Efficiency of medical service systems in the rural areas of Mainland China: a comparative study from 2013 to 2017

Inefficient rural medical service systems are one of major obstacles to the Deepening Healthcare Reform. The objectives of this work are to analyze the efficiency of China's rural medical service systems and explore the key related factors. Two-stage study including measuring efficiency and identifying factors. An output-oriented slacks-based data envelopment analysis model was used to measure the efficiency, and a Spearman rank correlation analysis and a multiple linear regression model were used to explore the factors. For the village-level medical service system, 20 out of 27 provinces were inefficient in 2013–2017, 12 out of 27 provinces had the efficiency lower than the average scores in 2013–2017 (0.633, 0.659, 0.638, 0.603, and 0.589), Guangdong had the highest scores of 1 in 2014–2017, whereas Tibet had the lowest scores (0.064–0.083) in 2013–2017, and the west region performed worst. For the township-level medical service system, 11 out of 27 provinces were inefficient in 2013–2017, 10 out of 27 provinces had the efficiency lower than the average scores in 2013–2017 (0.819, 0.791, 0.757, 0.787, and 0.811), Ningxia had the highest efficiency of 1 in 2013–2017, whereas Jilin had the lowest efficiency (0.313–0.370), and the central region performed worst. Additionally, rural residents' income was positively associated with the efficiency of village-level medical services, while the proportion of the vulnerable population was positively associated with the efficiency of township-level medical services. Most provinces had inefficient rural medical service systems in 2013–2017. The efficiency scores varied greatly across provinces, and most scores changed a little over time. Imbalances in the development of rural medical service systems existed across regions, and the efficiency of village-level medical services and township-level medical services was associated with different factors.