Assessment of Resilience of China's Healthcare System: A Comparison of Provincial Resource Allocation before and After COVID-19 (2019-2020)

The COVID-19 pandemic has functioned as a comprehensive test of the adaptive capacity and resilience of healthcare systems worldwide. This study investigates the heterogeneous resilience pathways among provincial healthcare systems in China by employing a multi-group difference-in-differences methodology applied to panel data from 31 provinces spanning the period 2012 to 2020. Following the established Four Major Regions framework, with the Eastern region serving as the reference, three distinct adaptation pathways emerge. The Eastern region demonstrated consistent and stable growth in healthcare capacity and service delivery, reflecting a mature system able to absorb shocks without major structural adjustments. In contrast, the Central and Western provinces exhibited a pronounced "catch-up" effect, achieving resilience primarily through substantial expansions in bed capacity and related infrastructure, which facilitated rapid service scaling to meet rising demand during the pandemic. The Northeast region followed a markedly different strategy, characterized by rapid institutional and organizational development while simultaneously reducing bed supply, representing a form of "scale expansion with resource dilution." These findings suggest that the mechanisms of healthcare system resilience are strongly influenced by regional conditions, historical development trajectories, and strategic policy choices. Understanding these differentiated pathways offers valuable guidance for policymakers seeking to strengthen health system preparedness, allocate resources effectively, and tailor interventions to regional needs, ultimately supporting sustainable resilience in the face of future public health crises.