Abstract
BackgroundOver the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China’s medical and health reform.MethodsBased on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE).Results(1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state’s allocation of medical and health resources has undergone major changes during “The Twelfth Five-Year Plan”.ConclusionThis study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China’s existing investment in medical and health resources is generally not effective. Therefore, although China’s health care reform has made certain achievement, it is still necessary to expand the investment in health care resources.
Highlights
In order to achieve the goal of basic medical and health service for all, as well as the improvement of the health of whole nation, a new round of health system reform was initiated by Chinese government in 2009
Two problems arise from this paradox: (1) Why the public failed to benefit enough from the increase of government public medical and health investment? (2) To increase public health investment, should we prioritize the increase of inputs to catch up with the level of developed countries in the world, or should we focus on creating a balanced and efficient medical and health service system? We believe that the process of medical and health system reform is a complicated social system engineering, the increase of public medical and health input plays an important role, the improvement of medical and health system operation efficiency, as well as service level and quality are much more vital
The findings are listed below: (1) Both the measurement results from stage 1 and stage 3 show that the overall public medical and health efficiency (PMHE) is descending in fluctuation in China, which means, the increase of public medical and health input failed to bring about PMHE improvement
Summary
Literature review The public medical and health efficiency (PMHE) is the efficiency of government fiscal expenditure by nature, namely the economic efficiency. Based on the previous research logic, this paper constructs a super-efficiency three-stage SBM-DEA model with random error and environmental factors removed, and expected output and undesirable output indicators combined, to measure PMHE for 31 provinces in China for the period from 2005 to 2017 so as to discover its spatial-temporal evolution rule and influencing factors. This means the increase in GDP per capita can lead to decrease of public medical and health input slack variable, so that waste will be reduced and PMHE is positively affected This is in accordance with theory and the facts that the higher the economic development level in the region with more financial revenue, the more likely the health expenditure to be higher. This is mainly because the method used in this paper uses the SFA model estimation of parameter regression in the adjustment process, so the result is more accurate than the non-parametric DEA model [40]
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