Liu Ling, Peng Jia, Kane Sumit, Wu Chenkai, Liu Yumei, Huang Jiayan
NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China.
Harvard T.H. Chan School of Public Health, Harvard University, USA.
J Glob Health. 2025 Feb 21;15:04045. doi: 10.7189/jogh.15.04045.
In China, most primary health care institutes (PHCIs) support ground-level medical services which are essential to residents' health levels. The Chinese government implemented a health reform in 2009 to strengthen PHCIs through increased fiscal inputs. However, how efficiently these inputs were converted into PHCIs' services remains unclear. We aimed to examine the efficiency of PHCIs' medical services and investigate if any changes occurred following the implementation of the health reform.
We aggregated data from PHCIs from Hainan's 18 districts (2011-21), treating those from the same district as one decision-making unit (DMU). We used three-stage data envelopment analysis (DEA) to assess the efficiencies of these PHCIs, adjusting the approach for environmental factors, managerial ineffectiveness, and statistical errors potentially arising from the background variability of measured data that deviates from the input and output values, allowing all DMUs to be compared in a homogeneous environment. We used the adjusted efficiency scores to evaluate the efficiency of PHCIs in Hainan each year and the Malmquist Productivity Index (MPI) to explore the productivity change of PHCIs over time.
After adjusting for environmental factors between 2011-21, technical efficiency (TE) decreased from 0.825 to 0.745, pure technical efficiency (PTE) increased from 0.936 to 0.954, and scale efficiency (SE) decreased from 0.883 to 0.783. Seven districts had full PTE (1.0) and two districts had full TE (1.0) after adjustment. The mean MPI from 2011 to 2021 was 0.9430, indicating a 5.7% decrease in PHCIs' efficiency. After excluding the low productivity index possibly influenced by COVID-19 (2019 to 2021), PHCIs' efficiency decreased by 0.49%, with a mean MPI of 0.9951.
The efficiency of PHCIs in Hainan has declined slightly since the health reform. Low level of scale efficiency posed a significant impact on the overall efficiency of the medical services in PHCIs. Among potential inefficient technological performances, future policy formulation might focus more on the imbalanced allocation of resources in less-developed regions and PHCIs' lack of attractiveness to local patients.
在中国，大多数基层医疗卫生机构（PHCIs）提供的基层医疗服务对居民健康水平至关重要。中国政府在2009年实施了一项卫生改革，通过增加财政投入来加强基层医疗卫生机构。然而，这些投入如何有效地转化为基层医疗卫生机构的服务仍不清楚。我们旨在研究基层医疗卫生机构医疗服务的效率，并调查卫生改革实施后是否发生了任何变化。
我们汇总了海南省18个区基层医疗卫生机构2011 - 2021年的数据，将来自同一区的机构视为一个决策单元（DMU）。我们使用三阶段数据包络分析（DEA）来评估这些基层医疗卫生机构的效率，针对环境因素、管理无效率以及因测量数据的背景变异性可能产生的统计误差调整该方法，测量数据的背景变异性会偏离投入和产出值，从而使所有决策单元能够在同质环境中进行比较。我们使用调整后的效率得分来评估海南省每年基层医疗卫生机构的效率，并使用曼奎斯特生产率指数（MPI）来探索基层医疗卫生机构随时间的生产率变化。
在对2011 - 2021年的环境因素进行调整后，技术效率（TE）从0.825降至0.745，纯技术效率（PTE）从0.936升至0.954，规模效率（SE）从0.883降至0.783。调整后，7个区的纯技术效率达到满分（1.0），2个区的技术效率达到满分（1.0）。2011年至2021年的平均曼奎斯特生产率指数为0.9430，表明基层医疗卫生机构的效率下降了5.7%。排除可能受新冠疫情影响（2019年至2021年）的低生产率指数后，基层医疗卫生机构的效率下降了0.49%，平均曼奎斯特生产率指数为0.9951。
自卫生改革以来，海南省基层医疗卫生机构的效率略有下降。规模效率低下对基层医疗卫生机构医疗服务的整体效率产生了重大影响。在潜在的低效技术表现中，未来政策制定可能更多地关注欠发达地区资源分配不均衡以及基层医疗卫生机构对当地患者缺乏吸引力的问题。
