Regional disparities and influencing factors of health production efficiency: evidence from China

Abstract

Background: The health of the populace is a fundamental pillar for China's sustainable economic growth. Health production efficiency refers to the ability to maximize the health outcomes of residents given a certain level of resource inputs. It reflects the efficiency of resource utilization in the process of health production. This paper evaluates health production efficiency in China, analyzes regional disparities, and explores influencing factors.

Methods: After constructing an evaluation index system for residents' health production efficiency, this study employs the undesired output-SBM super-efficiency model to measure health production efficiency. Regional disparities in health production efficiency are analyzed using the Dagum Gini coefficient, while a dynamic spatial Durbin model is applied to investigate the influencing factors and spatial spillover effects.

Results: The findings show: (1) Health production efficiency is generally on the rise nationwide, with eight major economic zones experiencing an increase in provinces with high efficiency and a decrease in those with low efficiency, except for a downturn in 2020 caused by the pandemic. (2) The overall disparity in health production efficiency has been steadily narrowing. Intra-regional disparities among the eight major economic zones vary, while inter-regional disparities have gradually declined but continue to represent the primary source of the overall gap. (3) Health production efficiency exhibits significant and positive spatial spillover effects both temporally and spatially. Per capita GDP exerts strong negative direct and spillover effects on health production efficiency. Residents' income demonstrates a positive spillover effect, while population density shows a significant negative overall effect.

Conclusions: This study conducts a comprehensive evaluation of health production efficiency through the construction of an index system, revealing an overall upward trend in health production efficiency. Intra-regional disparities remain the primary source of the overall differences in health production efficiency across China. Policymakers need to address the challenges posed by per capita GDP and population density on health production efficiency while leveraging the positive impact of residents' income levels to promote sustainable and balanced regional development. This study can assist the government in optimizing the allocation of healthcare resources, reducing regional health disparities, and formulating more equitable health policies.

Keywords: Dagum Gini Coefficient; Dynamic Spatial Durbin Model; Health production efficiency; Undesirable output-SBM super-efficiency model.

Fig. 1

Research Framework

Fig. 2

Trends in health production efficiency across the nation and the eight major comprehensive economic regions

Fig. 3

Overall Disparities in health production efficiency in China

Fig. 4

Intra-regional disparities

Fig. 5

Inter-regional disparities. Note: In the figure, regions are represented as follows: 1 - Northeast, 2 - Northern Coastal, 3 - Eastern Coastal, 4 - Southern Coastal, 5 - Middle Reaches of the Yellow River, 6 - Middle Reaches of the Yangtze River, 7 - Southwest, 8 - Northwest.(The chart displays only the top four regions with the highest and lowest values for means and coefficients of variation.)

Fig. 6

Sources and evolution of contributions to overall disparities