Efficiency Comparison of Public Hospitals under Different Administrative Affiliations in China: A Pilot City Case

Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984-2022

This study reviews scholarly publications on data envelopment analysis (DEA) studies on acute care hospital (ACH) efficiency published between 1984 and 2022 in scholarly peer-reviewed journals. We employ systematic literature review (SLR) method to identify and analyze pertinent past research using predetermined steps. The SLR offers a comprehensive resource that meticulously analyzes DEA methodology for practitioners and researchers focusing on ACH efficiency measurement. The articles reviewed in the SLR are analyzed and synthesized based on the nature of the DEA modelling process and the key findings from the DEA models. The key findings from the DEA models are presented under the following sections: effects of different ownership structures; impacts of specific healthcare reforms or other policy interventions; international and multi-state comparisons; effects of changes in competitive environment; impacts of new technology implementations; effects of hospital location; impacts of quality management interventions; impact of COVID-19 on hospital performance; impact of teaching status, and impact of merger. Furthermore, the nature of DEA modelling process focuses on use of sensitivity analysis; choice of inputs and outputs; comparison with Stochastic Frontier Analysis; use of congestion analysis; use of bootstrapping; imposition of weight restrictions; use of DEA window analysis; and exogenous factors. The findings demonstrate that, despite several innovative DEA extensions and hospital applications, over half of the research used the conventional DEA models. The findings also show that the most often used inputs in the DEA models were labor-oriented inputs and hospital beds, whereas the most frequently used outputs were outpatient visits, followed by surgeries, admissions, and inpatient days. Further research on the impact of healthcare reforms and health information technology (HIT) on hospital performance is required, given the number of reforms being implemented in many countries and the role HIT plays in enhancing care quality and lowering costs. We conclude by offering several new research directions for future studies.

Information-Driven Integrated Healthcare: An Analysis of the Cooperation Strategy of County Medical Community Based on Multi-Subject Simulation

The fragmentation and uneven quality of primary medical resources in China call for a deepening of integrated healthcare reform. China is promoting its county medical community (CMC) reform on a large scale in county-level administrative regions to promote the integration of local primary healthcare systems through information technology, which is consistent with the current trend of the digital governance era. Considering that the construction of a county medical community involves collaborative relationships between multi-level subjects, the evolutionary game theory was adopted in this study to construct a game model between the lead hospital of a CMC and primary healthcare institutions, and then the incentives of government department support were introduced to analyze the behavioral evolution of these three subjects. Taking into account the uncertainty of the real-life environment and information transformation, white Gaussian noise was introduced as a random disturbance term, and a numerical simulation was performed. In the two-subject model we focus on four parameters: information and management authority ceded by the primary healthcare institutions, integration coefficient of CMC information construction, intensity factor of information integration in the CMC, and medical resources delivered by the lead hospital. In the three-subject model we focus on three parameters: information and portion of authority ceded by the primary healthcare institutions and government departments, policy effect coefficient of CMC construction, and intensity of government departments' support for CMC construction. The simulation results show that there is a positive incentive for the concession of management power and information from the primary healthcare institutions to the lead hospital, but further determination of empowerment boundaries is needed. The lead hospital can improve the balance of medical resources in the county through the downward transfer of medical resources, but long-term resource delivery may inhibit the enthusiasm of the lead hospital. An improvement in the information integration intensity of the CMC can promote the efficient flow of information and knowledge and enhance the organizational closeness of the county medical community. At the same time, the integration of CMC information construction reduces the cost of collaboration among medical community members and streamlines and consolidates business modules, which can promote more efficient use of medical resources. The government departments' policies and funds provide obvious incentives to the lead hospital and primary healthcare institutions, but there is a need to explore appropriate financial payment ratios to balance the government's financial pressure.

Efficiency Measurement Using Data Envelopment Analysis (DEA) in Public Healthcare: Research Trends from 2017 to 2022

With the shifting healthcare environment, the importance of public healthcare systems is being emphasized, and the efficiency of public healthcare systems has become a critical research agenda. We reviewed recent research on the efficiency of public healthcare systems using DEA, which is one of the leading methods for efficiency analysis. Through a systematic review, we investigated research trends in terms of research purposes, specific DEA techniques, input/output factors used for models, etc. Based on the review results, future research directions are suggested. The results of this paper provide valuable information and guidelines for future DEA research on public healthcare systems.

