Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
National Health Accounts and Policy Studies, China National Health Development Research Center, Beijing, China.
BMJ Open. 2019 Aug 5;9(8):e027539. doi: 10.1136/bmjopen-2018-027539.
With escalating health expenditures and increasing health needs, improving health system performance has become imperative in China and internationally. The objective of this study is to examine the efficiency of China's health system and to understand the underlying causes of the variation in efficiency across provinces.
A system-wide perspective is adopted, focusing on performance in maternal health, child health and non-communicable diseases (NCDs) in the 31 provinces of mainland China during 2015.
Analyses were performed using bootstrapping data envelopment technique. Health outcomes were measured by infant survival rates, maternal survival rates and healthy life years calculated only considering NCDs. Health inputs were measured using health expenditure, and density of medical personnel and hospital beds. The model also examined the impact of environmental factors on health system efficiency.
Due to wide-spread scale inefficiency in the country, the average bias-corrected overall technical efficiency (OTE) was 0.8022 (95% CI values ranging from 0.7251 to 0.8492). Socioeconomic status, hospitalisation rate and share of out-of-pocket expenditures were significant determinants of OTE. Nearly 60% of the provinces operated at a decreasing return to scale, meaning that a gain in efficiency could be achieved only through downsizing the scale of operation.
Given the pervasive nature of diminishing returns across provinces, health policy makers must explore the optimum operational scale which is people-centred and focused on prevention, rather than on treatment, of diseases. Moreover, due consideration should be afforded to social determinants of health and health financing arrangements to complement health-sector based reforms and meet the ambitious goals of the Healthy China 2030 Plan.
随着医疗保健支出的不断增加和健康需求的不断增长，提高医疗体系的绩效在中国乃至国际上都变得至关重要。本研究旨在检验中国医疗体系的效率，并了解各省之间效率差异的根本原因。
本研究采用了系统视角，重点关注 2015 年中国大陆 31 个省份在孕产妇健康、儿童健康和非传染性疾病（NCDs）方面的绩效。
采用 bootstrap 数据包络分析技术进行分析。健康结果通过婴儿存活率、孕产妇存活率和仅考虑 NCD 的健康期望寿命来衡量。健康投入通过卫生支出、医务人员密度和病床密度来衡量。该模型还考察了环境因素对医疗体系效率的影响。
由于全国范围内普遍存在规模无效率，经偏差校正后的平均总体技术效率（OTE）为 0.8022（95%置信区间范围为 0.7251 至 0.8492）。社会经济地位、住院率和自付费用份额是 OTE 的显著决定因素。近 60%的省份处于规模报酬递减状态，这意味着只有通过缩小运营规模才能提高效率。
鉴于各省普遍存在收益递减的情况，卫生政策制定者必须探索以人民为中心、以预防为主的最佳运营规模，而不是以治疗疾病为主。此外，应充分考虑健康的社会决定因素和卫生筹资安排，以补充卫生部门的改革，实现《健康中国 2030 规划》的宏伟目标。
