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Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data

Author

Listed:
  • Martine Audibert

    (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)

  • Jacky Mathonnat

    (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)

  • Aurore Pelissier

    (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)

  • Xiao Xian Huang

    (CERDI - Centre d'Études et de Recherches sur le Développement International - UdA - Université d'Auvergne - Clermont-Ferrand I - CNRS - Centre National de la Recherche Scientifique)

  • Anning Ma

    (WMU - Weifang Medical University - Weifang Medical University)

Abstract

In the rural health-care organization of China, township hospitals ensure the delivery of medical services above village health stations and below county hospitals. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, the efficiency of township hospitals has been questioned, mainly because of the implementation since 2003 of the reform of health insurance in rural areas (New Rural Cooperative Medical Scheme). From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang Prefecture (Shandong), this study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientations to compute scores. The results show that technical efficiency has declined over time. The factors explaining technical efficiency are mainly environmental characteristics rather than internal ones. Among these environmental factors, NRCMS have in average a negative effect on the evolution of THs efficiency, although efficiency have improved for some of them.Our results suggest also that, in the context of China, the efficiency of township hospitals is influenced by unobservable factors. From our findings, we suggest five main orientations to improve THs efficiency.

Suggested Citation

  • Martine Audibert & Jacky Mathonnat & Aurore Pelissier & Xiao Xian Huang & Anning Ma, 2013. "Health insurance reform and efficiency of township hospitals in rural China: An analysis from survey data," Post-Print halshs-00910274, HAL.
    • Handle: RePEc:hal:journl:halshs-00910274
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    Cited by:

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    3. Sebastian Kohl & Jan Schoenfelder & Andreas Fügener & Jens O. Brunner, 2019. "The use of Data Envelopment Analysis (DEA) in healthcare with a focus on hospitals," Health Care Management Science, Springer, vol. 22(2), pages 245-286, June.
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    5. Zhou, Wenhui & Zheng, Yanfang & Morton, Alec & Luo, Feng, 2018. "Delivering universal health coverage for an aging population: An analysis of the Chinese rural health insurance program," China Economic Review, Elsevier, vol. 52(C), pages 204-224.
    6. Berger, Michael & Sommersguter-Reichmann, Margit & Czypionka, Thomas, 2020. "Determinants of soft budget constraints: how public debt affects hospital performance in Austria," LSE Research Online Documents on Economics 116865, London School of Economics and Political Science, LSE Library.
    7. Yibin Ao & Qiqi Feng & Zhongli Zhou & Yunfeng Chen & Tong Wang, 2022. "Resource Allocation Equity in the China’s Rural Three-Tier Healthcare System," IJERPH, MDPI, vol. 19(11), pages 1-17, May.
    8. Laurène PETITFOUR & Xiezhe HUANGFU & Martine AUDIBERT & Jacky MATHONNAT, 2017. "Efficiency of township hospitals in China in the context of the drug policy reform: Progress should not get bogged in midstream - A case study from a survey in Weifang prefecture," Working Papers P185, FERDI.
    9. See, Kok Fong & Ng, Ying Chu, 2021. "Do hospital reform and ownership matter to Shenzhen hospitals in China? A productivity analysis," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 145-155.
    10. Marlène Guillon & Martine Audibert & Jacky Mathonnat, 2022. "Efficiency of district hospitals in Zimbabwe: Assessment, drivers and policy implications," International Journal of Health Planning and Management, Wiley Blackwell, vol. 37(1), pages 271-280, January.
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    12. Wanke, Peter & Barros, Carlos Pestana, 2016. "Efficiency drivers in Brazilian insurance: A two-stage DEA meta frontier-data mining approach," Economic Modelling, Elsevier, vol. 53(C), pages 8-22.
    13. Xueli Chen & Vivian Valdmanis & Tuotuo Yu, 2020. "Productivity Growth in Chinese Medical Institutions during 2009–2018," Sustainability, MDPI, vol. 12(8), pages 1-17, April.
    14. Gökçe MANAVGAT & Ayhan DEMİRCİ, 2020. "Decentralization Matter of Healthcare and Effect on Regional Healthcare Efficiency: Evidence from Turkey," Sosyoekonomi Journal, Sosyoekonomi Society, issue 28(44).
    15. Jiaqi Chen & Song Xu & Jing Gao, 2020. "The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach," IJERPH, MDPI, vol. 17(5), pages 1-13, March.
    16. Laurene Petitfour & Xiezhe Huangfu & Martine Audibert & Jacky Mathonnat, 2015. "Estimating and explaining the efficiency of township hospitals in Shandong province in the context of the drug policy reform," Working Papers halshs-01180621, HAL.
    17. Jing You, 2016. "Lending to Parents and Insuring Children: Is There a Role for Microcredit in Complementing Health Insurance in Rural China?," Health Economics, John Wiley & Sons, Ltd., vol. 25(5), pages 543-558, May.
    18. Akkan, Can & Karadayi, Melis Almula & Ekinci, Yeliz & Ülengin, Füsun & Uray, Nimet & Karaosmanoğlu, Elif, 2020. "Efficiency analysis of emergency departments in metropolitan areas," Socio-Economic Planning Sciences, Elsevier, vol. 69(C).
    19. Martine Audibert & Marlène Guillon & Jacky Mathonnat, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia - What data tell us for Soum Health Centers in five provinces?," Working Papers hal-01795645, HAL.
    20. Kejia Chu & Ning Zhang & Zhongfei Chen, 2015. "The Efficiency and Its Determinants for China’s Medical Care System: Some Policy Implications for Northeast Asia," Sustainability, MDPI, vol. 7(10), pages 1-20, October.
    21. Martine Audibert & Marlène Guillon & Jacky Mathonnat, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia - What data tell us for Soum Health Centers in five provinces?," Post-Print hal-01795645, HAL.
    22. Laurene PETITFOUR & Xiezhe HUANGFU & Jacky MATHONNAT & Martine AUDIBERT, 2015. "Estimating and explaining the efficiency of township hospitals in Shandong province in the context of the drug policy reform," Working Papers 201517, CERDI.
    23. Martine AUDIBERT & Marlène GUILLON & Jacky MATHONNAT, 2018. "The challenge of improving efficiency of Soum Health Centers in Mongolia," Working Papers P226, FERDI.
    24. Dunfu Zhang & K. M. Atikur Rahman, 2020. "Government health expenditure, out‐of‐pocket payment and social inequality: A cross‐national analysis of China and OECD countries," International Journal of Health Planning and Management, Wiley Blackwell, vol. 35(5), pages 1111-1126, September.

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    More about this item

    Keywords

    data envelopment analysis; Technical efficiency; China; New Rural Cooperative Medical Scheme; Township Hospitals;
    All these keywords.

    JEL classification:

    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs
    • I1 - Health, Education, and Welfare - - Health
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies

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