Three-stage Data Envelopment Analysis Research Articles

Evaluating Agricultural Production Efficiency in Jiangsu and Anhui Provinces: A Three-Stage DEA and Malmquist Index Approach

This study assesses the agricultural production efficiency of Jiangsu and Anhui Provinces from 2018 to 2022, with a focus on the impact of the Yangtze River Delta Regional Integration Development Plan. Utilizing a three-stage Data Envelopment Analysis (DEA) model and the Malmquist index, the research controls for environmental factors and analyzes efficiency changes dynamically. The results indicate that Jiangsu achieved a higher rate of technological progress, with an average annual growth rate of 1.0066, which drove its overall productivity gains. In contrast, Anhui demonstrated substantial potential in scale efficiency, reflecting opportunities for future productivity improvements through optimized resource allocation. The regional integration plan appears to have played a pivotal role in advancing agricultural productivity in Jiangsu by facilitating technology-driven improvements. Findings suggest that while Jiangsu should continue to enhance its technological capabilities, Anhui could focus on harnessing its scale efficiency potential to bridge the productivity gap between the two provinces. These insights underscore the significance of regional integration policies in fostering balanced agricultural development, promoting both technological progress and scale efficiency across different regional contexts.

Evaluation of Capital Utilization Efficiency in Agricultural Listed Firms Based on a Three-Stage Data Envelopment Analysis

Rural revitalization is intricately tied to national prosperity, with listed companies in agriculture, forestry, animal husbandry, and fisheries playing pivotal roles in driving this transformative agenda. However, these sectors face critical challenges, notably resource constraints and environmental pressures, which underscore the necessity of evaluating capital utilization efficiency. This study employs a combined three-stage DEA model and Malmquist index to analyze capital utilization efficiency across 85 listed companies within China’s agriculture, forestry, animal husbandry, and fishery industries over the period 2018–2022. The primary objectives are to quantify capital utilization efficiency, identify pathways for industry optimization, advance ecological agricultural sustainability, and offer valuable insights to investors and policymakers. Key findings include: (1) When grouped by sub-sector and adjusted to account for external environmental factors and random disturbances, the initial comprehensive capital utilization efficiency in agricultural companies was found to be significantly overestimated. Subsequent third-stage adjustments revealed decreases in average comprehensive efficiency, technical efficiency, and scale efficiency by 29.79%, 3.03%, and 27.37%, respectively, largely driven by a marked decline in scale efficiency, ultimately diminishing overall efficiency. (2) The capital utilization efficiency in agricultural trading firms remains suboptimal, with scale efficiency posing a critical limitation. High dependency on government subsidies and excess specialized personnel further constrain efficiency improvements. (3) Dynamic analysis using the DEA-Malmquist model indicates low total factor productivity in the agricultural sub-sector, primarily due to inefficiencies in capital management and suboptimal scale allocation. These findings underscore the need for targeted strategies to enhance resource allocation and management, bolster talent development and financial management frameworks, and drive technological research and development, innovation, and efficient capital allocation across the agriculture, forestry, animal husbandry, and fishery sectors.

Regional healthcare resource allocation and decision-making: Evaluating the effectiveness of the three-stage super-efficiency DEA model

