Objective:It aims to explore the spatial heterogeneity,dynamic evolution patterns,and driving mechanisms of medical insurance fund sustainability across Chinese provinces,providing decision-making support for addressing regional development imbalances and improving collaborative governance of healthcare systems.Methods:Based on data from 31 provinces in China(2010-2023)on the accumulated balance of medical insurance funds available for payment months,the Dagum Gini coefficient decomposition method is employed to analyze regional disparity sources,combined with spatial autocorrelation analysis and the Spatial Durbin Model(SDM)to reveal spatial dependency pathways and multidimensional driving mechanisms.Results:The findings indicate a gradient disparity characterized by"high stability in the east and high heterogeneity in the west with some high-risk zone".Tibet and Gansu represent the extremes of this distribution.The regional disparity mechanism has shifted from inter-group dominance to super-variable density dominance,with the latter contributing 48.59％by 2023.Significant spatial agglomeration effects were observed(Moran's I≥0.249,P＜0.01),where economic development(total effect of regional average GDP=0.278),aging populations(total effect of the dependency ratio for the elderly=-0.324),and cross-regional healthcare utilization(total effect of cross-regional healthcare utilization=-0.223)exerted asymmetric impacts through spatial spillovers.Conclusion:The sustainability of medical insurance funds is shaped by the interplay of geographical and institutional spaces.A categorized governance framework and regional collaborative mechanisms are essential,prioritizing policy integration for economic empowerment,population regulation,and resource optimization to transition healthcare governance from"localized administration"to"regional coordination".

Objective:It aims to explore the spatial heterogeneity,dynamic evolution patterns,and driving mechanisms of medical insurance fund sustainability across Chinese provinces,providing decision-making support for addressing regional development imbalances and improving collaborative governance of healthcare systems.Methods:Based on data from 31 provinces in China(2010-2023)on the accumulated balance of medical insurance funds available for payment months,the Dagum Gini coefficient decomposition method is employed to analyze regional disparity sources,combined with spatial autocorrelation analysis and the Spatial Durbin Model(SDM)to reveal spatial dependency pathways and multidimensional driving mechanisms.Results:The findings indicate a gradient disparity characterized by"high stability in the east and high heterogeneity in the west with some high-risk zone".Tibet and Gansu represent the extremes of this distribution.The regional disparity mechanism has shifted from inter-group dominance to super-variable density dominance,with the latter contributing 48.59％by 2023.Significant spatial agglomeration effects were observed(Moran's I≥0.249,P＜0.01),where economic development(total effect of regional average GDP=0.278),aging populations(total effect of the dependency ratio for the elderly=-0.324),and cross-regional healthcare utilization(total effect of cross-regional healthcare utilization=-0.223)exerted asymmetric impacts through spatial spillovers.Conclusion:The sustainability of medical insurance funds is shaped by the interplay of geographical and institutional spaces.A categorized governance framework and regional collaborative mechanisms are essential,prioritizing policy integration for economic empowerment,population regulation,and resource optimization to transition healthcare governance from"localized administration"to"regional coordination".