Equity and efficiency of primary health care resource allocation in mainland China

Yue Zhang · Qian Wang · Jian Wang

174 citations0/0 files storedInternational Journal for Equity in Health

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Healthcare Systems and Reforms Efficiency Analysis Using DEA Healthcare Systems and Practices

Abstract

BACKGROUND: China had proposed the unification of equity and efficiency since the launch of the new round of health system reform in 2009. And the central government gave priority to the development of primary health care (PHC) whilst ensuring its availability and improving its efficiency. This study aimed to evaluate the changes of equity and efficiency in PHC resource allocation (PHCRA) and explored ways to improve the current situation. METHODS: The data of this study came from the China Health Statistical Yearbook (2013-2017) and China Statistical Yearbook (2017). Three and five indicators were used to measure equity and efficiency, respectively. The Lorenz curve, Gini coefficient (G), Theil index (T) and health resource density index (HRDI) were used to assess equity in demographic and geographical dimensions. Data envelopment analysis (DEA) and the Malmquist productivity index (MPI) were chosen to measure the efficiency and productivity of PHCRA. RESULTS: From 2012 to 2016, the total amount of PHCR had increased year by year. The Gs by population size were below 0.2 and that by geographical area were between 0.6 and 0.7. T had the same trend with G, and intra-regional contribution rates were higher than inter-regional contribution rates, which were all beyond 60%. From 2012 to 2016, the numbers of provinces that achieved an effective DEA were 4, 3, 4, 5 and 5, respectively. The mean of the total factor productivity index was 0.994. CONCLUSION: The equity of PHCRA in terms of population size is superior in the geographical area. Intra-regional differences are the main source of inequality. The eastern region has the highest density of PHCR, whereas the western region has the lowest. In addition, PHC institutions in more than 80% of the provinces are inefficient, and the productivity of the institutions decline by 0.6% from 2012 to 2016 because of technological retrogression.

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References

2005An Introduction to Efficiency and Productivity Analysis 1998An Introduction to Efficiency and Productivity Analysis 1994Data Envelopment Analysis: Theory, Methodology, and Applications 1994Productivity Developments in Swedish Hospitals: A Malmquist Output Index Approach 2007Advanced Robust and Nonparametric Methods in Efficiency Analysis: Methodology and Applications 2014Harnessing the privatisation of China's fragmented health-care delivery 2017Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions 2009China's health care reform: A tentative assessment

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