Asymmetry in inter-municipal cooperation in health services - How does it affect service quality and autonomy?

Will urban scale affect health services inequity? The empirical evidence from cities in China

Background

The equity of public resources triggered by city shrinkage is a global challenge. Significantly, the impact of city shrinkage on the allocation of health service resources needs to be better understood. This study explores the impact of population change on government investment and health service delivery in shrinking cities.

Data and method

Using data from China's Urban Statistical Yearbook (2010-2020), we employ regression discontinuity (RD) and fixed-effect models to examine the causal relationship between city shrinkage and health service provision.

Result

Shrinking cities show significant disparities in health resources, particularly in bed numbers (-1,167.58, p < 0.05) and doctor availability (-538.54, p < 0.05). Economic development (p < 0.01) and financial autonomy (p < 0.01) influence hospital bed distribution. Investments in public services (primary schools and teachers, p < 0.01) affect health resource delivery. Robustness tests support our results.

Conclusion

This study reveals how city shrinkage disrupts health service provision and equity, establishing a causal relationship between city shrinkage/expansion and health resource allocation, emphasizing the imbalance caused by urban population changes. City expansion intensifies competition for health resources, while shrinking cities struggle to provide adequate resources due to government reluctance. Policymakers should adapt health resource allocation strategies to meet patient demands in changing urban landscapes.

The effectiveness of inter-municipal cooperation for integrated sustainable waste management: A case study in Ecuador

There is an increasing awareness that effective waste management is essential for transitioning towards a circular economy and achieving sustainable development goals. Scholars have studied inter-municipal cooperation (IMC) as a governance solution with the potential to generate economies of scale and reduce financial costs in waste management. However, previous research has not yet focused on measuring the effectiveness of different types of cooperation on social and environmental outcomes. We analyse the effect of different types of IMC, ranging from indirect to collaborative, on Integrated Solid Waste Management (ISWM) indicators. Our embedded qualitative case study in the emerging metropolitan region of Cuenca-Azogues (Ecuador) found that municipalities that invested in more complex cooperation types achieved better integrated waste management performance, particularly on final disposal, citizen participation, inclusion of recyclers and environmental sustainability.