This study addresses the challenge of achieving a more rational allocation of medical resources at the regional level, using Guangxi Province, China, as a case study. A three-stage super-efficiency Data Envelopment Analysis (DEA) model is employed to assess and analyze the effectiveness of resource allocation. The research methodology involves identifying input, output, and environmental variable indicators to construct a healthcare resource allocation index system. The indicator data are processed using Excel software. The three-stage super-efficiency DEA model is then applied to evaluate the healthcare system in Guangxi Province, focusing on Pure Technical Efficiency Change (PEC), Scale Efficiency Change (SEC), Efficiency Change (EC), Technological Change (TC), and Total Factor Productivity (TFP). Finally, the Malmquist index method is utilized to measure and dynamically analyze the efficiency of healthcare resource allocation. The study's results show that, from a static perspective, the average comprehensive efficiency is 1.067 before adjustment and 1.054 after adjustment, indicating relatively high overall efficiency in healthcare resource allocation in Guangxi Province. However, environmental factors and random errors have led to an overestimation of healthcare resource allocation efficiency, which the three-stage super-efficiency DEA model effectively corrects. Additionally, the average SEC and PEC values are 0.997 and 0.998, respectively, both below 1. This indicates that both scale efficiency and pure technical efficiency contribute to a decline in technical efficiency. Based on the results of the sensitivity analysis, the conclusions regarding the efficiency of healthcare resource allocation in Guangxi are deemed highly reliable. Despite the influence of uncertain factors, the model consistently provides stable and coherent assessment results in most scenarios. Therefore, special attention is needed to improve scale efficiency in healthcare resource allocation within the region, alongside enhancing management and technological capabilities in the healthcare sector. Overall, this study provides valuable reference and guidance for researchers and practitioners in related fields and offers scientific decision support for healthcare resource allocation.

Regional efficiency analysis of fresh food cold chain logistics in China based on three-stage DEA model

PurposeAssessing the efficiency of fresh food cold chain logistics as accurately as possible is essential for industry development planning. This study was designed to analyze the efficiency of fresh food cold chain logistics in China.Design/methodology/approachA three-stage data envelopment analysis (DEA) model was used to analyze the efficiency of fresh food cold chain logistics in 30 provinces of China from 2013 to 2019. The stochastic frontier analysis (SFA) model in the second stage was used to eliminate the influence of external environmental factors and random disturbances on efficiency analysis results.Findings(1) The overall actual efficiency of fresh food cold chain logistics in China is unsatisfactory, with an average technical efficiency of 0.382 over the 7-year period. (2) The national average technical efficiency and average scale efficiency were overestimated by 29.9% and 40.0%, respectively, compared with the actual values. (3) The efficiency of fresh food cold chain logistics does not align with the level of regional economic development. (4) Distinct regional variations exist in the efficiency of fresh food cold chain logistics in China, with higher efficiencies observed in Northwest China and the Central Yangtze River regions, and the lowest efficiencies in the northeast regions.Originality/valueThis study applies a three-stage DEA model to assess the development and regional differences of fresh food cold chain logistics in China, enriching the application of models and empirical analysis in this field. By analyzing the situation in China, it provides ideas and references for other developing countries to develop cold chain logistics.

Quantitative simulation and validation of energy carbon emission efficiency changes in Chinese urban agglomerations

In the context of the global energy dilemma, enhancing energy efficiency has inevitably become a pivotal strategy for mitigating energy waste and promoting sustainable development. Urban agglomerations, as growth poles leading high-quality regional economic development, play a significant role in this process. Within these urban agglomerations, the aggregation of various factors and the substitution of energy resources substantially influence the energy carbon emission efficiency (ECEE) of surrounding cities during their development and maturation phases. This study initially employs a three-stage Data Envelopment Analysis (DEA) to quantitatively analyze the ECEE values of 19 urban agglomerations from 2006 to 2020. It then establishes a methodology for calculating the joint intensity (JI) and joint threshold (JT) of ECEE within these urban agglomerations. Finally, a validation process is executed using MATLAB simulation and verification methodology to fit and authenticate the evolutionary patterns of ECEE in Chinese urban agglomerations. The primary objective of this research is to model the evolution of ECEE, thereby exploring the sustainable development pathways for urban agglomerations in China. The research findings indicate that: (1) The results from the three-stage DEA demonstrate that, after removing the influences of external environmental factors and random errors, the comprehensive technical efficiency (TE) of energy carbon emissions for the 19 urban agglomerations in China experienced a wave-like increase, rising from 0.410 to 0.506 between 2006 and 2020. (2) The calculation results of the constructed JI model indicate that the JT values of ECEE for national-level, regional-level, and local-level urban agglomerations are 1006.92, 226.60, and 160.14, respectively. The national-level urban agglomerations have significantly higher JT values and JI than the other two levels of urban agglomerations. (3) The results of the Matlab simulation verification show that 16 urban agglomerations fit well with the wave-like ascending evolutionary pattern. However, four urban agglomerations exhibit an opposite fitting effect due to the influence of their pillar industries or the small number of cities within these accumulations, making them unrepresentative. Consequently, the evolutionary curve of ECEE in Chinese urban agglomerations generally exhibits a wave-like upward trend over time.

