Has the supply of care beds for older adults become more equal across Chinese provinces? Spatial distribution dynamics and convergence evidence from a thirteen-year panel

IntroductionEqualizing basic older adult care services is a core objective of China’s response to population aging, yet whether the provision of older adult care bed supply has become more equal across provinces, and how its spatial structure has evolved, remains unclear. We ask how large provincial disparities in bed supply are and where they originate, whether supply is spatially clustered, how the distribution has evolved, and whether gaps converge.MethodsUsing a balanced panel of 31 provinces over 2011–2023 (403 observations), bed supply is measured as beds in registered institutions and community facilities per 1,000 persons aged 60 and over. The analysis combines the Dagum Gini decomposition, global and local Moran’s I under three weight matrices, kernel densities, ordinary and spatial Markov chains, σ- and β-convergence tests with spatial-lag checks, the Phillips–Sul log t test, and system GMM.ResultsThe main findings are as follows: (i) the Gini coefficient fell from 0.256 in 2012 to 0.125 in 2023 (−51.1%), driven by the collapse of the net between-region component from 42.6 to 13.9% of total inequality, so that by 2023 transvariation (51.9%) rather than between-region gaps dominated; (ii) bed supply was significantly spatially clustered in 2011–2014 (Moran’s I up to 0.478, p < 0.001; a Yangtze River Delta high–high cluster), but clustering dissolved from 2015 onward; (iii) the distribution stayed unimodal and Markov mobility was bidirectional under relative and absolute classifications; (iv) the east fell from the highest to the lowest regional mean by 2023, led by sharp declines in Zhejiang, Hainan, Guangdong and Beijing; (v) β-convergence held in every specification and was unaffected by a spatial-lag term; the log t test did not reject national convergence (t = 0.958) but rejected it within the east (t = −4.445); system GMM implies about 23% per year, an upper bound.DiscussionEqualization of bed supply has advanced substantially and dissolved earlier spatial clustering, but coincides with declining relative provision as the older population outpaces bed expansion. The eastern decline may reflect a shift toward service-based care—eastern community service volume doubled over 2020–2023—but this expansion was not concentrated where beds fell, and mechanisms remain unidentified.