Evaluation of Health Resource Allocation Efficiency of Community

Health Service Institutions of China in 2019 based on DEA

Changmin Tang

, Sitong Zhou

†

, Li Chen

‡

and Na Li

School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China

Keywords: Data Envelopment Analysis (DEA), Community Health Service Institutions, Health Resource, Allocation

Efficiency.

Abstract: In the process of deepening the reform of medical and health system, community health service institutions

have developed well, but there are still some problems, therefore, we analyzed the allocation of health

resources in community health service institutions. Based on the theory and method of data envelopment

analysis (DEA), this paper made a horizontal analysis on the allocation of health resources in community

health service institutions of China in 2019. The results showed that there are differences in the allocation of

health resources among community health service institutions in the east, middle and the west of China, all

regions should rationally allocate health resources, innovate the management mechanism of community health

service institutions, rely on the strength of medical partnerships, carry out technological innovation, and

improve the quality and ability of medical staff at the basic level.

1 INTRODUCTION

Community health service institutions, as the main

body of primary medical and health service system,

is the first line of defense for residents' health. With

the gradual improvement of people's living standards,

people pay more attention to their physical health,

and people's health needs become diversified, which

brings severe challenges to the resource allocation of

community health service institutions. The

reasonable resource allocation would influence the

efficient use of resources and meet the needs of

patients effectively. And the allocation and utilization

rate of health resources directly affect the quality of

medical services provided to residents and the

satisfaction of patients. Therefore, it is necessary to

research on the allocation efficiency of health

resources in community health service institutions,

and how to promote the optimization of the allocation

of resources in community health service institutions.

Based on the open data of 2020 and using the DEA

method, this paper analyzed of the allocation

efficiency of health resources in 2019 of community

health service institutions in China, summarized the

present situation and existing problems of health

resources allocation in community health service

institutions, and put forward relevant suggestions to

the problems.

2 DATA AND METHODOLOGY

Based on data from the 2020 China Health Statistics

Yearbook, this paper analyzed the health resource

allocation efficiency of community health service

institutions in 31 provinces, municipalities and

autonomous regions of China in 2019 by DEA. The

statistical analysis method is DEA statistical analysis

method, which included the CCR model and BCC

model. This paper researched the efficiency of health

resource allocation in community health service

institutions using the BCC model (Yao 2021).

3 RESEARCH INDICATORS

After analyzing the present situation and

configuration characteristics of medical and health

resources in our community health service

institutions, the number of institutions, the number of

beds and the number of health technicians were

selected as input indexes, and the number of visits

and the utilization rate of beds were selected as the

output indexes.

138

Tang, C., Zhou, S., Chen, L. and Li, N.

Evaluation of Health Resource Allocation Efﬁciency of Community Health Service Institutions of China in 2019 based on DEA.

DOI: 10.5220/0011233700003438

In Proceedings of the 1st International Conference on Health Big Data and Intelligent Healthcare (ICHIH 2022), pages 138-143

ISBN: 978-989-758-596-8

4 RESULTS

The specific data of health resource input and output

of 31 provinces, autonomous regions and

municipalities directly under the central government

in 2019 was showed in Table 1 according to China

Health Statistics Yearbook 2020. And the input and

output data in Table 1 were put into BCC model to

obtain the health resource allocation efficiency

analysis of community health service institutions in

2019 using the DEAP2.1 (Table 2). In addition,

according to China Health Statistics Yearbook 2020,

we divided the 31 provinces, autonomous regions and

municipalities directly under the central government

into east, central and west areas of China. Beijing,

Tianjin, Hebei, Liaoning, Shanghai, Jiangsu,

Zhejiang, Fujian, Shandong, Guangdong and Hainan

are the eastern area; Shanxi, Jilin, Heilongjiang,

Anhui, Jiangxi, Henan, Hubei and Hunan are the

central regions; Inner Mongolia, Chongqing,

Sichuan, Guangxi, Guizhou, Yunnan, Tibet, Shaanxi,

Gansu, Qinghai, Ningxia and Xinjiang are the

western regions.The BCC model could calculate the

overall technical efficiency (TE) , which can be

further decomposed into scale efficiency (SE) and

pure technical efficiency (PTE) , that is TE = SE *

PTE.The results in table 2 showed that the allocation

of health resources were relatively effective in the

community health service institutions of Beijing,

Shanghai, Zhejiang, Hainan, Qinghai, and Ningxia in

2019 according to the DEA analysis. The returns to

scale remained unchanged, and the TE, PTE and SE

were all 1, which illustrated that the health resources

in these six regions have been fully utilized, and the

resource allocation is reasonable and effective. The

six regions were all located in east and west area of

China.

Table 1: Health resources input and output in community health service institutions in 31 provinces, autonomous regions and

municipalities in 2019.

