Health and Policy Research Center, Guangxi Medical University, Nanning, China.
School of Information and Management, Guangxi Medical University, Nanning, China.
BMJ Open. 2023 Sep 6;13(9):e075030. doi: 10.1136/bmjopen-2023-075030.
To evaluate the health systems efficiency in China and Association of Southeast Asian Nations (ASEAN) countries from 2015 to 2020.
Health efficiency analysis using data envelopment analysis (DEA) and stochastic frontier approach analysis.
Health systems in China and ASEAN countries.
DEA-Malmquist model and SFA model were used to analyse the health system efficiency among China and ASEAN countries, and the Tobit regression model was employed to analyse the factors affecting the efficiency of health system among these countries.
In 2020, the average technical efficiency, pure technical efficiency and scale efficiency of China and 10 ASEAN countries' health systems were 0.700, 1 and 0.701, respectively. The average total factor productivity (TFP) index of the health systems in 11 countries from 2015 to 2020 was 0.962, with a decrease of 1.4%, among which the average technical efficiency index was 1.016, and the average technical progress efficiency index was 0.947. In the past 6 years, the TFP index of the health system in Malaysia was higher than 1, while the TFP index of other countries was lower than 1. The cost efficiency among China and ASEAN countries was relatively high and stable. The per capita gross domestic product (current US$) and the urban population have significant effects on the efficiency of health systems.
Health systems inefficiency is existing in China and the majority ASEAN countries. However, the lower/middle-income countries outperformed high-income countries. Technical efficiency is the key to improve the TFP of health systems. It is suggested that China and ASEAN countries should enhance scale efficiency, accelerate technological progress and strengthen regional health cooperation according to their respective situations.
评估 2015 年至 2020 年中国和东南亚国家联盟（东盟）国家的卫生系统效率。
使用数据包络分析（DEA）和随机前沿分析（SFA）对卫生效率进行分析。
中国和东盟国家的卫生系统。
采用 DEA-Malmquist 模型和 SFA 模型分析中国和东盟国家卫生系统的效率，采用 Tobit 回归模型分析这些国家卫生系统效率的影响因素。
2020 年，中国和 10 个东盟国家卫生系统的平均技术效率、纯技术效率和规模效率分别为 0.700、1 和 0.701。11 个国家卫生系统 2015 年至 2020 年的平均全要素生产率（TFP）指数为 0.962，下降了 1.4%，其中平均技术效率指数为 1.016，平均技术进步效率指数为 0.947。在过去 6 年中，马来西亚卫生系统的 TFP 指数高于 1，而其他国家的 TFP 指数均低于 1。中国和东盟国家的成本效率相对较高且稳定。人均国内生产总值（当前美元）和城市人口对卫生系统效率有显著影响。
中国和大多数东盟国家的卫生系统效率较低。然而，中低收入国家的表现优于高收入国家。技术效率是提高卫生系统 TFP 的关键。建议中国和东盟国家根据各自情况，提高规模效率，加快技术进步，加强区域卫生合作。
