Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province

Ye Tian; Jia Peng; Yumei Liu; Jiayan Huang

doi:10.3389/fpubh.2023.1269473

Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province

Front Public Health. 2023 Nov 6:11:1269473. doi: 10.3389/fpubh.2023.1269473. eCollection 2023.

Authors

Ye Tian^#¹, Jia Peng^#², Yumei Liu¹, Jiayan Huang²

Affiliations

¹ International School of Public Health and One Health, Hainan Medical University, Haikou, China.
² Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China.

^# Contributed equally.

Abstract

Objective: This article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China.

Methods: The efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result.

Results: The bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, -0.0003, -0.0316, and - 0.0041 respectively, which were statistically significant (p < 0.05).

Conclusion: There was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.

Keywords: Malmquist productivity index; Tobit regression; data envelopment analysis; efficiency; public health service.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China
Efficiency, Organizational*
Ethnicity
Health Care Reform*
Health Services
Humans
Minority Groups

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This article was supported by the Major Program of National Social Science Fund (No. 20VMG027), Quality control of Hainan Essential Public Health Services Programs (2023), and Performance evaluation of Hainan Essential Public Health Services Programs (2023).