IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v15y2025i1d10.1186_s13561-025-00600-3.html
   My bibliography  Save this article

Impact of pilot public hospital reform on efficiencies: a DEA analysis of county hospitals in East China, 2009–2015

Author

Listed:
  • Wei Jiang

    (Ningbo University of Finance & Economics)

  • Xuyan Lou

    (University of Nottingham Ningbo China)

  • Qiulin Chen

    (Universityof Chinese Academy of Social Sciences)

  • Lina Song

    (Nottingham University Business School, University of Nottingham)

  • Zhuo Chen

    (University of Nottingham Ningbo China
    University of Georgia)

Abstract

Background China started a pilot public hospital reform in 2012 to improve governance and efficiency in healthcare services delivery among county-level hospitals. This study aims to investigate the impact of the pilot reform on hospital efficiency and productivity by using a unique dataset of county hospitals in East China during 2009–2015. Methods A three-stage approach is used. First, this study uses the output-oriented data envelopment analysis (DEA) to estimate hospital efficiency with variable returns to scale. Second, propensity score matching is used to address potential biases associated with the selection of counties for the pilot program. In the third stage, we assess the impact of the pilot reform on efficiency by using a Tobit Difference-in-Differences approach. Results The average level of hospital efficiency for the whole sample experienced a rapid drop in 2013, then returned to a peak in 2014. Except in the reform year (2012), the overall hospital efficiency for the post-reform period is higher than that for the pre-reform period. The baseline model results show that the pilot reform is associated with a 3% decline in pure technical efficiency and a 2.3% increase in hospital scale efficiency, respectively. Our findings are robust when we apply bootstrapped DEA efficiency scores and use different specifications. Conclusion The findings of this study suggest no improvements in overall hospital efficiency associated with the pilot reform, possibly due to the combined effects of inefficient governance and hospital scale expansion. This study suggests that further efforts are needed to increase county hospital performance by strengthening management and optimizing resource utiliziation.

