Evaluation of performance and impacts of maternal and child health hospital services using Data Envelopment Analysis in Guangxi Zhuang Autonomous Region, China: a comparison study among poverty and non-poverty county level hospitals

Abstract

BackgroundAs the core of the county-level Maternal and Child Health Hospitals (MCHH) in rural areas of China, the service efficiency affects the fairness and availability of healthcare services. This study aims to identify the determinants of hospital efficiency and explore how to improve the performance of MCHH in terms of productivity and efficiency.MethodsData was collected from a sample of 32 county-level MCHHs of Guangxi in 2014. Firstly, we specified and measured the indicators of the inputs and outputs which represent hospital resources expended and its profiles respectively. Then we estimated the efficiency scores using Data Envelopment Analysis (DEA) for each hospital. Efficiency scores were decomposed into technical, scale and congestion components, and the potential output increases and/or input reductions were also estimated in this model, which would make relatively inefficient hospitals more efficient. In the second stage, the estimated efficiency scores are regressed against hospital external and internal environment factors using a Tobit model. We used DEAP (V2.1) and R for data analysis.ResultsThe average scores of technical efficiency, net technical efficiency (managerial efficiency) and scale efficiency of the hospitals were 0.875, 0.922 and 0.945, respectively. Half of the hospitals were efficient, and 9.4 % and 40.6 % were weakly efficient and inefficient, respectively. Among the low-productiveness hospitals, 61.1 % came from poor counties (Poor counties in this article are in the list of key poverty-stricken counties at the national level, published by The State Council Leading Group Office of Poverty Alleviation and Development, 2012). The total input indicated that redundant medical resources in poverty areas were significantly higher than those in non-poverty areas. The Tobit regression model showed that the technical efficiency was proportional to the total annual incomes, the number of discharge patients, and the number of outpatient and emergency visits, while it was inversely proportional to total expenditure and the actual number of open beds. Technical efficiency was not associated with number of health care workers.ConclusionThe overall operational efficiency of the county-level MCHHs in Guangxi was low and needs to be improved. Regional economic differences affect the performances of hospitals. Health administrations should adjust and optimize the resource investments for the different areas. For the hospitals in poverty areas, policy-makers should not only consider the hardware facilities investment, but also the introduction of advanced techniques and high-level medical personnel to improve their technical efficiency.

Equity and efficiency of maternal and child health resources allocation in Hunan Province, China

“…By measuring the distance from the inputs and outputs of inefficient DMUs to their efficient peers, we could calculate the over-supplied inputs and expected outputs for the inefficient DMUs, which can provide the quantitative basis for improving the efficiency of MCH allocation of each DMU. Thus, we preferred to select the BCC model in this study to evaluate the efficiency of MCH resources allocation [9,23].…”

Evaluation of resource utilization efficiency in obstetrics and gynecology units in China: A three‐stage data envelopment analysis of the Shanxi province

“…For example, Katharaki measured the efficiency of 32 Greek OB/GYN units and reported the arithmetic mean of TE was 0.8933. The average TE of maternal and child health hospitals in Guangxi, China, was 0.875 . Compared with other studies, the results indicate that the TE of the OB/GYN units in Shanxi is in urgent need of improvement; this means that the utilization efficiency of maternal and child health resources in Shanxi is low .…”

“…Third, since the number of discharged patients is not controlled by the administrator, the DEA model can be applied to the problem of how to optimize the input resources, under the condition of constant output. Furthermore, the model is suited to health care units, which face a shortage of health care resources …”

“…Previous studies on the efficiency of health care institutions for maternal mothers and their children in China provide references for this study. Wang et al measured the efficiency of county‐level maternal and child hospitals in the Guangxi province in 2016 and suggested that the technical efficiency of county‐level maternal and child hospitals was low and in need of improvement. Yan et al used the DEA approach to measure the efficiency of county‐level maternal and child hospitals in Jiangsu, during 2011, and suggested that the overall input‐output level of hospitals in the region required further improvement.…”

Child Healthcare Workers’ Knowledge About Autism and Attitudes Towards Traditional Chinese Medical Therapy of Autism: A Survey from Grassroots Institutes in China

“…In comparison to participants working at community health service centers, participants at town health service centers lacked more knowledge of ASD in Chongqing. It is probable that the urban-rural gap in medical human resources influences the knowledge of children with ASD (19,20). Childhood neurodevelopmental disorders are increasingly being recognized along with demands for earlier diagnosis and intervention.…”