Bootstrapping Data Envelopment Analysis of Efficiency and Productivity of County Public Hospitals in Eastern, Central, and Western China after the Public Hospital Reform

• Published in: Current medical science Vol. 37; no. 5; pp. 681 - 692
• Main Author: 王曼丽;方海清;陶红兵;程兆辉;林小军;蔡苗;许昌;蒋帅
• Format: Journal Article
• Language: English
• Published: Wuhan Huazhong University of Science and Technology 01-10-2017; Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China%Administration Office, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen 518020, China%Department of statistics and development research, Chongqing Health Information Center, Chongqing 401120, China%Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri 63103, USA
• Subjects: Medicine; Medicine & Public Health; bootstrapping; Malmquist productivity index; data envelopment analysis; county public hospital; technical efficiency
• ISSN: 1672-0733; 2096-5230; 1993-1352; 2523-899X
• DOI: 10.1007/s11596-017-1789-6

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.