The efficiency evaluation of Out-of-Pocket healthcare expenditure in China: Data envelopment analysis-tobit analysis based on panel data

Background: Several times healthcare reform have been implemented by China central government since the 1980s. And the government also greatly increases the state healthcare expenditure especially from the new century. But the problem of inadequate and overly expensive medical services still does not alleviate for normal people. Objective: To examine that the out-of-pocket(OOP) healthcare expenditure efficiency decreasing induces the stagnation of total healthcare expenditure efficiency, though the state healthcare expenditure efficiency is increasing. And analyze the influence factors of the OOP healthcare expenditure efficiency. Data and methods: The provincial panel data from 2002 to 2009 by the Statistics Bureau of China were utilized. Data Envelopment Analysis(DEA) method is applied to study the efficiency of provincial total healthcare and OOP expenditure. Panel Tobit model is used to analyze the influence factors of OOP healthcare expenditure efficiency. Results: Our results indicate that the state healthcare expenditure efficiency is increasing but personal OOP healthcare expenditure efficiency is descending. So the total healthcare expenditure efficiency is not rising and the problem of inadequate and overly expensive medical services is not solved. There are different OOP expenditure efficiency among 3 different regions in China. The efficiency of east regions are higher than that of the west and central regions. The efficiency influence factors include population structure, per local fiscal expenditure, urbanization ratio, per GDP and population scale. Conclusions: It is the descending of OOP healthcare expenditure efficiency that impedes the government solving the problem of inadequate and overly expensive medical services. The government should pay more attention to govern the influence factors of OOP healthcare expenditure efficiency. Especially for the central and west regions government, pure economic increasing model should be turned into overall social development.