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. 2025 Apr 22;25(1):578.
doi: 10.1186/s12913-025-12767-w.

Assessing healthcare efficiency and determinants in China: the perspective of provincial-level social health expenditure

Chuanhai Xu  1   2 , Jieyao Chen  3 , Yuehui Li  1   2 , Dongyu Huang  1   2 , Yuan Xue  4   5
Affiliations

Assessing healthcare efficiency and determinants in China: the perspective of provincial-level social health expenditure

Chuanhai Xu et al. BMC Health Serv Res. .

Abstract

Objective: Social healthcare expenditure is a crucial component of global healthcare expenditure. Assessing the relative efficiency, dynamic changes, and influencing factors of province-level social investment in China would facilitate the continued and stable development of healthcare services.

Methods: Based on the Malmquist Data Envelopment Analysis and Tobit regression model, this study pursued panel data from 2012 to 2020 for a set of 31 provinces and cities in China to estimate the efficiency of social health expenditure and explore the factors that influence the efficiency.

Results: All provinces experience a decline in the total factor productivity change index in the period 2012-2020. The average value is 0.917, which implies a deterioration of 8.3% per year. Most provinces show increased efficiency change but experience declines in technical progress, except Sichuan, Guangdong, and Shandong. Although efficiency change shows an upward trend, the positive impact is offset by technological regression, leading to a decline in overall productivity. Population density and urbanization level are found to be associated with expenditure efficiency in opposite directions. Higher levels of urbanization are associated with higher efficiency scores and the opposite impact is observed for population density.

Conclusions: This study shows that there is still much room for improving the efficiency of province-level social health expenditure and reinforcing the imperatives to increase investment in technological progress in health to foster the efficiency of social healthcare expenditure. Policy reforms and adjustments tailored to the specific conditions of different regions may be necessary for better alignment.

Keywords: DEA; Efficiency; Malmquist; Social health expenditure.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trends of social health expenditure efficiency from 2012 to 2020
Fig. 2
Fig. 2
Trends of social health expenditure efficiency in 31 provinces from 2012 to 2020
See this image and copyright information in PMC

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