Smart city development and medical service performance: evidence from a province-level panel study in China

Objectives This study examines whether smart city development is associated with improvements in medical service performance across Chinese provinces, addressing the limited large-scale quantitative evidence on digital governance and healthcare systems in developing-country contexts. Methods A balanced province-level panel dataset covering 31 provinces in mainland China from 2013 to 2024 was constructed using national statistical yearbooks and official smart city pilot lists. Medical service performance was measured by a composite Medical Service Performance Index (MSPI) capturing healthcare utilization structure, care quality, and preventive health management capacity. Two-way fixed effects models were applied to estimate the association between smart city exposure and healthcare system performance. Results Higher smart city exposure is associated with improved medical service performance. In baseline models, smart city exposure is positively related to MSPI (β = 0.182, p 0.01). Mechanism analyses show improvements in preventive health management (β = 0.184, p 0.01), care quality (β = 0.135, p 0.01), and reduced reliance on high-intensity hospital services (β = −0.120, p 0.01). After accounting for these mechanisms, the direct association becomes statistically insignificant. Conclusion Smart city development is linked to better medical service performance in China, suggesting that digital governance initiatives may strengthen healthcare systems through improved coordination, care quality, and preventive health management.