Area

Output Input

Number of

visits

Hospital bed

utilization rate

(%)

Number of

institutions

Number of

beds

Number of

health

technicians

Beijing 59974362 34.2 340 4879 32818

Tianjin 19552600 17.7 124 2435 8285

Hebei 7891873 39.3 343 13552 16745

Shanxi 4378641 29.8 230 4379 11896

Inner Mongolia 4823180 22.4 334 4863 12117

Liaoning 10677454 24.6 398 7437 15847

Jilin 5165843 28.3 228 3450 7900

Heilongjiang 6929932 28.3 459 6771 12263

Shanghai 85823561 85.2 321 15827 31397

Jiangsu 80158069 54.6 563 22720 48414

Zhejiang 105578894 41.8 479 8426 37990

Anhui 16970843 38.6 380 8188 18853

Fujian 18191671 34.9 228 4001 12994

Jiangxi 4539998 31.2 179 3875 7736

Shandong 25209712 44.6 567 18594 37265

Henan 17111648 45.6 468 12504 22226

Hubei 17446667 57.2 353 15996 21205

Hunan 12856480 58.6 370 15469 18803

Guangdong 112960327 47.1 1136 9340 51100

Guangxi 8844937 53.1 173 2672 8466

Hainan 1056743 37.3 49 1187 3264

Chongqing 8630411 71.2 203 9928 11842

Sichuan 26723522 65.3 433 12133 20578

Evaluation of Health Resource Allocation Efﬁciency of Community Health Service Institutions of China in 2019 based on DEA

139

Guizhou 5702169 39.7 264 5356 11520

Yunnan 5688416 50.5 197 5201 9097

Tibet 136860 - 9 135 225

Shaanxi 6335799 31.2 265 3692 11189

Gansu 3845766 49.7 209 4286 8677

Qinghai 880029 40.8 36 1536 2531

Ningxia 1281457 17.8 36 427 2703

Xinjiang 5739060 39.5 187 8186 9036

Table 2: Health resource allocation efficiency of community health service institutions in 2019.

Provinces TE PTE SE Returns to scale

Relative

effectiveness

Beijing 1.000 1.000 1.000 No change Effective

Tianjin 0.904 0.919 0.984 Increment Invalid

Hebei 0.276 0.278 0.995 Increment Invalid

Shanxi 0.291 0.295 0.985 Increment Invalid

Inner Mongolia 0.235 0.243 0.968 Increment Invalid

Liaoning 0.300 0.306 0.981 Increment Invalid

Jilin 0.415 0.422 0.982 Increment Invalid

Heilongjiang 0.303 0.309 0.981 Increment Invalid

Shanghai 1.000 1.000 1.000 No change Effective

Jiangsu 0.601 0.601 0.999 Increment Invalid

Zhejiang 1.000 1.000 1.000 No change Effective

Anhui 0.403 0.405 0.996 Increment Invalid

Fujian 0.620 0.622 0.996 Increment Invalid

Jiangxi 0.412 0.419 0.985 Increment Invalid

Shandong 0.278 0.279 0.996 Increment Invalid

Henan 0.353 0.354 0.998 Increment Invalid

Hubei 0.405 0.477 0.849 Decline Invalid

Hunan 0.385 0.507 0.760 Decline Invalid

Guangdong 0.967 1.000 0.967 Decline

Weak

effectiveness

Guangxi 0.826 1.000 0.826 Decline

Weak

effectiveness

Hainan 1.000 1.000 1.000 No change Effective

Chongqing 0.559 1.000 0.559 Decline

Weak

effectiveness

Sichuan 0.579 0.695 0.834 Decline Invalid

Guizhou 0.354 0.354 0.998 Increment Invalid

Yunnan 0.502 0.694 0.723 Decline Invalid

Tibet 0.219 1.000 0.219 Increment Invalid

Shaanxi 0.385 0.388 0.991 Increment Invalid

Gansu 0.473 0.711 0.666 Decline Invalid

Qinghai 1.000 1.000 1.000 No change Effective

Ningxia 1.000 1.000 1.000 No change Effective

Xinjiang 0.439 0.441 0.996 Increment Invalid

ICHIH 2022 - International Conference on Health Big Data and Intelligent Healthcare

140

The data also showed that there were three regions

with weak-form efficiency of DEA: Guangdong,

Guangxi and Chongqing, including one province in

the east, one autonomous region and one municipality

directly under the central government in the west. The

PTE of these three regions was 1, the SE was less than

1 with decreasing returns to scale, and the slack

variable was 0. The PTE was 1, which reflected that

in 2019, at the current technical level, the community

health service institutions in these three regions were

efficient in the use of input resources. The main

reasons for their failure to achieve comprehensive

efficiency were ineffective scale, excessive input and

oversize scale of health resources. With the increase

of input, the added value of output dwindled

continuously. And the output growth rate of health

resources was lower than the input growth rate,

resulting in resource redundancy and difficulty in

coordination. Therefore, the focus should be placed

on how to give better play to the scale efficiency.

