Spatial and Temporal Differences in the Health Expenditure Efficiency of China: Reflections Based on the Background of the COVID-19 Pandemic

Evaluation of healthcare efficiency in China: a three-stage data envelopment analysis of directional slacks-based measure

Background

A consensus on the changing pattern of healthcare efficiency in China is current absent. This study tried to identify temporal fluctuations in healthcare efficiency from 2012 to 2021, and conducted a comparative analysis on the performance of 31 regions in China using region-level balanced panel data.

Methods

Employing three-stage data envelopment analysis (DEA) as the analytical framework, we measured healthcare efficiency and its changes using the directional slacks-based measure and global Malmquist-luenberger (GML) indexes. We also decomposed the sources of healthcare inefficiency and extended our analysis to changes in healthcare efficiency across different primary medical service levels and regional economic development tiers.

Results

The average efficiency score of medical institutions (0.956) was slightly higher than that of hospitals (0.930). We found that the average GML indexes of medical institutions in China stood at 0.990, while the average technical change (TC) index was 0.995 and the average efficiency change (EC) index was 0.998 from 2012 to 2021. The GML indexes, TC indexes, and EC indexes of hospitals were 1.002, 1.009, and 0.994, respectively. The healthcare inefficiency for both inputs and desirable outputs in medical institutions was primarily attributed to the redundant numbers of institutions, outpatient visits slacks and inpatient surgery volume slacks, accounting for 50.040, 49.644, and 28.877%, respectively. The undesirable output inefficiency values of medical institutions concerning in-hospital mortality stood at 0.012, while the figure for hospital regarding the average length of stay (LOS) was 0.002. Additionally, healthcare efficiency in both medical institutions and hospitals exhibited an upward trend from 2012 to 2021, corresponding to an increase in the volume of primary medical services, primary medical staff, and the total gross domestic product (GDP).

Conclusion

Total factor productivity (TFP) of medical services declined in China from 2012 to 2021. The excessive number of medical institutions and the slack of medical service volumes were the main sources of healthcare inefficiency. Regions prioritizing primary medical services and boasting higher GDP levels exhibited superior healthcare efficiency. These findings are expected to inform policymakers' efforts in building a value-based and efficient health service system in China.

Unveiling spatial disparities in basic medical and health services: insights from China's provincial analysis

Based on the panel data of 31 provinces (municipalities and autonomous regions) in China from 2012 to 2019, this paper constructs the evaluation index system of basic medical and health services in China from seven dimensions: medical and health facilities, health expenditure, medical services, traditional Chinese medicine hospital services, maternal and child health care, people's health and medical security, disease control and public health. The entropy method was used to measure the level of basic medical and health services in China, and its spatial differences and convergence characteristics were further investigated. In this study, we employ the entropy weight method, σ convergence, and β convergence as our primary methodologies. The entropy weight method is used to evaluate the variability of each indicator, determine the weights of indicators, and quantify the information content of the data. σ convergence illustrates the process by which the variance of a sample decreases over time. β convergence refers to the gradual approach of variables within an economic system towards their long-term equilibrium level over time. The results show that: (1) The scores of basic medical and health services in China's four major regions (including Northeast, East, Central and West) remain in a relatively stable state, with small fluctuations and great room for improvement; (2) There are significant regional differences in the level of basic medical and health services in China, and the intra-regional differences are much greater than the inter-regional differences; (3) There is no significant σ convergence observed in China and its four major regions; however, there is a notable presence of β convergence.

Pension level, subjective wellbeing, and preference of care model among elderly people: An empirical study based on structural equation modeling

The problem of population aging is becoming increasingly serious, and the elderly care model has become the social focus in China. It is urgent to improve the traditional home based elderly care model and increase the recognition of the residents for the socialized elderly care model. Based on the data of the 2018 China Longitudinal Aging Social Survey (CLASS), this paper uses structural equation model (SEM) to empirically test the impact of the elderly group's social pension level and subjective well-being on their choice of various care models. The results show that the improvement of elderly's pension level can significantly inhibit their choice of home-based care model, and promote their choice of community and institution care model. Subjective well-being can play a mediating role in the home-based and community care model choices, but the indirect approach mediated by subjective well-being only plays a supplementary role. In addition, the heterogeneity analysis shows that there are discrepancies in the impact and path for the elderly with different gender, age, household registration, marital status, health status, education level, number of children, and gender of children. The results of this study will help the improvement and development of social pension policy, optimizing the structure of residents' elderly care model and the process of "active aging".

