| Since the new medical reform in 2009,China’s healthcare sector has developed rapidly,with an increasing total amount of healthcare resources,improved coverage of healthcare services and significant improvement in health level.However,there are also issues of low efficiency and significant regional imbalances in the health system.Efficiency and equity are core elements for evaluating healthcare system and also focal points of the new round of medical reform.The improvement of health system efficiency contributes to fully utilizing available resources to meet residents’ healthcare service needs,improving health conditions.Exploring the inefficiency and imbalance in the healthcare system is crucial for addressing practical issues.Based on geographical location,economic development level,and healthcare policy factors,China’s healthcare exhibits typical regional characteristics in the eastern,central,and western regions.It is of great practical significance to study the heterogeneity of healthcare system technology levels and the efficiency imbalance in different regions.Since the implementation of new medical reform,the government has been attempting to strike a balance between market-oriented and government-oriented policies.Due to significant differences in efficiency levels and policies across regions,how to better leverage the government’s role in promoting efficiency and facilitate regional coordinated development has gradually become a focus for policymakers.Therefore,this article constructs an analytical framework for health system efficiency based on regional heterogeneity,analyzes the spatiotemporal evolution patterns and dynamic changes,and clarifies the government role in health system efficiency.It holds significant importance for improving health system efficiency and promoting regional coordinated development.The main research content and conclusions are as follows:(1)We build healthcare system efficiency measurement model based on regional technology heterogeneity.We evaluate the health system efficiency combining the non-radial directional distance function with the meta-frontier approach based on the classification of eastern,central and western regions.This method evaluates the meta-frontier efficiency,group frontier efficiency,and technology gap ratio of provinces in different regions.From the time trends of meta-frontier efficiency and group frontier efficiency,the eastern region shows significant improvement from 2010 to 2012,while the time trends in the central and western regions are generally consistent,lagging behind the eastern region.Regarding the kernel density distribution of the technology gap ratio,the eastern region is seen as a technological leader,while the central and western regions are seen as technological followers.The technological gap has a trend of continuous expansion over time.(2)We analyze the temporal convergence characteristics and spatial evolution trends of health system efficiency from both temporal and spatial dimensions.The analysis of temporal convergence examines σ-convergence,absolute β-convergence,conditional β-convergence based on parametric analysis,as well as distributional dynamics based on non-parametric analysis.It delves into the temporal convergence of efficiency and the technology gap ratio at the national and regional levels.The study reveals that there is no σ-convergence observed in the meta-frontier efficiency,group-frontier efficiency,and technology gap ratios,indicating the provincial disparities have not narrowed,but there exists conditional βconvergence,indicating a convergence towards their respective steady-state levels over time.The distribution dynamics test using non-parametric analysis demonstrates that the metafrontier efficiency and group frontier efficiency exhibit similar distribution characteristics at higher efficiency levels.Provinces with higher efficiency values tend to have upward shifts,while provinces with lower efficiency exhibit some path dependence and show minimal changes.Significant upward shifts in technology gap ratios occur only at very low levels,and most technology gap ratios experience minimal variations.In the spatial dimension,the spatial aggregation and spatial evolution of health system efficiency are visually presented through spatial correlation and spatial evolution analysis.In terms of the analysis of spatial correlation there exist only "high-high agglomeration" and "low-low agglomeration"patterns nationwide.In terms of the analysis of spatial evolution,the spatial distribution of efficiency exhibits a convergence pattern at low levels,and shows a weak-to-weak convergence phenomenon,while the strong-to-strong phenomenon is not evident.(3)We analyze the dynamic changes in health system efficiency and identify the driving factors.Based on the non-radial directional distance function and the meta-frontier method,the study constructs the meta-frontier non-radial Malmquist Health System Efficiency Index(MNMHEI)to evaluate efficiency dynamically and decompose the driving factors.The research findings reveal that the growth in the eastern region is mainly driven by technological progress,while the decline in the central and western regions comes from the technological regress and the widening technological gap,respectively.The eastern region maintains its position as a continuous technological leader during the study period while the western region exhibits a persistent expansion of technological gaps.The time trend of the technological progress in the eastern region aligns with the trend of MNMHEI.In terms of innovation provinces,the eastern region is predominantly concentrated in the Yangtze River Delta area,while the central and western regions are mainly concentrated in southern provinces.(4)We construct a Bayesian Tobit quantile regression model to explore the heterogeneity of influencing factors.Based on the Bayesian Tobit quantile regression model,we analyze the heterogeneous effects of government roles,market factors,and socioeconomic factors on efficiency at different efficiency levels,in order to better formulate differentiated strategies.The study finds that the proportion of private hospitals has a significant heterogeneous impact on efficiency.In provinces with lower efficiency levels,increasing the proportion of private hospitals can stimulate market vitality and improve healthcare system efficiency,while in provinces with higher efficiency levels,the proportion of private hospitals has no significant impact on efficiency.The negative impact of subsidy proportion on efficiency persists at different quantiles.Population density and dependency ratio demonstrate a positive influence on efficiency at different quantiles,with a greater positive effect in provinces with higher efficiency levels and a smaller positive effect in provinces with lower efficiency levels.Due to variations in expense ratio and reimbursement policies,outpatient service price exhibits a negative impact on efficiency,while the impact of inpatient service price on efficiency is not significant at most efficiency levels.This study has the following innovations:(1)We construct a health system efficiency measurement model based on regional heterogeneity.Based on the background of the new medical reform and regional technological heterogeneity,we adopt the methodology combining non-radial directional distance function and meta-frontier approach to construct a measurement model for health system efficiency,enriching the research framework of health system efficiency.(2)We investigate the convergence patterns and evolution forms of health system efficiency from a spatiotemporal perspective using the nonparametric methods,providing a new research perspective for analyzing the spatiotemporal pattern of health system efficiency.A multi-scale spatiotemporal pattern analysis framework is constructed based on parametric and nonparametric methods.(3)We construct a model of factors influencing health system efficiency based on quantile regression.Based on regional differences in efficiency levels and government roles,we use quantile regression and Bayesian methods to examine the heterogeneous effects of influencing factors on health system efficiency,providing reference for differentiated policies. |
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