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International Journal for Equity in Health

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Open Access 01-12-2020 | Research

Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China

Authors: Ming Yi, Jiachao Peng, Lian Zhang, Yao Zhang

Published in: International Journal for Equity in Health | Issue 1/2020

Abstract

Background

Over the last decade, the expenditure on public medical and health has increased greatly in China, however, problems as low efficiency and unfairness still exist. How to accurately describe the effectiveness of existing medical and health resources in combination with regional heterogeneity is of great significance to China’s medical and health reform.

Methods

Based on provincial panel data for the period of 2005 to 2017, combining expected output and unexpected output, this paper constructs a super-efficiency three-stage SBM-DEA model, to measure and analyze the spatial-temporal heterogeneity characteristics and influencing factors of public medical and health efficiency (PMHE).

Results

(1) After the impacts of random error and external environmental factors are removed, the mean value of overall PMHE is 0.9274, failing to reach DEA efficiency, and PMHE shows a fluctuated downward trend. (2) The adjusted PMHE level shows a prominent spatial imbalance at the stage 3. The average efficiency level is ranked by the East > the West > the Central > the Northeast. (3) The increases of GDP per capita and population density are beneficial to the improvement of PMHE, while income level and education level are disadvantageous to PMHE, and last, the urbanization level, an uncertain effect. (4) There is no σ convergence of the PMHE in the East, the Central and the West, that is, the internal differences may gradually expand in the future, while the Northeast shows a significant σ convergence trending of PMHE. (5) The state’s allocation of medical and health resources has undergone major changes during “The Twelfth Five-Year Plan”.

Conclusion

This study innovatively incorporates undesired outputs of health care into the efficiency evaluation framework by constructing the main efficiency evaluation indicators. The results of the robust evaluation conclude that China’s existing investment in medical and health resources is generally not effective. Therefore, although China’s health care reform has made certain achievement, it is still necessary to expand the investment in health care resources.

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This refers to the bed utilization rate (%), and the number of hospital beds refers to the number of beds in medical institutions in “③ Material Input (MHI)”, that is, these beds can be supplied by Medical institutions do their best. The bed utilization rate (%) reflects the ratio of daily bed use to actual bed use, that is, the ratio of the total bed days occupied to the total bed days opened.

The infant mortality rate in the monitored areas of China ‘s Health Statistics Yearbook includes New born infant mortality rate (‰), Infant mortality rate (‰), Under-five child mortality (‰) and Maternal mortality rate (1/100,000). Considering that the Under-five child mortality (‰) and Maternal mortality rate (1/100,000) are more capable of measuring the output capacity of the region’s medical and health resources about maternal and child hygiene level, it is used as one of the maternal and child hygiene level indicators. Thanks to the review experts for their help in this part.

From two independent perspectives of UL and POP, their impacts on PMHE are proposed: is there an alternative relationship between UL and POP? That is, in the case of low UL, can the increase in POP significantly increase PMHE to make up for the problem of low efficiency caused by insufficient urbanization; on the other hand, in the case of insufficient POP, the improvement of UL has made up for the inefficiency of PMHE caused by insufficient POP.

The National Bureau of Statistics of China stipulated that since 2005, the specific divisions of the East, the Central, the West and the Northeast involved in the statistics are: the 10 eastern provinces (cities) include Beijing, Tianjin, Hebei, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong, Guangdong and Hainan; 6 provinces in central China include Shanxi, Anhui, Jiangxi, Henan, Hubei and Hunan; 12 provinces (regions and cities) in western China include Inner Mongolia, Guangxi, Chongqing, Sichuan, Guizhou, Yunnan, Tibet, Shaanxi, Gansu, Qinghai, and Ningxia And Xinjiang; the three northeast provinces include Liaoning, Jilin and Heilongjiang. For details, see the website: http://www.stats.gov.cn/tjzs/cjwtjd/201308/t20130829_74318.html.

The increase of residents’ income does not make use of capital investment in health care. This is mainly because the current state reform of the public healthcare system relies only on financial burden and allocation of medical resources. The development of China’s medical and health resources mainly relies on large public hospitals, with high barriers to entry, and it is difficult for residents’ income to cross the threshold. In addition, this article mainly discusses public health, which leads to an increase in residents’ income and may lead to investment in private medical resources. Such investment will snatch public medical resources. This high threshold and the obstruction of the political system make even the increase in residents’ income does not effectively promote PMHE, which will be the main topic of our discussion in the next stage.

We also tried to use other proxy variables, such as average years of schooling, etc., and the regression results did not differ significantly. Therefore, we mainly discussed the influence and possible causes of this variable.

“The Tenth Five-Year Plan” is mainly the tenth five-year plan outline formulated by the Chinese government for economic and social development. It is a grand blueprint for China’s economic and social development from 2001 to 2005. Correspondingly, “The Eleventh Five-Year Plan” is for the period 2006 to 2010, “The Twelfth Five-Year Plan” is for 2011 to 2015, while “The thirteenth Five-Year Plan” is for 2016 to 2020.

Convergence of variation (CV) refers to the variation of PMHE between different regions or provinces, which gradually decreases over time. As in refence [45], we use the following equation to analyze the variation trend of the coefficient of variation (CV) of the PMHE in each region.

We can further study the internal differences of different regions according to the spatial analysis method, due to space limitations, we will not discuss it further here.

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Title: Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China
Authors: Ming Yi
Jiachao Peng
Lian Zhang
Yao Zhang
Publication date: 01-12-2020
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2020
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-020-01201-8

At a glance: The STEP trials

Springer Medicine

Is the allocation of medical and health resources effective? Characteristic facts from regional heterogeneity in China

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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