Study of the medical service efficiency of county-level public general hospitals based on medical quality constraints: a cross-sectional study

OBJECTIVES: Since the new medical reform in 2009, county-level hospitals in China have achieved rapid development, but health resource waste and shortage issues still exist. DESIGN: We applied the meta-frontier and slacks-based measurement-undesirable data envelopment analysis model to measure the medical service efficiency with or without medical quality constraints of the county-level public general hospitals (CPGHs). The assessment includes four inputs, three desirable outputs and one undesirable output. We conducted the assessment via Max-DEA V.8.19 software. Moreover, we analyse the factors affecting CPGHs' medical service efficiency based on the fractional response model. SETTING: A total of 77 sample CPGHs were selected from Shanxi province in China from 2013 to 2018. RESULTS: The results of this study showed that the efficiency level of county-level public hospitals in Shanxi Province is relatively low overall (the mean value of efficiency is 0.61 without quality constraints and 0.63 under quality constraints). This showed that ignoring medical quality constraints will result in lower efficiency and lower health resource usage for high medical quality hospitals. The medical service efficiency of CPGHs differs greatly among different regions. Under the meta-frontier, the hospitals in the central region had the highest efficiency (efficiency score 0.70), followed by those in the south (efficiency score 0.63) and the hospitals in the north had the lowest efficiency (efficiency score 0.54). Factors that have larger impacts on the service efficiency of county public hospitals are the average length of hospital stay, per capita disposable income and financial subsidy income. CONCLUSIONS: To improve CPGHs' medical service efficiency, the government should increase investment in the northern region, and hospitals should improve the management level and allocate human resources rationally.