Abstract
BackgroundThe new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals. The purpose of this study is to evaluate county hospitals efficiency before and after the healthcare reform, and further assess the reform effectiveness through the comparative analysis of the efficiency.MethodsData envelopment analysis (DEA) was employed to calculate the efficiency of 1105 sample hospitals which were selected from 31 provinces of China, also, Tobit regression was used to regress against those main external environmental factors.ResultsOur results show that the scales and amounts of service of hospitals had increased sharply, however, the efficiency was relatively low and decreased slightly from 2008 to 2012. Thirteen (1.18%) in 2008 and six (0.54%) hospitals in 2012 were defined as technically efficient, and the average scores were 0.2916 and 0.2503. The technical efficiency average score of the post-reform was significantly less than that of the pre-reform (p < 0.001), and the score of eastern region was highest and the western was lowest among three regions of China.ConclusionsIt suggests the reform had not well improved county hospital efficiency although hospitals have reached a fair developing scale, and the corresponding policies and measures should be put into effect for improving efficiency, especially in the level and structure of health investment, operation and supervision mechanism of county hospitals.
Highlights
The new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals
This paper focused on evaluating the efficiency of county hospitals in China before and after healthcare reform and exploring external determinants of hospital efficiency
The central region were taken as the reference cases, the eastern region had a significant positive coefficient in physicians in 2008 and a significant negative coefficient in beds, nurses and technicians in 2012, and the western region had a significant negative coefficient in four inputs in 2008 and in those three inputs except beds in 2012
Summary
The new round of Healthcare Reform in China has implemented over 3 years since 2009, and promoted greatly the development of public county hospitals. The government committed to spending an additional CNY 850 billion (USD 125 billion) in the ensuing 3 years for achieving comprehensive universal health coverage by 2020 [1] Those core contents of the healthcare reform are focusing on the reform of wide range of medical insurance coverage, national essential drug system, medical care and public health service system, basic public health service and pilot reform of public hospitals [2]. In the rural areas of China, the health service system, i.e. Rural Three-level Health Service Network, is made up of county and its subordinate health organizations, including government-run county hospital, township health center and village clinic, in which county hospital is the central of technical guidance and treatment in the system, township health center is the hinge of county and village health services, and village clinic is the base. County hospitals as health service providers in the healthcare system are important carriers for the government to provide basic medical and health services to county residents
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