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
SBM-undesirable（Slacks-based Measurement-undesirable) DEA(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
analyze the factors affecting CPGHs’ medical service
efficiency based on the FRM 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 utilization 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.