Background The county‐level traditional Chinese medicine hospitals have significantly expanded in recent decades. This study aims to assess the changes in the efficiency and productivity of the county‐level traditional Chinese medicine hospitals and explore the possible causes of such changes. Methods Sixty one hospitals spanning from 2001 to 2017 were selected as samples in this study. And a slacks‐based measure of super‐efficiency in Data Envelopment Analysis and Malmquist index were used to respectively measure the changes in the efficiency and productivity. Results The scale of sample hospitals in Hubei continuously expanded from 2001 to 2017. The mean values of technical efficiency, pure technical efficiency and scale efficiency in 2017 were 0.686, 0.74 and 0.933, respectively. The technical efficiency changes in 2017 was 1.97 times that of 2001, and the technological changes in 2017 was 1.45 times that of 2001. Conclusions The medical environment and resources have been greatly improved due to the expansion of the sample hospitals, but the technical efficiency value indicates that the operation efficiency of sample hospitals still needs to be significantly improved. Decision‐makers are advised to attach importance to the efficiency of operation management and consider the impact of multiple factors on the change in productivity.

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BackgroundThe efficient operation of county-level medical institutions is a significant guarantee in constructing Chinese rural tertiary care service networks. However, it is still unclear how to increase the efficiency of county hospitals under the interaction of multiple factors. In this study, 35 county general hospitals in China were selected to explore the configuration paths of county hospitals' high and poor efficiency status under the Environment-Structure-Behavior (ESB) framework and provide evidence-based recommendations for measures to enhance its efficiency.MethodsData envelopment analysis with the bootstrapping procedure was used to estimate the technical efficiency value of case hospitals. A fuzzy-set qualitative comparative analysis approach was carried out to explore the configuration of conditions to the efficiency status.ResultsAntecedent configurations affecting the efficiency status of county hospitals were identified based on the ESB analytical framework. Three high-efficiency configuration paths can be summarized as structural optimization, capacity enhancement, and government support. Another three types of paths, namely insufficient capacity, aggressive expansion, and poor decision-making, will lead to inefficient configurations.ConclusionQualitative comparative analysis is necessary when exploring complex causality. The efficiency situation of county hospitals results from a combination of influencing factors instead of the effect of a single one. There is no solitary configuration for high efficiency that applies to all healthcare units. Any measures aimed at efficiency promotion should be discussed within the framework of a case-specific analysis.

An accurate assessment of current healthcare resource allocations is essential to address existing inequities in the hierarchical diagnosis and treatment system introduced in China. The data come from statistical reports of local governments and the developer platform of Amap, a Chinese mobile map. The data were analysed using the hierarchical two-step floating catchment area method. By spatial accessibility analysis, the distribution of accessibility to hierarchical healthcare facilities in Zhongshan City, Guangdong Province was found to be uneven, with clustered high accessibility in the central, north-western and southern parts of the city. To enhance the capacity of healthcare services, the government should allocate healthcare resources rationally to better associate with population densities.