Efficiency and equity of hospital services in mainland China: based on data from 2017 to 2021

Abstract

Background: Hospitals are an essential part of the health care system. The purpose of this study is to evaluate the equity and service efficiency of health resource allocation in the hospital service system of 31 provinces (municipalities directly under the central government and autonomous regions) in mainland China from 2017 to 2021, and to analyze the influencing factors of hospital service efficiency to provide a reference for rational allocation of hospital health resources and improvement of hospital service efficiency. Methods: Equity of allocation of hospital health resources in mainland China was evaluated in three dimensions using the Gini coefficient and Lorenz curve. Hospital service efficiency was calculated by output-oriented super efficiency slack-based model-data envelopment analysis (SE-SBM-DEA) model and DEA-based Malmquist total factor productivity index (MTFP), and the influencing factors of hospital service efficiency were analyzed by panel data regression. Results: The number of hospitals in mainland China grew from 31056 to 36570 between 2017 and 21st. The equity ranking of the dimensions of hospital health resource allocation was Demographic > Economic > Geographic. However, the curvature of the demographic and economic dimensions is smaller compared to the curvature of the Lorenz curve for the geographic dimension. The demographic dimension has the lowest average Gini coefficient (0.167), followed by the economic (0.295) and the geographical (0.616). The 2017-2021 MTFP results show that none of the DMU efficiency values exceed 1. SE-SBM-DEA results show 15 DMUs in 2021 with total factor productivity above 1. The five-year average efficiency values ranked West (0.851) > East (0.834) > Central (0.673); Five influential factors identified by panel data regression analysis, Among them, X1(The proportion of urban population), X3(The percentage of illiterate population to total aged 15 and over) and X10(The proportion of the volume of medical service in primary medical facilities) have a positive relationship with hospital service efficiency, and X5(The level of per capital outpatient and emergency treatment expenditure) and X8(The proportion of hospital personnel) have a negative relationship with hospital service efficiency. Conclusion: After five years of development, the hospital service system in mainland China has grown significantly in number and size, but there are still differences in the allocation of hospital health resources between the East and the West, and intra-regional differences remain large. The overall level of efficiency in hospital services over the last five years was poor, with the West overtaking the East as the region with the highest five-year average. The regression model verified the effect of some factors on hospital service efficiency, and the effect of disadvantaged groups on hospital service efficiency was not significant (P>0.05).