The Technical Efficiency of Essential Public Health Services Provision in China: Based on a Panel Data Analysis
Authors: Cao Fankun , Xi Yan , Bai Tongyu , Dong Shushan , Sun Qiang 
Published: June 2021

Abstract
BackgroundProviding essential public health services equally to all Chinese is one of the objectives of health system reform since 2009. Essential public health service program is to provide a package of public health services for all Chinese freely by the primary health institutions. Since the implementation of the national essential public health service program, the level of funding and the intensity of input have been continuously increasing. However, in the context of China’s economic development entering a new normal phase, the growth rate of funding for essential public health services has far exceeded the growth rate of GDP and central fiscal revenue, and the sustainability of the development of national essential public health service programs has been seriously challenged. Improving the efficiency of resource use may be an effective way to ensure the continuation of the national essential public health service program. But little evidence was available about technical efficiency in essential public health services provision. Therefore, the aim of this study was to assess the technical efficiency of essential public health services in Shandong province.Methods This study was a retrospective study based on the historical panel data of Shandong Province, East China. The data came from the Shandong Provincial Essential public health Service Program Database of the Medical Management Center of Shandong Provincial Health Commission, which covered all 137 counties and districts in 16 cities of Shandong Province from 2014 to 2019. The principal component analysis method was used to classify multiple output indicators of essential public health service programs, so as to achieve the purpose of generic index extraction. The efficiency coefficient transformation analysis method was used to transform the data of each principal component score after the principal component analysis of the input index of essential public health service programs. The CCR model and BBC model in the Data Envelopment Analysis （DEA） method were used to calculate the comprehensive technical efficiency, pure technical efficiency and scale efficiency of essential public health services.ResultsThe average comprehensive technical efficiency of essential public health services in Shandong Province showed a slight downward trend from 0.8896 in 2014 to 0.8753 in 2019. The average pure technical efficiency of essential public health services was kept at 0.99. The average scale efficiency of essential public health services showed a slight downward trend from 0.8871 in 2014 to 0.8744 in 2019. The proportion of counties and districts with the comprehensive technical efficiency of essential public health services in Shandong Province was increased from 15.3% in 2014 to 21.9% in 2019. But the proportion of counties with the pure technical efficiency decreased from 38.0% in 2014 to 35.9% in 2019. The proportion of counties with scale efficiency of essential public health services showed an upward trend, rising from 14.8% in 2014 to 22.6% in 2019, increasing by 7.8%.The ratio of effective comprehensive technical efficiency of essential public health services in Shandong Province to all counties and districts has shown a upward trend. Among them, the proportion of counties with effective pure technical efficiency was higher than the proportion of counties with efficient scale efficiency each year. At the same time, the increase in the proportion of counties with effective scale efficiency was higher than the increase in the proportion of counties with effective pure technical efficiency. The increasing proportion of effective counties in the comprehensive technical efficiency of essential public health services in Shandong Province was mainly due to the increasing proportion of effective counties in the scale efficiency and the good performance of effective counties in the pure technical efficiency. This showed that, although the investment scale of Shandong Province in the counties was gradually sufficient, there was still a phenomenon of insufficient resource investment in most counties. That would ultimately affect the sustainability of the implementation of essential public health services.Conclusion The research have demonstrated that the technical efficiency of essential public health services in Shandong Province has shown a slight downward trend, and the main reason for its downward trend was the decline in scale efficiency. The scale efficiency in essential public health services affected the technical efficiency and would ultimately threaten the sustainable development of essential public health services. It is recommended that future research directions should focus on the influencing factors and improvement measures of the scale efficiency of essential public health services.