INTRODUCTION:
Healthcare services represent a significant and growing contributor to global greenhouse gas emissions. This study aimed to quantify the regional carbon footprints from healthcare services in China, identify the main driving activities, and explore potential emission reduction pathways.

METHODS:
An environmentally extended input-output approach (EEIOA) was utilized to assess the carbon footprint of the healthcare services in 30 provinces in China. Data on expenditures for public hospitals, private hospitals, other healthcare institutions, building construction in healthcare services and medical research are obtained from the statistical yearbooks and input-output tables of each province.

RESULTS:
In 2017, the carbon footprint of healthcare services across 30 Chinese provinces exhibited a distinct spatial pattern, higher in the northeast and northwest, and lower in the central-western and southeastern regions. Hebei Province recorded the highest total carbon footprint (40 MtCO₂e), accounting for 10% of the national healthcare total, while Hainan had the lowest (2.5 MtCO₂e), representing just 0.6%. Significant variations were observed in the primary emission sources by region: Ningxia Autonomous Region led in power and heat (which accounts for 76% of the total healthcare carbon footprint in the region), Guizhou in direct healthcare emissions (40%), Qinghai in chemical products (38%), Hebei in coal mining (35%), Beijing in transport (22%), Shanghai in metal products (21%), and Hainan in non-metal products (16%).

CONCLUSIONS:
The carbon footprint of China's healthcare services was spatially clustered in the Northeast, Northwest, and Southwest, with significant disparities between high- and low-emission regions and notable variations in emission sources across provinces. Therefore, tailored low-carbon transformation strategies should be developed to suit local conditions and achieve nationwide decarbonization of the healthcare sector.