Resource allocation efficiency in 68 county-level traditional Chinese medicine hospitals in China: a data envelopment analysis.

Analysing and evaluating how efficiently health resources are allocated to county-level Traditional Chinese Medicine (TCM) hospitals in Zhejiang Province, this study aims to provide empirical evidence for improving operational efficiency and optimising resource allocation in these hospitals. The study employed a three-stage Data Envelopment Analysis (DEA) model to assess efficiency, using data from 68 county-level TCM hospitals. Four input and five output variables related to TCM services were selected for the analysis. The first-stage DEA results indicated that in 2022, the technical efficiency (TE) of TCM hospitals in Zhejiang Province was 0.788, the pure technical efficiency (PTE) was 0.876 and the scale efficiency (SE) was 0.903. The classification of hospitals into four groups based on the bed size showed statistically significant differences in returns to scale (p<0.001). The Stochastic Frontier Analysis regression results were significant at the 1% level across four regressions, showing that environmental variables such as per capita GDP, population density and the number of hospitals impacted efficiency. In the third stage DEA, after adjusting the input variables, the TE, PTE and SE improved to 0.809, 0.833 and 0.917, respectively. The adjusted mean TE rankings by region were West (0.860) > East (0.844) > South (0.805) > North (0.796) > Central (0.731). There is an imbalance between the inputs and outputs of county-level TCM hospitals. Each region must consider factors such as the local economy, population and medical service levels, along with the specific development characteristics of hospitals, to reasonably determine the scale of county-level TCM hospital construction. Emphasis should be placed on improving hospital management and technical capabilities, coordinating regional development, promoting the rational allocation and efficient use of TCM resources and enhancing the efficiency of resource allocation in county-level TCM hospitals.

Research on Energy-Saving Efficiency and Influencing Factors of Green and Low-Carbon Enterprises Based on Three-Stage DEA and Tobit Models

Implementing the “dual-carbon” objective has profoundly affected China’s businesses, prompting a continuous process of transformation and innovation. Green, low-carbon transformation, upgrading, and sustainable development have emerged as the means to achieve high-quality company growth, with firms playing a crucial role in achieving the “dual-carbon” target. By prioritizing firms’ green, low-carbon, and sustainable growth, not only can their economic efficiency be improved, but it also serves as a vital measure to advance high-quality development. To achieve this objective, it is crucial to analyze the elements that impact the energy-saving effectiveness of businesses to develop optimization tactics that can enhance their competitiveness. This study combines the three-stage Data Envelopment Analysis (DEA) and the Tobit model to assess the energy-saving efficiency of green and low-carbon firms from 2018 to 2022. The analysis focuses on selected samples from various areas and industries. The study investigates the relationship between energy-saving effectiveness and different regional and industrial parameters, considering the distinct attributes of each firm and the key elements that influence its energy-saving performance. The findings indicate that green, low-carbon firms typically demonstrate suboptimal energy-saving efficiency but have considerable room for improvement. Upon considering environmental concerns, it becomes clear that the primary limitation on energy-saving performance is the lower efficiency of the enterprise scale. The energy-saving efficiency of green, low-carbon firms varies significantly across different regions and industries. On average, northern firms in the energy-saving and carbon reduction industry, as well as the resource recycling industry, have higher energy-saving efficiency compared to southern enterprises. In contrast, the environmental protection industry in southern firms demonstrates a better average energy-saving efficiency compared to their northern counterparts. Employee quality, policy support, and automation are key factors that greatly enhance the energy-saving efficiency of firms in both regions. Enterprise size has a beneficial impact on the energy-saving efficiency of southern firms but a negative impact on northern enterprises. Moreover, the industry and financial structures exert a detrimental influence on enhancing the energy-saving efficiency of green and low-carbon firms. Thus, in order to improve the energy-saving effectiveness of businesses, it is essential to utilize the elements that have a positive influence on energy-saving performance and reduce the impact of those that have negative impacts. This strategy will enhance the energy-saving efficiency of businesses and promote the development of an environmentally friendly and low-carbon society.

