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Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data

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  • Audibert, Martine
  • Mathonnat, Jacky
  • Pelissier, Aurore
  • Huang, Xiao Xian
  • Ma, Anning

Abstract

In the rural health-care organization of China, township hospitals ensure the delivery of medical services above village health stations and below county hospitals. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, the efficiency of township hospitals has been questioned, mainly because of the implementation since 2003 of the reform of health insurance in rural areas (New Rural Cooperative Medical Scheme). From a database of 24 randomly selected township hospitals observed over the period 2000–2008 in Weifang Prefecture (Shandong), this study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientations to compute scores. The results show that technical efficiency has declined over time. The factors explaining technical efficiency are mainly environmental characteristics rather than internal ones. Among these environmental factors, NRCMS have in average a negative effect on the evolution of THs efficiency, although efficiency have improved for some of them. Our results suggest also that, in the context of China, the efficiency of township hospitals is influenced by unobservable factors. From our findings, we suggest five main orientations to improve THs efficiency.

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  • Audibert, Martine & Mathonnat, Jacky & Pelissier, Aurore & Huang, Xiao Xian & Ma, Anning, 2013. "Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data," China Economic Review, Elsevier, vol. 27(C), pages 326-338.
  • Handle: RePEc:eee:chieco:v:27:y:2013:i:c:p:326-338
    DOI: 10.1016/j.chieco.2013.01.004
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    Cited by:

    1. Laurène PETITFOUR & Xiezhe HUANGFU & Martine AUDIBERT & Jacky MATHONNAT, 2017. "Efficiency of township hospitals in China in the context of the drug policy reform: Progress should not get bogged in midstream - A case study from a survey in Weifang prefecture," Working Papers P185, FERDI.
    2. Martine AUDIBERT & Marlène GUILLON & Jacky MATHONNAT, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia," Working Papers P226, FERDI.
    3. Wanke, Peter & Barros, Carlos Pestana, 2016. "Efficiency drivers in Brazilian insurance: A two-stage DEA meta frontier-data mining approach," Economic Modelling, Elsevier, vol. 53(C), pages 8-22.
    4. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
    5. Laurene Petitfour & Xiezhe Huangfu & Martine Audibert & Jacky Mathonnat, 2015. "Estimating and explaining the efficiency of township hospitals in Shandong province in the context of the drug policy reform," Working Papers halshs-01180621, HAL.
    6. Zhou, Wenhui & Zheng, Yanfang & Morton, Alec & Luo, Feng, 2018. "Delivering universal health coverage for an aging population: An analysis of the Chinese rural health insurance program," China Economic Review, Elsevier, vol. 52(C), pages 204-224.
    7. Martine Audibert & Marlène Guillon & Jacky Mathonnat, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia - What data tell us for Soum Health Centers in five provinces?," Working Papers hal-01795645, HAL.
    8. Kejia Chu & Ning Zhang & Zhongfei Chen, 2015. "The Efficiency and Its Determinants for China’s Medical Care System: Some Policy Implications for Northeast Asia," Sustainability, MDPI, Open Access Journal, vol. 7(10), pages 1-20, October.
    9. Martine Audibert & Marlène Guillon & Jacky Mathonnat, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia - What data tell us for Soum Health Centers in five provinces?," Post-Print hal-01795645, HAL.
    10. Firdaus Hafidz & Tim Ensor & Sandy Tubeuf, 2018. "Efficiency Measurement in Health Facilities: A Systematic Review in Low- and Middle-Income Countries," Applied Health Economics and Health Policy, Springer, vol. 16(4), pages 465-480, August.
    11. Laurene PETITFOUR & Xiezhe HUANGFU & Jacky MATHONNAT & Martine AUDIBERT, 2015. "Estimating and explaining the efficiency of township hospitals in Shandong province in the context of the drug policy reform," Working Papers 201517, CERDI.
    12. Martine AUDIBERT & Marlène GUILLON & Jacky MATHONNAT, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia," Working Papers P226, FERDI.
    13. Laurène PETITFOUR & Xiezhe HUANGFU & Martine AUDIBERT & Jacky MATHONNAT, 2017. "Efficiency of township hospitals in China in the context of the drug policy reform: Progress should not get bogged in midstream - A case study from a survey in Weifang prefecture," Working Papers P185, FERDI.

    More about this item

    Keywords

    Data Envelopment Analysis; Technical efficiency; China; New Rural Cooperative Medical Scheme; Township hospitals;

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I1 - Health, Education, and Welfare - - Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development

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