Objective To analyze the fairness and efficiency of health resource allocation and their regional differences in China, providing references for promoting high⁃quality and efficient integration of health resources. Methods Data on the input and output of health resources from 31 provinces (autonomous regions, municipalities directly under the central government) from 2010 to 2021 were collected, and the fairness of health resources allocation was analyzed by the degree of agglomeration. The three⁃stage data envelopment analysis (DEA) model was used to conduct a static analysis of the efficiency of health resource allocation in China, and the Malmquist index was used to conduct a dynamic analysis of the relevant data from 2010 to 2021. Results (1) When allocated by geographical area, the agglomeration degree of physical health resources in China's provinces (autonomous regions, municipalities directly under the central government) in 2021 ranged from 0.02 to 25.71, while that of human health resources ranged from 0.02 to 30.89. The health resource agglomeration degree (HRAD) across the four major economic regions showed the pattern of Eastern>Central>1>Northeastern>Western. When allocated by population, in terms of medical institutions, Xizang Autonomous Region had the highest HRAD/population agglomeration degree (PAD) value, while Shanghai had the lowest. For actual hospital beds, Heilongjiang Province had the highest HRAD/PAD value, while Guangdong Province had the lowest. Regarding health technical personnel, Beijing had the highest HRAD/PAD value, while Jiangxi Province had the lowest. For physical health resources, the HRAD/PAD values across the four major economic regions generally followed the pattern of Northeastern>Western>Central>1>Eastern, while for human health resources, the pattern was Northeastern>Western>Eastern>1>Central. (2) Before the three⁃stage DEA adjustment, the average values of comprehensive efficiency, scale efficiency, and pure technical efficiency in China's health resource allocation were 0.837, 0.935, and 0.897, respectively. Five provinces (autonomous regions, municipalities directly under the central government), including Chongqing, were in a DEA⁃effective state, while 26 provinces (autonomous regions, municipalities directly under the central government), such as Liaoning Province, were in a DEA⁃ineffective state. In terms of returns to scale, among the 31 provinces (autonomous regions, municipalities directly under the central government), 15 exhibited increasing returns to scale, and 11 exhibited decreasing returns to scale. After adjustment, the average values of comprehensive efficiency, scale efficiency, and pure technical efficiency in China's health resource allocation changed to 0.798, 0.883, and 0.897, respectively. The comprehensive efficiency declined in 13 provinces (autonomous regions, municipalities directly under the central government), including Tianjin, while it improved in 13 others, such as Heilongjiang. Post⁃adjustment, eight provinces (autonomous regions, municipalities directly under the central government), including Jiangsu, achieved DEA effectiveness, with Sichuan, Jiangsu, and Guangdong newly reaching the technological frontier. (3) From 2010 to 2021, the mean total factor productivity of China's health resource allocation was 0.990, with an average annual decline of 1.00%. There were significant disparities in health resource allocation efficiency among provinces (autonomous regions, municipalities directly under the central government). Shanghai and 13 other provinces (autonomous regions, municipalities directly under the central government) were classified as high⁃agglomeration, high⁃efficiency regions. Beijing and 8 other provinces (autonomous regions, municipalities directly under the central government) fell into high⁃agglomeration, low⁃efficiency regions. Xizang Autonomous Region and 6 other provinces (autonomous regions, municipalities directly under the central government) were categorized as low⁃agglomeration, low⁃efficiency regions. Yunnan Province was the only low⁃agglomeration, high⁃efficiency region. When analyzed by the four major economic regions as follows: the Eastern and Central regions were high⁃agglomeration, high⁃efficiency regions, the Northeastern and Western regions were low⁃agglomeration, low⁃efficiency regions. Conclusion The fairness and efficiency of health resource allocation in China are unbalanced and uncoordinated. At the same time, the efficiency of health resource allocation is low and declining, and the improvement of technological progress is the key to improving the efficiency of health resource allocation. It is recommended to take into account multiple factors, formulate regional health planning with regional characteristics, and promote the balanced distribution and rational use of regional high⁃quality medical resources.

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