Equity and efficiency of medical service systems at the provincial level of China’s mainland: a comparative study from 2009 to 2014

Abstract

BackgroundThe astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery.MethodsA descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants.ResultsThe inputs and outputs of most provincial medical service systems increased gradually from 2009 to 2014. Overall, the eastern region allocated more human and capital resources than the other two regions, and produced more than 50% of the total outpatient and emergency room visits, whereas the western region produced more inpatient services (about 30% of the total volume of inpatient services) according to the distribution of the population. The average efficiency scores of the provincial medical systems in China’s mainland were 0.895, 0.927, 0.929, 0.963, 0.977 and 0.968 from 2009 to 2014, with a slight average improvement of 1.60%. The efficiency score of each provincial medical service system varied greatly from one another: Tibet (1.475 ± 0.057) performed extremely well, whereas several others including Heilongjiang (0.579 ± 0.001) performed poorly. Furthermore, the proportion of high-class medical facilities was negatively associated with efficiency, whereas the proportion of the vulnerable population, the per capita Gross Domestic Product, the proportion of the illiterate population and the improvement of primary health care had positive effects on efficiency.ConclusionInequity in health resources allocation and service provision existed across the regions, but not all the gaps have begun to narrow since 2009. The difference of efficiency was great among provincial medical service systems but minor across regions, and the score changed very little over time. More importantly, the central region held the lowest average efficiency score in the past 6 years, while the western region held the largest average efficiency score at the first 5 years, which should receive enough attention of the government and decision-makers. In practice, efficiency was related to many complicated factors, indicating that the improvement of efficiency is a complex and iterative process that requires the strong cooperation of many sectors.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5084-7) contains supplementary material, which is available to authorized users.

Equity and efficiency of primary health care resource allocation in mainland China

“…Further analysis of the mean of TE, PTE and SE in the eastern, central and western regions showed that west>east>middle. The same result had been found in the study of Ding et al [ 21 ]. This finding seemed to be an interesting phenomenon.…”

“…This finding means that the eastern region, with its economic and geographical advantages, is starting to improve its poor PHCRA [ 13 ]. The equity of western region had considerably improved because of inclined policies and aids [ 21 ]. However, the central region presented a relatively reduced development due to shortage of priority and positivity.…”

“…The number of institutions and beds represents the capital, and health workers represents the human resources. The health workers include physicians, nurses, other clinical staff, administrative staff, and other nonclinical staff [ 21 ]. They were chosen as input indicators to measure equity.…”

Efficiency Estimates of Public Health Center II Facilities in Southwestern Uganda

“…Overall, the average TE and SE estimates of health centres were 93 percent and 91 percent during the study periods respectively. In the estimation of efficiency and equity in medical service systems, Ding et al (2018) find that efficiency scores of provincial level facilities varied significantly from one another. Related estimates in Meru county in Kenya by Makheti (2017) indicates that the mean technical efficiency from the sampled public health facilities was 45.2% suggesting that the existing health services can be augmented by 54.8% without the provision of additional input resources.…”

Analysis on the Differences of Health Resources Allocation in Undeveloped Areas of Chongqing, China: A Cross-Sectional Study

“…Since the implementation of the new health care reform in 2009 and the targeted poverty alleviation strategy in 2015, China has significantly optimized the allocation of health resources in undeveloped areas in the west. The capacity, accessibility, and resource utilization efficiency of medical services have improved significantly (Ding et al, 2018). However, previous studies confirmed that the fairness of the allocation of health resources in Inner Mongolia, Qinghai, Xinjiang, and Tibet by geographic area in western China was poor.…”