Healthcare inequities in Chinese megacities: the older adult population's accessibility to public hospitals in suburban Shanghai
Provisionally accepted
- 1School of Social Development, East China Normal University, Shanghai, China
- 2Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Hong Kong, Hong Kong, SAR China
- 3School of Social Development and Public Policy, Fudan University, Shanghai, China
- 4School of Business, East China University of Science and Technology, Shanghai, China
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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.
Keywords: health equity, health inequality, hospital accessibility, Older adult, Shanghai, China
Received: 06 Sep 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 WANG, LI, ZHANG, Gu and YANG. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anni ZHANG
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