Equity and efficiency of public hospitals' health resource allocation in Guangdong Province, China

Background

To better meet people’s growing demand for medical and health services, 21 cities in Guangdong Province were involved in the reform of public hospitals in 2017. This paper evaluates the equity and efficiency of public hospitals’ health resource allocation in Guangdong Province and explores ways to change the current situation.

Methods

Data were collected from the Guangdong Health Statistical Yearbook 2016–2020 and Guangdong Statistical Yearbook 2017–2021. The Gini coefficient (G), Theil index (T), and health resource density index (HRDI) were used to measure the equity of health resource allocation. An improved three-stage DEA method was applied in efficiency evaluation. The entropy weight method was employed to calculate the weight of different indicators to obtain a comprehensive indicator representing the overall volume of health resources in each city. A two-dimensional matrix was drawn between the HRDI of the comprehensive indicator and efficiency and the per capita government financial subsidies and efficiency to observe the coordination of equity and efficiency across regions.

Results

From 2016 to 2020, the G of public hospital, bed, and health technician allocation by population remained below 0.2, while that by geographical area ranged from 0.4 to 0.6; the G of government financial subsidies by population was above 0.4, while that by geographical area was greater than 0.7. The results for T showed that inequality mainly comes from intraregional differences, and the Pearl River Delta contributes most to the overall differences. Although the HRDI of the Pearl River Delta is far greater than that of other regions, obvious differences exist across cities in the region. Only 38.1% of cities were found to be efficient in 2020. The Pearl River Delta was in the first quadrant, and the other three regions were in the third quadrant, accounting for a large proportion.

Conclusion

The equity of government financial subsidies allocation was the worst, and there were distinct regional differences in the geographical distribution of health resources. The development of healthcare within the Pearl River Delta was highly unbalanced. The development of healthcare was uneven between the Pearl River Delta, eastern, western, and mountainous regions. In addition, most cities in the eastern, western, and mountainous regions bore the dual pressures of relatively insufficient health resources and inefficiency.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01741-1.

The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals

Parametric and non-parametric frontier applications are typical for measuring the efficiency and productivity of many healthcare units. Due to the current COVID-19 pandemic, hospital efficiency is the center of academic discussions and the most desired target for many public authorities under limited resources. Investigating the state of the art of such applications and methodologies in the healthcare sector, besides uncovering strategical managerial prospects, can expand the scientific knowledge on the fundamental differences among efficiency models, variables and applications, drag research attention to the most attractive and recurrent concepts, and broaden a discussion on the specific theoretical and empirical gaps still to be addressed in future research agendas. This work offers a systematic bibliometric review to explore this complex panorama. Hospital efficiency applications from 1996 to 2022 were investigated from the Web of Science base. We selected 65 from the 203 most prominent works based on the Core Publication methodology. We provide core and general classifications according to the clinical outcome, bibliographic coupling of concepts and keywords highlighting the most relevant perspectives and literature gaps, and a comprehensive discussion of the most attractive literature and insights for building a research agenda in the field.

Configurational Paths to Higher Efficiency in County Hospital: Evidence From Qualitative Comparative Analysis

Background

The efficient operation of county-level medical institutions is a significant guarantee in constructing Chinese rural tertiary care service networks. However, it is still unclear how to increase the efficiency of county hospitals under the interaction of multiple factors. In this study, 35 county general hospitals in China were selected to explore the configuration paths of county hospitals' high and poor efficiency status under the Environment-Structure-Behavior (ESB) framework and provide evidence-based recommendations for measures to enhance its efficiency.

Methods

Data envelopment analysis with the bootstrapping procedure was used to estimate the technical efficiency value of case hospitals. A fuzzy-set qualitative comparative analysis approach was carried out to explore the configuration of conditions to the efficiency status.

Results

Antecedent configurations affecting the efficiency status of county hospitals were identified based on the ESB analytical framework. Three high-efficiency configuration paths can be summarized as structural optimization, capacity enhancement, and government support. Another three types of paths, namely insufficient capacity, aggressive expansion, and poor decision-making, will lead to inefficient configurations.

Conclusion

Qualitative comparative analysis is necessary when exploring complex causality. The efficiency situation of county hospitals results from a combination of influencing factors instead of the effect of a single one. There is no solitary configuration for high efficiency that applies to all healthcare units. Any measures aimed at efficiency promotion should be discussed within the framework of a case-specific analysis.

