Optimizing health promotion resource allocation and health facility spatial layout to match supply and demand: A fairness–Efficiency synergy approach

As urbanization accelerates in China, the mismatch between the supply and demand of public health facilities is shifting from a quantity mismatch to a spatial one, with growing concerns about the imbalance between fairness and efficiency in allocation. To achieve balance of fairness and efficiency in both spatial and quantitative, this study focuses on Xihu District, Hangzhou, examining two types of health facilities: sports and medical facilities. Using indicators such as the coefficient of variation, Gini coefficient, and match degree, the study employs a Two-Step Floating Catchment Area (2SFCA) method, based on life circles and “service circles,” to assess the fairness, efficiency, and spatial mismatch characteristics of health promotion resource allocation from the dual perspectives of supply-demand coupling and supply-demand separation. The results show that: (1) While fairness and efficiency show an “identity relationship” in health facility allocation, the balance of supply-demand, and the allocation features in the quantity-space dimension, will influence the connotation of fairness and efficiency. (2) The supply and demand of health facilities are generally balanced in quantity, but they exhibit a heterogeneous spatial mismatch, characterized by the differentiation of supply shortages and oversupply across different regions. Compared to medical facilities, the spatial mismatch for sports facilities is more pronounced. (3) Methods of supply-demand separation and coupling demonstrate complementary advantages. The former is more suitable for evaluating supply-demand quantity issues at specific facilities or residential points, while the latter more accurately reflects spatial issues at the regional scale. Finally, the study suggests a “fairness-efficiency” synergy approach for health promotion resource allocation in Xihu District and uses an iterative method to optimize the facility layout. This research offers a new perspective on urban public facility allocation and provides guidance for creating a fair and efficient healthy city.