Assessing regional healthcare service efficiency in China: a ten-year data envelopment analysis [2010–2019]

Background: Addressing healthcare equity is of paramount importance. By improving the efficiency of hospitals, a country can increase its capacity to provide medical services to a larger population. This, in turn, can contribute to a more equitable distribution of healthcare resources. To address these inequalities, the Chinese government has implemented extensive reform measures, including initiatives to enhance hospital efficiency. This study assesses the efficiency of hospital services across various regions in China over a 10-year period, with the aim of supporting the government’s ongoing healthcare reform efforts. Methods: Using data envelopment analysis (DEA) and the Malmquist Productivity Index (MPI), this study assessed the operational efficiency of decision-making units within the healthcare system, reflecting entities from agencies to regions. A decade of data [2010–2019] was compiled, incorporating five input indicators—investment, healthcare institutions, available beds, and the number of doctors and nurses—along with two output indicators: the average number of outpatient visits and the annual hospitalization rates for each of the 31 provinces, municipalities, and autonomous regions under consideration. Results: From 2010 to 2019, significant improvements in efficiency were observed across western and central China, with the eastern region nearly achieving optimal performance scores. The central region showed lesser technical efficiency, but scale efficiency remained consistent across all regions. The MPI indicated positive efficiency trends from 2011 to 2016, with most years surpassing the baseline. Technical and pure efficiency changes generally remained above. Conclusions: China’s western and central regions have shown improved healthcare efficiency post-reforms, suggesting a focused allocation of resources to address inequality stemming from economic imbalances. The management of healthcare institutions has remained adept throughout these changes.