China's industrial green development and its influencing factors under the background of carbon neutrality

To measure and analyze the evolution characteristics and influencing factors of China's industrial green development level is of great significance in achieving carbon neutrality goal. Based on the panel data from 2000 to 2018 of 30 provinces in China, this research uses the super slack-based measuring model and the Malmquist-Luenberger index to calculates China's industrial green total factor productivity and to describe its evolution characteristics using the kernel density function and moreover uses the Spatial Durbin model and the partial differential method to explores its main influencing factors. This study finds that China's overall industrial green development level is not high but shows an upward trend year by year; carbon emissions, fiscal decentralization, and urbanization are not conducive to improving the national industrial green development level, whereas economic development, foreign direct investment, industrial structure, and technological progress are positive contributors. At the same time, the level of economic development and technological progress have significant direct and spatial spillover effect. Our findings also provide some policy implications for improving China's industrial green development.

Efficiency measurement and spatial spillover effect of provincial health systems in China: Based on the two-stage network DEA model

The effectiveness of a health care system is an important factor for improving people's health and quality of life. The purpose of this research is to analyze the efficiency and spatial spillover effects of provincial health systems in China using panel data from 2009 to 2020. We employ the two-stage network DEA model to evaluate their efficiencies and use a spatial econometric model for empirical estimation. The results suggest that the overall efficiency, resource allocation efficiency, and service operation efficiency of health systems in different regions of China generally have fluctuating upward trends, with large differences in efficiency among the various regions. Further analysis reveals that the efficiency of China's health system has a significant spatial spillover effect. The level of economic development, fiscal decentralization and old-age dependency ratio are important factors affecting the health system efficiency. Our findings help to identify the efficiency and internal operating mechanisms of China's health system at different stages, and are expected to contribute to policymakers' efforts to build a high-quality health service system.

Capital misallocation, technological innovation, and green development efficiency: empirical analysis based on China provincial panel data

The study aims to analyze the impacts of capital misallocation and technological innovation on green development efficiency in China by using the panel data from 2000 to 2018. We employ the Super-SBM model to evaluate green development efficiency and use the system generalized method of moments (GMM) for empirical estimation. The results suggest that capital misallocation has a significant inhibitory effect on green development efficiency. Moreover, capital misallocation restrains technological innovation, which plays an important role in improving green development efficiency. Further research on the effect of regional heterogeneity indicates that the negative impact of capital misallocation on green development efficiency is more significant in the central and western regions, while the effect is not significant in the eastern region. Our findings provide useful policy implications for improving green development efficiency in China.

The impact of environmental regulation on China’s industrial green development and its heterogeneity

The research analyzes the impact of environmental regulation on industrial green development using panel data from 30 provinces in China from 2006 to 2018. We employ the Super-slack-based measuring (SBM) model to measure the level of domestic industrial green development and use the ordinary panel model, the panel threshold model, and the spatial panel model for empirical estimation. The results reveal that the environmental regulation index plays a significant role in promoting such development. Environmental regulation index, command-and-control environmental regulation, market-incentive environmental regulation, and public-participation environmental regulation all have only a single threshold of technological progress and fiscal decentralization. Further analysis shows that China’s industrial green development presents obvious spatial agglomeration characteristics, and there is a significantly positive spatial correlation between different environmental regulation indicators and industrial green development. Our findings provide useful policy recommendations for promoting industrial green development in China.

Human Health, Environmental Quality and Governance Quality: Novel Findings and Implications From Human Health Perspective

Human health and wellbeing are intimately linked to the state of the environment. The current study emphasizes the role of environmental quality, government policies, and human health. This paper provides a detailed literature review of existing findings regarding our key variables of interest. The results argue that the implications of poor government policies and environmental pollution for rising economic development have led to poor environmental quality and health issues for humans. Based on earlier investigations, the present study reviewed the state-of-the-art review and determined innovative insights for outdoor and indoor environment difficulties. This study provides a detailed review of human health, environmental quality, and governance quality. In addition, the study conducts an empirical analysis using the annual data of low-income countries from 1996 to 2020. Government actions and health systems must be modified immediately to address these rising concerns successfully. The report offers policy recommendations for addressing health, governance, and environmental change mitigation issues, all of which are directly or indirectly related to the study. This article presents an overview of environmental change's health impacts and explores how health hazards may be reduced or eliminated through effective adaptation strategies.