Suggested Citation

  • Wei Jiang & Xuyan Lou & Qiulin Chen & Lina Song & Zhuo Chen, 2025. "Impact of pilot public hospital reform on efficiencies: a DEA analysis of county hospitals in East China, 2009–2015," Health Economics Review, Springer, vol. 15(1), pages 1-18, December.
    • Handle: RePEc:spr:hecrev:v:15:y:2025:i:1:d:10.1186_s13561-025-00600-3
    DOI: 10.1186/s13561-025-00600-3
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-025-00600-3
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-025-00600-3?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Fu, Hongqiao & Li, Ling & Yip, Winnie, 2018. "Intended and unintended impacts of price changes for drugs and medical services: Evidence from China," Social Science & Medicine, Elsevier, vol. 211(C), pages 114-122.
    2. Bruce Hollingsworth, 2008. "The measurement of efficiency and productivity of health care delivery," Health Economics, John Wiley & Sons, Ltd., vol. 17(10), pages 1107-1128, October.
    3. Yuting Zhang & Qianheng Ma & Yingchun Chen & Hongxia Gao, 2017. "Effects of Public Hospital Reform on Inpatient Expenditures in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 421-430, April.
    4. Robert Stefko & Beata Gavurova & Kristina Kocisova, 2018. "Healthcare efficiency assessment using DEA analysis in the Slovak Republic," Health Economics Review, Springer, vol. 8(1), pages 1-12, December.
    5. Antonio Giuffrida & Hugh Gravelle, 2001. "Measuring performance in primary care: econometric analysis and DEA," Applied Economics, Taylor & Francis Journals, vol. 33(2), pages 163-175.
    6. R. D. Banker & A. Charnes & W. W. Cooper, 1984. "Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis," Management Science, INFORMS, vol. 30(9), pages 1078-1092, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Varabyova, Yauheniya & Schreyögg, Jonas, 2013. "International comparisons of the technical efficiency of the hospital sector: Panel data analysis of OECD countries using parametric and non-parametric approaches," Health Policy, Elsevier, vol. 112(1), pages 70-79.
    2. Rita Bastião & Nuno de Sousa Pereira, 2020. "Performance in the Delivery of Primary Health Care Services: A Longitudinal Analysis," CEF.UP Working Papers 2002, Universidade do Porto, Faculdade de Economia do Porto.
    3. Fengyi Lin & Yung-Jr Deng & Wen-Min Lu & Qian Long Kweh, 2019. "Impulse response function analysis of the impacts of hospital accreditations on hospital efficiency," Health Care Management Science, Springer, vol. 22(3), pages 394-409, September.
    4. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Post-Print hal-01414677, HAL.
    5. Liu, John S. & Lu, Louis Y.Y. & Lu, Wen-Min & Lin, Bruce J.Y., 2013. "A survey of DEA applications," Omega, Elsevier, vol. 41(5), pages 893-902.
    6. George Fragkiadakis & Michael Doumpos & Constantin Zopounidis & Christophe Germain, 2016. "Operational and economic efficiency analysis of public hospitals in Greece," Annals of Operations Research, Springer, vol. 247(2), pages 787-806, December.
    7. Dinesh R. Pai & Fatma Pakdil & Nasibeh Azadeh-Fard, 2024. "Applications of data envelopment analysis in acute care hospitals: a systematic literature review, 1984–2022," Health Care Management Science, Springer, vol. 27(2), pages 284-312, June.
    8. Aleksandar Medarević & Dejana Vuković, 2021. "Efficiency and Productivity of Public Hospitals in Serbia Using DEA-Malmquist Model and Tobit Regression Model, 2015–2019," IJERPH, MDPI, vol. 18(23), pages 1-22, November.
    9. Ronald G. McGarvey & Andreas Thorsen & Maggie L. Thorsen & Rohith Madhi Reddy, 2019. "Measuring efficiency of community health centers: a multi-model approach considering quality of care and heterogeneous operating environments," Health Care Management Science, Springer, vol. 22(3), pages 489-511, September.
    10. Helmut Herwartz & Christoph Strumann, 2012. "On the effect of prospective payment on local hospital competition in Germany," Health Care Management Science, Springer, vol. 15(1), pages 48-62, March.
    11. Ferreira, D.C. & Marques, R.C., 2019. "Do quality and access to hospital services impact on their technical efficiency?," Omega, Elsevier, vol. 86(C), pages 218-236.
    12. Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
    13. David Mayston, 2015. "Analysing the effectiveness of public service producers with endogenous resourcing," Journal of Productivity Analysis, Springer, vol. 44(1), pages 115-126, August.
    14. Alonso, José M. & Clifton, Judith & Díaz-Fuentes, Daniel, 2015. "The impact of New Public Management on efficiency: An analysis of Madrid's hospitals," Health Policy, Elsevier, vol. 119(3), pages 333-340.
    15. repec:ptu:bdpart:e202312 is not listed on IDEAS
    16. Berger, Michael & Sommersguter-Reichmann, Margit & Czypionka, Thomas, 2020. "Determinants of soft budget constraints: how public debt affects hospital performance in Austria," LSE Research Online Documents on Economics 116865, London School of Economics and Political Science, LSE Library.
    17. Oliver Tiemann & Jonas Schreyögg, 2012. "Changes in hospital efficiency after privatization," Health Care Management Science, Springer, vol. 15(4), pages 310-326, December.
    18. Zare Ahmadabadi, Habib & Zamzam, Fatemeh & Emrouznejad, Ali & Naser Sadrabadi, Alireza & Morovati Sharifabadi, Ali, 2024. "Measuring sustainable performance of OECD countries considering CO2 emissions: A new optimistic-pessimistic distance friction Minimization Model," Socio-Economic Planning Sciences, Elsevier, vol. 96(C).
    19. Kontodimopoulos, Nick & Nanos, Panagiotis & Niakas, Dimitris, 2006. "Balancing efficiency of health services and equity of access in remote areas in Greece," Health Policy, Elsevier, vol. 76(1), pages 49-57, March.
    20. Kosycarz, Ewa & Dędys, Monika & Ekes, Maria & Wranik, Wiesława Dominika, 2023. "The effects of provider contract types and fiscal decentralization on the efficiency of the Polish hospital sector: A data envelopment analysis across 16 health regions," Health Policy, Elsevier, vol. 129(C).
    21. Cordero Ferrera, Jose Manuel & Alonso Morán, Edurne & Nuño Solís, Roberto & Orueta, Juan F. & Souto Arce, Regina, 2013. "Efficiency assessment of primary care providers: A conditional nonparametric approach," MPRA Paper 51926, University Library of Munich, Germany.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:hecrev:v:15:y:2025:i:1:d:10.1186_s13561-025-00600-3. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.