Dynamic Performance Assessment of Hospitals by Applying Credibility-Based Fuzzy Window Data Envelopment Analysis

The goal of the current research is to propose the credibility-based fuzzy window data envelopment analysis (CFWDEA) approach as a novel method for the dynamic performance evaluation of hospitals during different periods under data ambiguity and linguistic variables. To reach this goal, a data envelopment analysis (DEA) method, a window analysis technique, a possibilistic programming approach, credibility theory, and chance-constrained programming (CCP) are employed. In addition, the applicability and efficacy of the proposed CFWDEA approach are illustrated utilizing a real data set to evaluate the performance of hospitals in the USA. It should be explained that three inputs including the number of beds, labor-related expenses, patient care supplies, and other expenses as well as three outputs including the number of outpatient department visits, the number of inpatient department admissions, and overall patient satisfaction level, are considered for the dynamic performance appraisal of hospitals. The experimental results show the usefulness of the CFWDEA method for the evaluation and ranking of hospitals in the presence of fuzzy data, linguistic variables, and epistemic uncertainty.

Spatio-Temporal Disparity and Driving Forces of the Supply Level of Healthcare Service in the Yangtze River Delta

The equalization of healthcare supply is not only related to the people's need for a better life, but can also provide a strong guarantee for the high-quality and sustainable development of the Yangtze River Delta integration. By using exploratory spatial analysis techniques, this study analyzed the spatio-temporal evolution characteristics and heterogeneous influence effects of the supply level of healthcare service in the Yangtze River Delta from 2007 to 2019. It was found that the supply level of healthcare service in the Yangtze River Delta had improved significantly. The differences in the supply level of healthcare service between cities had tended to narrow without polarization, and the supply level of healthcare service generally showed a high spatial pattern in the south delta and low spatial pattern in the north delta. The higher the supply level of healthcare service was, the weaker the interannual variability was. The supply level of healthcare service in the Yangtze River Delta region presented obvious spatial association and differentiated tendency of local high and low spatial clusters. The relative length and curvature of the supply level of healthcare service in the Yangtze River Delta generally presented a spatial pattern with low values in the northeast and high values in the southwest. Population density and urban-rural income gap generally exhibited negative spatio-temporal impact on the supply level of healthcare service across most cities. On the other hand, urbanization level and per capita disposable income generally had positive spatio-temporal impact on the supply level of healthcare service across most cities. Per capita gross domestic product (GDP) showed an increasingly positive spatio-temporal impact on the supply level of healthcare service across most cities. While per capita fiscal expenditure exhibited significantly negative impact on the supply level of healthcare service across most cities in space.

The Reduction of Credit Risk in the Health Care Industry in China: Are We Returning to the Pre-COVID-19 Era?

This study aims to evaluate the changes in the credit risk of the health care industry in China due to the COVID-19 epidemic by the modified KMV (named by Kealhofer, Mcquown, and Vasicek) model to calculate the default distances. We observe that the overall default distance mainly first decreased and then increased before and after the COVID-19 epidemic control in China; after the epidemic was controlled, the overall credit risk was reduced by 22.8%. Specifically, as shown in subdivided industries, health care equipment and health care facilities have larger credit risk fluctuations, while health care suppliers, health care distributors, and health care services have smaller fluctuations. These results can contribute to our understanding of why the COVID-19 epidemic in China could be controlled earlier, and software facilities are more important than hardware facilities in public health safety. Our methodological innovation is to use the GARCH (generalized autoregressive conditional heteroskedasticity) model and threshold regression model to modify the important parameters of the KMV model. This method has good accuracy in the Chinese environment.

Multifaced Evidence of Hospital Performance in Pennsylvania

As health care costs and demands for health care services have been rising for decades in the United States, health care reforms have focused on increasing the performance of health care delivery. Competition has been considered as a mechanism to improve the quality of health care services and operational performance. Evidence on health care performance and market competition, however, has not sufficiently been reported to track its progress. The purpose of this study is twofold: First, we measure hospital performance over nine years, using the Malmquist Productivity Index. Second, we examine the impact of market competition on hospital efficiency in Pennsylvania, using a two-stage estimation procedure. The bootstrapped Malmquist productivity indices resulted in noticeable performance improvements. However, no steady performance trends were found during the course of nine years. In examining the impact of market competition, the bootstrapped panel Tobit analysis was applied after computing the efficiency scores with Data Envelopment Analysis. The results of the Tobit model found that hospitals run more efficiently in less competitive regions than in more competitive regions. The finding implies that hospitals underperforming in productivity growth should benchmark best practices of efficient hospitals to improve their productivity level. Another implication is that market competition would not be the best approach to effect the improvement of hospital efficiency in delivering health care services.