Efficiency of community health centers in China during 2013-2015: A synchronic and diachronic study

Objective: We aimed to explore the efficiency of community health centers (CHCs) in China from 2013 to 2015, providing policy suggestions for optimizing the allocation of health resources. Methods: Data on the efficiency of CHCs in 30 provinces/autonomous regions/municipalities in mainland China (except Tibet) from 2013 to 2015 were collected from China's Health and Family Planning Statistical Yearbook 2014, China's Health and Family Planning Statistical Yearbook 2015, and China's Health and Family Planning Statistical Yearbook 2016. Data envelopment analysis and Malmquist index analysis were performed to investigate the efficiency of sampled CHCs during this period at the national level and the regional level. The applied input indicators include the numbers of CHCs, community health workers, and beds, and the output indicators consist of the numbers of visits and inpatients, the occupancy rate of beds, and the average length of stay. Results: In 2015, the average annual overall technical efficiency, pure technical efficiency, and scale efficiency of CHCs in 30 regions at the national level were 0.715, 0.705, and 0.972, respectively. Eight regions (Guangdong, Guizhou, Hainan, Ningxia, Qinghai, Shanghai, Zhejiang, and Chongqing, accounting for 26.7% of the total) had efficient CHCs with overall technical efficiency of 1.000, and the other 22 regions had surpluses of 131 CHCs, 5573 community health workers, and 2086 beds on average. In 2015, the average annual technical change index, pure technical efficiency change index, total factor productivity, technical efficiency change index, and scale efficiency change index of CHCs at the national level were 1.034, 1.002, 1.024, 0.990, and 0.988, respectively. Compared with 2013, the former three increased by 3.4%, 0.2%, and 2.4%, respectively, while the latter two decreased by 1.0% and 1.2%, respectively. Conclusion: On the whole, efficiency improvements of CHCs were achieved at the national level from 2013 to 2015, but with obvious interregional differences. In regions with inefficient CHCs identified by data envelopment analysis, there was a problem of coexistence of shortage and wastage of community health resources. In view of this, targeted measures should be taken to optimize the allocation of community health resources, and the management of CHCs should be strengthened to improve the efficiency of these institutions.