The other 22 provinces, municipalities directly

under the central government and autonomous

regions saw inefficiency, with 5 provinces and 1

municipality in the east, 8 provinces in the central

China, and 5 provinces as well as 3 autonomous

regions in the west. The returns to scale in provinces

of Hubei, Hunan, Sichuan, Yunnan and Gansu were

declining, combined with a relatively low pure

technical efficiency. Consequently, we should think

about how to effectively improve the output from the

technical level, such as innovating the management

mode of medical institutions and learning the

management mode of Grade Ⅲ hospitals to

improve the management level and the resource

utilization rate.The increasing returns to scale of the

other 17 provinces, municipalities and autonomous

regions showed that increasing input can create a

certain value, and the output still increased with the

increase of input.

Overall, in 2019, the average TE of health

resources input and output of community health

service institutions in 31 provinces, municipalities

and autonomous regions was 0.564, the average PTE

was 0.636, and the average SE was 0.911; the mean

values of technical efficiency, pure technical

efficiency, and scale efficiency of 11 provinces and

municipalities in the east were 0.722, 0.728, and

0.993 respectively; the mean values of technical

efficiency, pure technical efficiency, and scale

efficiency of the 8 provinces in the central China were

0.371, 0.399 and 0.942 respectively; the mean values

of technical efficiency, pure technical efficiency, and

scale efficiency of the 12 western provinces,

municipalities and autonomous regions were 0.548,

0.711 and 0.815 respectively. It showed that the mean

values of technical efficiency and pure technical

efficiency of the central region was the lowest, while

average scale efficiency of the western region was the

lowest. From the perspective of rational resource

allocation, the east and the west of China witnessed

the efficiency and weak-form efficiency of DEA, and

the average TE of the east and the west was higher

than that of the central area. It can be seen that the

rational allocation of resources of the eastern and

western regions is better, while the central region

need to be strengthened in this regard. Therefore,

attention should be paid to the combining the health

resources allocation with the reality. It is also very

essential to invest health resources scientifically

based on the health demand.

5 DISCUSSIONS AND

SUGGESTIONS

5.1 Allocating Medical Resources of

Community Health Service

Institutions based on Local

Conditions

we should comprehensively analyze the local medical

and health demands so as to carry out reasonable

resource allocation suiting local conditions, for

economically developed regions and central regions,

we should strengthen the integration of medical

treatment, medical insurance and medicines supply at

the grass-roots level, guiding residents to choose to

see a doctor in community health service institutions

and improving the overall utilization of medical

resources; whereas in economically underdeveloped

regions, we should be more concerned about

improving the quality of diagnosis and treatment,

purchasing advanced medical devices, strengthening

the training of professional and technical personnel,

and introducing high-level and high-quality

talents(Tian 2021)

5.2 Innovating Management

Mechanism and Improving

Management in Community Health

Service Institutions

Community health service institutions can rely on the

strength of the medical treatment partnerships,

learning the management experience of superior

hospitals in it，innovating management mechanism

Evaluation of Health Resource Allocation Efﬁciency of Community Health Service Institutions of China in 2019 based on DEA

141

and improving management in community health

service institutions. At the same time, community

health service institutions should optimize the

personnel structure, reduce the burden of grass-roots

medical personnel, perfect the personnel salary

system, emphasize that personal salary should be

linked to actual labor and contribution ， and

formulate a reasonable and effective incentive

mechanism to improve the enthusiasm of grass-roots

medical workers.

5.3 Carrying out Technological

Innovation by Relying on the

Strength of the Medical Treatment

Partnerships

Strengthening the cultivation of high-quality talents

and improving the output level. In addition to

controlling input and avoiding redundancy caused by

excessive input, we should improve the output

quality, strengthen the construction of high-quality

talents in community health service institutions,

introduce talents equipped with medical and

management skills in hospital management, optimize

personnel structure, strengthen skill training for

medical personnel, and improve the medical level of

community health service institutions (Zhang 2019).

5.4 Strengthening the Construction of

Information Platform and the

Management of Health Archives

Community health service institutions should

strengthen the construction of information platform,

improve the three-tiered health service network, and

set up information sharing to carry out up-down

referral quickly and effectively, and finally improve

the efficiency of medical services and the utilization

efficiency of medical resources. In the meantime, the

protection of patient information, the security

protection index of information system, and the

network supervision should also be strengthened to

prevent patient information leakage, and effectively

protect the rights and interests of patients

(Hao 2020).

