ArticleHealth economics review2025
Impact of pilot public hospital reform on efficiencies: a DEA analysis of county hospitals in East China, 2009-2015.
Article in Health economics review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Hospital efficiency assessment: a systematic review of DEA and hybrid DEA-machine learning approaches.Frontiers in medical technology · 2026Review
- A study on the efficiency and spatial correlation of health resource allocation in Chinese hospitals.PloS one · 2026Article
- Distribution dynamics and spatial dependence in healthcare resource allocation efficiency: evidence of path dependence and club formation in China.Frontiers in public health · 2026Article
- Total factor productivity growth and spatial-temporal evolution of China's health system: a three-stage DEA-Malmquist approach.Frontiers in public health · 2026Article
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5 authors.
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Abstract
backgroundChina 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.
methodsA 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.
resultsThe 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.
conclusionThe 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.
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