Equity and efficiency of health resource allocation in the Chengdu-Chongqing Economic Circle of China.

This study aimed to evaluate the fairness and efficiency of health resource allocation (HRAE) in Chengdu-Chongqing Economic Circle after the new healthcare reform. This study also aimed to identify existing problems, providing empirical evidence for the government to formulate regional health plans scientifically and reasonably. The fairness of health resource allocation was analyzed using the Gini coefficient, Theil index, and agglomeration degree from population and geographical area perspectives. The three-stage data envelopment analysis and the Malmquist productivity index were used to analyze HRAE from static and dynamic perspectives. The Gini coefficient for population allocation in Chengdu-Chongqing Economic Circle was 0.066-0.283, and the Gini coefficient for geographical area allocation was 0.297-0.469. The contribution rate within a region was greater than that between regions, and health resources were mainly concentrated in economically developed core areas. The overall fairness of Chengdu Economic Circle was relatively better than that of Chongqing Economic Circle. Moreover, the adjusted mean technical efficiency was 0.806, indicating room for HRAE improvement in Chengdu-Chongqing Economic Circle. Stochastic Frontier Analysis found that different environmental variables have varying degrees of impact on HRAE. The adjusted mean total factor productivity change (Tfpch) was 1.027, indicating an overall upward trend in HRAE since the new healthcare reform. However, scale efficiency change (Sech) (0.997) limited the improvement of Tfpch. The fairness of health resources allocated by population was better than that allocated by geographical area. The unfairness of health resources mainly stemmed from intra-regional differences, with considerable health resources concentrated in core areas. Over the past 13 years, HRAE has improved but exhibited spatial heterogeneity and Sech-hindered productivity improvement. The study recommends strengthening regional cooperation and sharing to promote the integrated and high-quality development of the health and well-being in Chengdu-Chongqing Economic Circle.

Research on Business Performance of Shandong Province Based on Three-Stage Data Envelopment Analysis

Research on Business Performance of Shandong Province Based on Three-Stage Data Envelopment Analysis

Based on Three-Stage Data Envelopment Analysis of The Efficiency Evaluation Model of Specialty Construction

Based on Three-Stage Data Envelopment Analysis of The Efficiency Evaluation Model of Specialty Construction

Does water rights trading promote the efficiency of water use? Empirical evidence from pilot water rights trading in China

ABSTRACT Water rights trading policy is an important economic tool in China's water resource management. Accurately estimating the level of water resource utilization efficiency in experimental areas and impartially assessing the impact of the water rights trading market's operation on water resource utilization efficiency have policy implications for improving water resource governance tools and capabilities. Based on the panel data of 19 provinces (regions) in China from 2010 to 2019, this paper describes the development of a three-stage data envelopment analysis model to measure water use efficiency and the application of the difference-in-differences method based on propensity score matching (PSM-DID) to examine the effect of water rights trading policies on the model. The results indicate that (1) after the introduction of the water rights trading policy, the water use efficiency in the experimental areas improved substantially; (2) the PSM-DID method also confirms this finding, and water rights trading has a positive influence on water use efficiency. The research outcomes of this study can be used to objectively appraise the policy performance of the water rights trading policy and provide a theoretical foundation for its nationwide implementation.

Are listed banks only pretending to be more social?