5.5 Strengthening the Cultivation of

High-quality Talents and

Improving the Output Level

In addition to controlling input and avoiding

redundancy caused by excessive input, we should

improve the output quality, strengthen the

construction of high-quality talents in community

health service institutions, introduce talents equipped

with medical and management skills in hospital

management, optimize personnel structure,

strengthen skill training for medical personnel, and

improve the medical level of community health

service institutions, so as to improve the efficiency of

medical services(Zhang 2019). With the development

of information technology, in order to provide talent

guarantee for the information construction of

community health service institutions, these

institutions should continuously update the advanced

medical information system. Meanwhile, they should

also make efforts on the introduction and training of

information technology talents.

5.6 Perfecting the Personnel Salary

System and Formulating a

Scientific and Effective Incentive

Mechanism

Belonging to grass-roots medical institutions,

community health service institutions suffer from

some long-term problems like talent shortage and

outflow. Because of the unreasonable and unfair

salaries of medical personnel, the limited career

growth space, and the difficulty of reflecting their

personal value, it is difficult for community health

service institutions to retain medical talents with a

low willingness to obtain employment in them.

Therefore, we should perfect the personnel salary

system, improve the salary of grass-roots medical

personnel, formulate scientific and reasonable

performance evaluation indicators within the

organization, and emphasize that personal salary

should be linked to actual labor and contribution, so

that medical personnel feels their contribution being

paid. The infrastructure construction of community

health service institutions should be strengthened to

create a good medical practice environment for

medical personnel. At the same time, the promotion

of professional titles should be inclined to the grass-

roots level, and render relevant favorable policies to

community health service institutions to encourage

medical personnel to improve their work enthusiasm

and willingness to work there.

ICHIH 2022 - International Conference on Health Big Data and Intelligent Healthcare

142

5.7 Strengthening the Integration of

Medical Treatment, Medical

Insurance and Medicines Supply

and Enhancing the Service

Capacity of Community Health

Service Institutions

In terms of medical insurance, we should gradually

improve the quota management of medical insurance

expenses of grass-roots medical and health

institutions. Combined with the actual situation and

the social and economic level of different regions, we

should greatly improve the total standard of medical

insurance and the quota standard per case, improve

the reasonable over-expenditure compensation

mechanism of medical insurance, truly implement

and improve the total reimbursement system of

medical insurance, and provide policy preferences to

community health service institutions (Liu 2020).

6 CONCLUSIONS

Through the detailed analysis of the data, we can find

that there are some problems in the resource

allocation of community health service institutions,

mainly the unbalanced resource allocation in

different regions and the unreasonable internal

resource allocation in some regions. In order to better

meet people's needs and ensure the health of the

whole people, we should pay attention to the

allocation of health resources and solve the problems

in time. To improve these problems, we should

comprehensively analyze the local medical and

health demands so as to carry out reasonable resource

allocation suiting local conditions, innovating

management mechanism and improving management

in community health service institutions, carrying out

technological innovation by relying on the strength of

the medical treatment partnerships. AIso we can

strengthen the construction of information platform

and the management of health archives, perfect the

personnel salary system and formulating a scientific

and effective incentive mechanism, perfect the

personnel salary system and formulating a scientific

and effective incentive mechanism, strengthen the

integration of medical treatment, medical insurance

and medicines supply and enhance the service

capacity of community health service institutions.

REFERENCES

Hao Xiaoning, Ma Chengyu, Liu Zhiye, et al. The Effects

and Problems on the Reform of Primary Health

Informatization in China[J]. Health Economics

Research, 2020,37 (7): 3-5 + 9.

Liu Zeyao, Tang Wenxi. Review on Payment Models and

Effects of Closely Partnered Medical Unions [J]. China

Health Insurance, 2020 (10): 14-19.

Tian Jinying, Liao Ruibin, Zhang Hui, Chen Lin. Analysis

on the allocation efficiency of primary medical

institutions in Guangdong from the perspective of

hierarchical diagnosis and treatment.[J]. Modern

Preventive Medicine, 2021,48 (03): 464-468.

Yao Weizi, Zhang Yali, Pu Xingyue, Xiao Lei, Li Jiawei.

Analysis on Resource Allocation Efficiency of Primary

Medical and Health Institutions in Sichuan Province

under the Background of Regional Cooperation [J].];

and Modern Preventive Medicine ,2021,48(05):849-

853.

Zhang Yiqing, Wang Gaoling. Evaluating the Service

Efficiency of China’s Grassroots Medical and Health

Institutions Based on DEA and RSR Methods. [J].

Chinese Health Service Management, 2019,36 (04):

261-265.

Zhang Yiqing, Wang Gaoling. Evaluating the Service

Efficiency of China’s Grassroots Medical and Health

Institutions Based on DEA and RSR Methods. [J].

Chinese Health Service Management, 2019,36 (04):

261-265.

Evaluation of Health Resource Allocation Efﬁciency of Community Health Service Institutions of China in 2019 based on DEA

143