Research on Urban Medical and Health Services Efficiency and Its Spatial Correlation in China: Based on Panel Data of 13 Cities in Jiangsu Province

Tao

et al. 2022

Front. Public Health

BackgroundThe hierarchical medical system (HMS) refers to the classification of treatment according to disease priorities based on severity and difficulty to promote the fairness of medical services for residents, which is regarded as the key to the success of medical reform in China.MethodsIn the past decade of “New Medical Reform,” the efficiency of HMS, including secondary and tertiary hospitals and primary healthcare centers (PHCs), was measured horizontally and vertically by employing the combination of an output-oriented superefficiency slack-based model-data envelopment analysis (SE-SBM-DEA) model with the Malmquist total factor productivity index (MTFP). In the second stage, the overall technical efficiency (OTE) scores were regressed against a set of environmental characteristics and several managerial factors through bootstrapping truncated regression.ResultsOn average, the OTE score in tertiary hospitals was 0.93, which was higher than that in secondary hospitals and PHCs (0.9 and 0.92, respectively). In terms of trend, the OTE of tertiary hospitals declined at first and then increased. The opposite was true of secondary hospitals, in which the APC of the OTE was 10.82 and −3.11% in early and late 2012, respectively. The PHCs generally showed a fluctuating downward trend. In the aspects of productivity, all institutions showed a downturn by an annual average rate of 2.73, 0.51, and 2.70%, respectively. There was a significant negative relationship between the ratio of outpatients to inpatients and tertiary hospitals. Additionally, the medical technical personnel per 1,000 population negatively affected PHCs. In contrast, the GDP per capita had a significantly positive effect on tertiary hospitals, and the number of beds per 1,000 population positively influenced PHCs.ConclusionThe efficiency of medical institutions at various levels in HMS was unbalanced and took the form of an “inverted pyramid.” Multilateral factors influence the efficiency of HMS, and to address it, multi-intervention packages focusing on sinking high-quality medical resources and improving healthcare capacity, and guiding hierarchical medical practice should be adopted.

Section: Methodsmentioning

confidence: 99%

Levels, trends, and determinants of effectiveness on the hierarchical medical system in China: Data envelopment analysis and bootstrapping truncated regression analysis

Tao

et al. 2022

Front. Public Health

“…The focus of research on the dynamics of health service networks lies in inter-regional coordination and the optimal allocation of resources, aiming to enhance the e ciency and overall quality of health services (Lin et al, 2021). Although cross-sectional studies primarily focus on the immediate state of resource distribution, broader research has revealed the spatial spillover effects of health system e ciency, and by assessing the spatial clustering patterns of healthcare facilities, the rationality of the existing healthcare systems has been evaluated, thereby highlighting the necessity of optimising resource allocation strategies (Wang & Nie, 2019;Yang et al, 2022).…”

Section: Resource Flow Network and Equity Of Health Servicesmentioning

confidence: 99%

The Spatial Network Structure and Dynamic Changes of Health Services: Under the Flow of Patients and Resources Behind the Ongoing Inequality

Xu,

Zou,

Huang

2024

Preprint

Background Health services inequities are often investigated empirically as associations between socioeconomic characteristics and differences between health service resource utilization and needs-based utilization. However, the static analysis of unfair healthcare services overlooks the structural changes in health service resources or patients in different regions. In China, large-scale patient mobility can easily lead to the gradual concentration of health service resources. Method This study explores the spatial network structure of health services and its influencing factors using data collected from 31 Chinese provinces from 2010 to 2018, including per capita GDP, health expenses, hospitals, geographical distance, etc. We spatialize different networks of health service and examine the impact of spatial network effects. We use social network analysis (SNA) and compare the structure of health service networks in different years, visualize them, and use CONCOR analysis to construct block models to explore the spatial structure of health service networks. We also use the QAP regression method to explore the factors that affect the structure of the health service network. Results Findings showed that China's health service network has significant spatial agglomeration and spillover effects that lead to spatial inequality in health services, accelerate the flow of health service resources, and increase the cost for patients seeking high-quality healthcare. From CONCOR analysis results, we found that the spatial and geographical gap in health services is gradually shifting from an east-west to a north-south gap. Additionally, we found that the differences in transfer payments enhance the spatial gravitational of health service networks (0.115, P < 0.001), accelerating the flow of service resources and patients. Conclusion Our exploratory study underlines the crucial role of equitable resource distribution in addressing the current irrational network structure of health services. The observed concentration of resources in developed provinces and the corresponding patient migration highlight the pressing need for a decentralized approach to health service allocation. Recognizing the dynamic nature of health service equity, our findings emphasize the necessity of recalibrating central-to-local transfer payments to mitigate regional disparities and foster a more balanced health service network. Identifying the spatial structure of health services is critical to enhancing our understanding of the spatial context of regional health governance and further distilling the spatial correlation characteristics of health services within an equitable health framework.

“…Management issues concerning individuals and organizations are integral to the research field of public health. By effectively utilizing health informatics techniques, valuable information can be extracted to provide deeper insights that support informed decision making [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

Section: The Organization Of This Special Issuementioning

confidence: 99%

Health Informatics: The Foundations of Public Health

Lee

2023

Healthcare