It is widely accepted that listed organizations have potential to achieve greater economic results. In return, they are expected to provide reliable information on its economic and financial activity in a timely and accurate manner; and also, non-financial or sustainability information since 2018. Nowadays, organizations demonstrate not only their economic performance, but also their social commitment. Therefore, financial institutions attempt to be both economically and socially efficient. This paper tries to resolve this specific issue: determining whether listed financial institutions are more economically and socially efficient, due to the fact that, as they are listed and bigger, they can spend more resources in communication. But we do not know whether they truly are more socially efficient or simply have a reputation as such. To give an answer to this question a three-stage Data Envelopment Analysis has been used, which includes Spanish financial institutions Panel Data from 2014 to 2019.

Provincial Coal Flow Efficiency of China Quantified by Three-Stage Data-Envelopment Analysis

The exploration of regional variations in coal flow efficiency (CFE) in China and the collaborative strategies for emission reduction are vital for accelerating the progress of ecological civilization within the coal industry and achieving an optimal allocation of coal resources. To unveil the evolutionary traits of actual CFE and its decomposition, this study employs a current technology based on a combined super-efficient measure (SBM), global SBM, the stochastic frontier approach (SFA), and the global Malmquist–Luenberger index (GML) model on panel data from 2010 to 2021 across 30 provinces in China. The research conclusions are as follows. First, significant efficiency gaps are observed among provinces, showcasing superior performance in the north and east regions. Moreover, the impact of environmental factors and random disruptions on individual slack variables varies, resulting in a decrease of 0.18 and 0.43 in the CFE of source-area and sink-area when these factors are not taken into account. Thirdly, a clear distinction emerges between the technical efficiency change index (EC) and the best-practice gap change index (BPC). Lastly, the CFE displays regional disparities marked by an upward trajectory and fluctuating patterns resembling a “W” shape.

Efficiency decomposition in three-stage data envelopment analysis with undesirable and returnable factors

PurposeThe purpose of this paper is to evaluate the efficiency of a series network system with undesirable and unreturnable simultaneously.Design/methodology/approachThe research was conducted by applying data envelopment analysis (DEA) approach to measure the efficiency score of a system and substages with an undesirable output of the second and third stages separately. For each case, new production technology was introduced, and based on them, novel DEA models were proposed.FindingsOne of the most important issues in the development of a country is the banking industry. In this study, 51 branches of commercial banks as a three-stage system with undesirable and unreturnable outputs in the second stage are considered. Then, the efficiency of each branch and substages is measured by using proposed models.Originality/valueThe efficiency of a three-stage network in the presence of undesirable and unreturnable outputs was assessed. In this model, Kousmanen’s technology was used.

Green efficiency strategy considering cyclical relationships among CO2 emissions, green patents, and green bonds

Globally increasing concerns on climate change have garnered considerable attention toward green investments. Although the effects of green investments have been investigated, their productivity remains largely unexplored. This study proposes an initial discussion of green efficiency based on the cyclical relationship among green investments, technology, and national-level performance. This study applies a three-stage data envelopment analysis to compare green efficiency of 19 countries based on carbon dioxide emissions, green patents, and green-bond issuance data of 12 years starting from 2010 when national green-bond issuance was initiated. We use a logistic regression to derive policy implications by analyzing major factors affecting green efficiency. The results reveal that no country is efficient across all stages. Overall, the finding reveals which stage each country should focus on to improve green efficiency; suggests benchmarks and green efficiency strategies for inefficient countries; and highlights the appropriate level of research and development (R&D) expenditure and adoption support for solar/wind energy as part of the technology support policy. As the national green efficiency level is derived in stages, our approach contributes to forming green efficiency strategies at the national level in three stages. Moreover, this study presents the policy implications related to R&D expenditures and technology support to address the limited understanding of green efficiency management.

