ObjectiveTo measure the operational efficiency and explore the phenomenon of the economy of scale in secondary public general hospitals of China for improving the health service efficiency.MethodsFrom February to August 2019, the data set of two input indicators (the number of employees and actual open beds) and two output indicators (the numbers of outpatients and discharges) in 511 secondary general hospitals of Shandong, Anhui, Shanxi, Hubei and Hainan provinces in 2018 were collected for data envelopment analysis. The analysis processes were three folds: First, the technical efficiency, pure technical efficiency, scale efficiency and scale compensation status of the sample hospitals were calculated respectively. Second, the comparative analysis of efficiency value and scale compensation status was carried out in 5 groups according to the bed scale. Finally, the input and output projection analysis was carried out on the ineffective decision making units.ResultsThe medians of technical efficiencies, pure technical efficiencies, and scale efficiencies of the 511 secondary general hospitals were 0.472, 0.531, and 0.909, respectively. In the 511 hospitals, 493 hospitals (96.5%) were in ineffective state, of which 321 hospitals (62.8%) were in the state of decreasing return to scale. The staff redundancy of the group with beds >100 and ≤300 was 23.86%, and its service quantity could be increased by 39.37%.ConclusionsThe overall operating efficiencies are inefficiency in secondary general hospitals of China and the optimal scale of actual open beds is between 300 and 500 beds from the perspective of scale efficiency.
ObjectiveTo measure the total factor productivity and its component changes of public secondary general hospitals in China from 2012 to 2018.MethodsFrom February to September in 2019, stratified systematic sampling method was used to collect the panel data of input and output indicators from 2012 to 2018 of 511 public secondary general hospitals in 5 provinces of China (Shandong, Hubei, Hainan, Anhui, and Shanxi), and Bootstrap-Malmquist-data envelopment analysis was used to calculate the total factor productivity and its component changes of the hospitals.ResultsFrom 2012 to 2018, the total factor productivity of the 511 public secondary general hospitals decreased by 0.22%, technical efficiency decreased by 5.24%, technical changes increased by 5.29%, pure technical efficiency decreased by 1.40%, and scale efficiency decreased by 3.89%, respectively.ConclusionsIn the past 7 years, the total factor productivity of public secondary general hospitals in China has declined slightly, mainly due to the decline of scale efficiency and pure technical efficiency, and the technological progress is the main reason for its improvement. The implications for the public secondary general hospitals are three folds: avoiding blind expansion and exploring optimum scale of beds, strengthening the internal fine management to improve the management practice and technical efficiency, and promoting technological progress by healthcare cooperating organizations.