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. 2025 Oct 1;25(1):1275.
doi: 10.1186/s12913-025-13478-y.

Efficiency and productivity of county-level CDCs in Qingdao municipal, China: a retrospective study based on 6 years of panel data

Chongyi Wang #  1   2 , Kunzheng Lyu #  3 , Dan Lin  3 , Mile Lin  1   2 , Ying Zhang  1   2 , Ayan Mao  1   2 , Yujie Yang  4   5 , Wuqi Qiu  6   7
Affiliations
Free article

Efficiency and productivity of county-level CDCs in Qingdao municipal, China: a retrospective study based on 6 years of panel data

Chongyi Wang et al. BMC Health Serv Res. .
Free article

Abstract

Background: County-level Centers for Disease Control and Prevention (CDCs) are the foundational units of China's public health system. The COVID-19 pandemic has highlighted the shortcomings of the system, making it urgent to strengthen the functions of county-level CDCs. The efficiency and equity of resource allocation are crucial for enhancing public health outcomes. Therefore, this study aimed to evaluate six-year trends (2018-2023) in equity and efficiency of resource allocation among the ten county-level CDCs in Qingdao and to identify actionable measures for optimizing grassroots public-health capacity in the post-COVID-19 era.

Methods: We used Gini coefficient and Lorenz curve to assess the equity of resource allocation in the county-level CDCs in Qingdao. The efficiency of CDCs was evaluated using data envelopment analysis (DEA) and Bootstrap DEA. Efficiency change was analyzed by employing the Malmquist productivity index (MPI).

Results: The health resources at the Qingdao CDCs showed an overall upward trend from 2018 to 2023. During 2018-2023, CDC personnel allocation showed good equity in demographic and economic dimensions (Gini < 0.3), but suboptimal equity in geographic distribution (Gini 0.3-0.5). The average technical efficiency was 0.940, pure technical efficiency averaged 0.995, and scale efficiency was 0.944. Among 10 CDCs, 50% achieved DEA efficiency. According to the total factor productivity (TFP) reflected by the indicator system constructed in this study, TFP grew at a rate of 6.0% between 2022 and 2023. Changes in technical efficiency change (TEC) and scale efficiency change (SEC) generally exceeded those in technological progress (TC).

Conclusion: In order to enhance the equity and efficiency of resource allocation in county-level CDCs in Qingdao City. The government needs to adopt targeted policies, such as implementing flexible staffing adjustments, increasing the number of technical personnel and senior experts, and strengthening continuous training to enhance workforce capabilities. Also, fiscal efficiency should be enhanced by linking fund allocation with performance evaluation. Meanwhile, accelerating technological modernization and enhancing technological capabilities through digital tools and management innovation are crucial. Overall, these comprehensive measures aim to enhance resource utilization efficiency and strengthen the resilience of public health services.

Clinical trial number: Not applicable.

Keywords: County-level centers for disease control and prevention; Data envelopment analysis; Efficiency; Gini coefficient and Lorenz curve.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in line with the ethical principles of the Declaration of Helsinki. And this study utilized anonymized administrative data routinely collected by Qingdao CDC branches for operational reporting purposes. No individual-level human data, biological samples, or personal identifiers were involved. According to China’s “Ethical Review Measures for Biomedical Research Involving Humans” (National Health Commission, 2016), analyses of aggregated institutional performance data without personal identifiers are exempt from ethics committee review. Informed consent was obtained from all the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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