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. 2024 Jul 3;24(1):777.
doi: 10.1186/s12913-024-11244-0.

Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach

Zhi Zeng #  1   2 , Xiru Yu #  3 , Wenjuan Tao  1 , Wei Feng  4 , Wei Zhang  5   6
Affiliations

Efficiency evaluation and promoter identification of primary health care system in China: an enhanced DEA-Tobit approach

Zhi Zeng et al. BMC Health Serv Res. .

Abstract

Background: With Primary Health Care (PHC) being a cornerstone of accessible, affordable, and effective healthcare worldwide, its efficiency, especially in developing countries like China, is crucial for achieving Universal Health Coverage (UHC). This study evaluates the efficiency of PHC systems in a southwest China municipality post-healthcare reform, identifying factors influencing efficiency and proposing strategies for improvement.

Methods: Utilising a 10-year provincial panel dataset, this study employs an enhanced Data Envelopment Analysis (DEA) model integrating Slack-Based Measure (SBM) and Directional Distance Function (DDF) with the Global Malmquist-Luenberger (GML) index for efficiency evaluation. Tobit regression analysis identifies efficiency determinants within the context of China's healthcare reforms, focusing on horizontal integration, fiscal spending, urbanisation rates, and workforce optimisation.

Results: The study reveals a slight decline in PHC system efficiency across the municipality from 2009 to 2018. However, the highest-performing county achieved a 2.36% increase in Total Factor Productivity (TFP), demonstrating the potential of horizontal integration reforms and strategic fiscal investments in enhancing PHC efficiency. However, an increase in nurse density per 1,000 population negatively correlated with efficiency, indicating the need for a balanced approach to workforce expansion.

Conclusions: Horizontal integration reforms, along with targeted fiscal inputs and urbanisation, are key to improving PHC efficiency in underdeveloped regions. The study underscores the importance of optimising workforce allocation and skillsets over mere expansion, providing valuable insights for policymakers aiming to strengthen PHC systems toward achieving UHC in China and similar contexts.

Keywords: China; Data envelopment analysis; Efficiency evaluation; Horizontal integration; Primary health care; Tobit regression.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trends in GML Index Across Years. Note: This figure illustrates the annual changes in the GML index for the entire municipality (blue line) and specifically for County P (red line) from 2009 to 2018. The y-axis represents the GML index, indicating TFP changes, while the x-axis denotes the time
See this image and copyright information in PMC

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