Healthcare services efficiency and its intrinsic drivers in China: based on the three-stage super-efficiency SBM model.

BACKGROUND: The purpose of this study is to examine the development of healthcare services efficiency in China since the reform of the healthcare system. By examining the development environment of healthcare services in China and examining the driving factors affecting the efficiency of healthcare services, we provide a reference for the future high-quality development of healthcare services in China. METHODS: A three-stage super-efficient slack-based measure (SBM) model with undesirable outputs was used to measure the efficiency of healthcae services in 31 Chinese provinces from 2009 to 2021, and a global Malmquist-Luenberger (GML) index was used to assess their spatiotemporal evolution characteristics and internal influencing mechanisms of healthcare services efficiency. RESULTS: The empirical results showed that the efficiency of China's healthcare services changed significantly from 2009-2014 and then remained stable. During the study period, the efficiency of healthcare services in the eastern region was higher than the national level, while it was lower in the western region. The results of the analysis of environmental factors indicated that an increase in population density reduced the redundancy of healthcare input resources and that economic development as well as an increase in government subsidies, contributed to an increase in the redundancy of healthcare input resources. The main contribution to the growth of healthcare sercices efficiency in China came from the technological innovation effect, and the growth was most significant in the western region. CONCLUSION: From 2009 to 2021, the efficiency of national healthcare services generally showed a slow upward trend, and the efficiency of healthcare services varied widely among regions. Under the existing environmental constraints, relevant departments in each region should strengthen technological innovation in healthcare services, completely focus on the regional catch-up effect, and promote the balanced development of regional health.

Measuring the efficiency of public hospitals: A multistage data envelopment analysis in Fujian Province, China.

Objective: The present study aimed to evaluate the operational efficiency of public hospitals in Fujian Province and the factors responsible for the inefficiency of these hospitals and provide relevant suggestions for health policymakers in allocating service resources. Method: In the first stage of the research, the variables affecting the efficiency of hospitals were extracted by qualitative and quantitative methods, including literature optimization, gray related analysis and gray clustering evaluation. In the second stage, the data envelopment analysis (DEA) method was used to evaluate the operational efficiency of 49 hospitals of different levels and types selected by sampling in 2020. Finally, a Tobit regression model with introduced institutional factors and background factors was established to study the main influencing factors of hospital inefficiency. Results: In the first stage, 10 input variables and 10 output variables necessary from the mangers' point of view were identified to test efficiency. In the second stage, the average comprehensive TE, PTE, and SE of 49 sample hospitals was 0.802, 0.888, and 0.902, respectively. 22.45% of these hospitals met the effective criteria, i.e., the overall effective rate was 22.45%. The low SE value of the hospital was the main reason hindering the improvement of the comprehensive efficiency value. The overall effective rate of secondary public hospitals (30.77%) was higher than that of tertiary public hospitals (19.44%), and the overall effective rate of public specialized hospitals (30%) was higher than that of general public hospitals (18.92%). Based on the third stage results, the bed occupancy rate (BOR) and the proportion of beds (POB) were major factors affecting the operation efficiency of grade III hospitals (p < 0.01). However, the operating efficiency of grade II hospitals was significantly affected by POB and regional per capita GDP(GDPPC) (p < 0.05). Moreover, the impact of BOR and GDPPC was positive, and POB was negatively correlated with hospital operation efficiency. Conclusions: The study results indicated that the overall operation efficiency of public hospitals in Fujian Province is low. This study revealed that intervention should be strengthened from a policy and management perspective to improve the operation efficiency of public hospitals.

Measurement of local government green governance efficiency based on total waste emissions and PM2.5 concentration: Evidence from China.

The problem of environmental pollution is becoming more and more prominent. Making ecological governance take an effective and sustainable development path has become a complex problem for countries to think about. The proposal of green governance provides new ideas for governments to manage enterprises and local environmental governance. The DEA method is commonly used to measure the effectiveness of environmental governance, but the traditional DEA method ignores environmental factors and management factors, and the measurement error is significant. Therefore, this paper introduces the total waste discharge and PM2.5 average concentration and other unexpected outputs, using the three-stage DEA model and three-stage DEA Malmquist index model, creatively constructing the green governance measurement index system, which measures and evaluates the green governance efficiency of 30 provinces in China from 2004 to 2019 from static and dynamic perspectives. The research results show that the efficiency value obtained by the three-stage DEA model is higher than the first stage, which confirms that the external environmental factors have a specific impact on the GGE. At the same time, the comprehensive technical efficiency value presents a "U"-shaped trend with time. From the perspective of sub-regions, there is heterogeneity in the efficiency values between regions, showing a decreasing trend of "east, west, and middle." From the efficiency decomposition results, the main reason for the negative growth rate of GGE is the low efficiency of technological progress, which provides targeted suggestions for governance in various regions of China. This study will help provinces prepare to strengthen investment in technological innovation, maximize the benefits of input and output, and promote green and sustainable development.