The Impact of Blockchain on the Administrative Efficiency of Provincial Governments Based on the Data Envelopment Analysis–Tobit Model

Since its reform and opening up in 1978, China has maintained strong economic growth for more than four decades. For a long time, China’s economic growth has been characterized by a crude growth mode, which is mainly manifested in growth driven by large amounts of capital, energy and raw materials, and labor inputs, with little contribution from innovation and technology, which will make it difficult to promote sustainable development in the era of the knowledge economy. On the other hand, improving administrative efficiency is one of the key paths to realizing China’s sustainable development strategy. The Chinese government emphasizes high-quality development, and long-term development and stable management can be achieved only if administrative efficiency is improved on the basis of achieving sustainable development. For the purpose of transforming and developing the Chinese government to a higher standard, this study examined how blockchain affects administrative effectiveness across different provinces. The three-stage Data Envelopment Analysis (DEA) model was chosen to evaluate China’s regional administrative efficiency. It used the typical markers found in both the international and domestic literature. The input–output indicators were determined using the Delphi method, and the findings showed that while most provinces had reasonably high administrative efficiency, there were notable regional variations. This article empirically employed the Tobit model to examine the effect of blockchain on administrative efficiency based on administrative efficiency calculations. The findings showed that administrative efficiency was significantly impacted by blockchain research investment, blockchain research output, the number of blockchain policies, and the size of the population. In contrast, there was not a significant impact on administrative efficiency due to the quantity of procurements for blockchain government initiatives.

Technical Efficiency Evaluation of Maize Production in Ghana: An Application of Three-Stage Data Envelopment Analysis

Purpose: In Ghana, maize constitutes the primary source of revenue and food for small-scale farmers, and to attain maize self-sufficiency, appropriate production techniques must be employed, coupled with the scaling up of production efficiency to supplement our food output. The objectives of the study are to estimate the technical efficiency and analyze the trend in total factor productivity of maize production. Method: This study focuses on forty-eight (48) cities in six (6) selected regions of Ghana: Northern, Upper East, Upper West, Central, Eastern, and Volta. Secondary data on maize production was obtained from the Ministry of Food and Agriculture from the 2010/11 to 2020/21 cropping seasons. Environmental variables (amount of rainfall and temperature) were sourced from the Ghana Meteorological Agency (GMA) from 2010/11 to 2020/21. Results and Conclusion: The results displayed a fairly high level of TE, and environmental factors significantly influence production efficiency. The study revealed that the TE of maize cultivation was 0.752 and 0.853 for the first and third stages, respectively. From the findings, the efficiency scores attained after the adjustments to the input in the third stage of the DEA model were greater than those in the first stage. Also, the results indicated the eastern region had the highest TE scores, showed an increment in productivity, and serves as the finest region for maize cultivation. Overall, the technical performance of maize cultivation had shown an upward trend in productivity, and the eastern region recorded the highest efficiency performance and technological progress. Implications of the Research: The research highlights the significance of the maize crop to the Ghanaian economy and how environmental factors impact farmers' production efficiency. It also emphasizes the benefits of resource use efficiency and its implied effects on the total factor productivity of maize cultivation. Policy suggestions include sustainable production practices primarily for farmers living in susceptible areas to enhance productivity and improve their food security status. Originality/Value: The gap discovered in the examined literature was that there exists a substantial deficiency in the usage of the three-stage DEA Malmquist model for analyzing technical efficiency and limited studies on the estimation of the total factor productivity (TFP) changes, specifically focusing on maize farming. This paper adds to the body of the existing literature by utilizing a three-stage DEA model to evaluate the TE of maize production. This is entirely limited both in theory for annual crops and methodologically in the Ghanaian literature on efficiency studies.

Evaluating and Analyzing the Efficiency and Influencing Factors of Cold Chain Logistics in China’s Major Urban Agglomerations under Carbon Constraints

With environmental degradation and energy shortages, green and low-carbon development has become an industry trend, especially in regards to cold chain logistics (CCL), where energy consumption and emissions are substantial. In this context, determining how to scientifically evaluate the cold chain logistics efficiency (CCLE) under carbon emission constraints is of great significance for achieving sustainable development. This study uses the three-stage data envelopment analysis (DEA) and the Malmquist index model to analyze the overall level and regional differences regarding CCLE in China’s four major urban agglomerations, under carbon constraints, from 2010 to 2020. Then, the influencing factors of CCLE are identified through Tobit regression. The results reveal that: (1) the CCLE in the four urban agglomerations is overestimated when carbon constraints are not considered; (2) the CCLE in the four urban agglomerations shows an upward trend from 2010 to 2020, with an average annual growth rate of 1.25% in regards to total factor productivity. However, there are significant spatial and temporal variations, with low-scale efficiency being the primary constraint. (3) Different influencing factors have different directions and exert different effects on CCLE in different urban agglomerations, and the improvement of economic development levels positively affects all regions.

Analysis of the Operational Efficiency of Public Hospitals in Tianjin City based on a Three-Stage Data Envelopment Analysis Model

The purpose is to analyze the operational efficiency of 132 public hospitals in Tianjin in 2021, providing reference for them to fully play the role of "leading institutions" and optimize resource allocation. We constructed an evaluation index system with multiple inputs, outputs, and environmental variables and utilized a three-stage DEA model to assess efficiency by removing the influence of random errors and environmental factors. The average comprehensive technical efficiency, pure technical efficiency, and scale efficiency of public hospitals were 0.865, 0.989, and 0.875, respectively. Among them, seven districts, including Heping, Hedong, and Hexi, had a comprehensive technical efficiency of 1. Among the remaining nine districts, except for Baodi, the rest showed an increasing trend in scale efficiency. Public hospitals in Tianjin City exhibit high operational efficiency, but significant variations exist among different districts, leading to uneven development. The main reason for this disparity is the presence of scale inefficiency. It is recommended to prioritize resource optimization and address the shortcomings that hinder efficiency improvement in a targeted manner. Emphasizing the "triple integration" of service capacity, efficiency, and quality in public hospitals is essential to maximize both social and economic benefits."

Evaluation of healthcare efficiency in China: a three-stage data envelopment analysis of directional slacks-based measure.

A consensus on the changing pattern of healthcare efficiency in China is current absent. This study tried to identify temporal fluctuations in healthcare efficiency from 2012 to 2021, and conducted a comparative analysis on the performance of 31 regions in China using region-level balanced panel data. Employing three-stage data envelopment analysis (DEA) as the analytical framework, we measured healthcare efficiency and its changes using the directional slacks-based measure and global Malmquist-luenberger (GML) indexes. We also decomposed the sources of healthcare inefficiency and extended our analysis to changes in healthcare efficiency across different primary medical service levels and regional economic development tiers. The average efficiency score of medical institutions (0.956) was slightly higher than that of hospitals (0.930). We found that the average GML indexes of medical institutions in China stood at 0.990, while the average technical change (TC) index was 0.995 and the average efficiency change (EC) index was 0.998 from 2012 to 2021. The GML indexes, TC indexes, and EC indexes of hospitals were 1.002, 1.009, and 0.994, respectively. The healthcare inefficiency for both inputs and desirable outputs in medical institutions was primarily attributed to the redundant numbers of institutions, outpatient visits slacks and inpatient surgery volume slacks, accounting for 50.040, 49.644, and 28.877%, respectively. The undesirable output inefficiency values of medical institutions concerning in-hospital mortality stood at 0.012, while the figure for hospital regarding the average length of stay (LOS) was 0.002. Additionally, healthcare efficiency in both medical institutions and hospitals exhibited an upward trend from 2012 to 2021, corresponding to an increase in the volume of primary medical services, primary medical staff, and the total gross domestic product (GDP). Total factor productivity (TFP) of medical services declined in China from 2012 to 2021. The excessive number of medical institutions and the slack of medical service volumes were the main sources of healthcare inefficiency. Regions prioritizing primary medical services and boasting higher GDP levels exhibited superior healthcare efficiency. These findings are expected to inform policymakers' efforts in building a value-based and efficient health service system in China.