Evaluation of the efficiency of county-level medical and health services under the background of county medical community policy: a case study of Sanming, China

BACKGROUND: Integrated care has become a global focus in efforts to improve health system performance and service delivery. China began exploring the construction of integrated care and the formation of county medical communities to improve county-level medical services in 2017. The Fujian-Sanming model has attracted extensive attention during this process. In this study, we used Sanming as the example, and the data envelopment analysis (DEA) model and Malmquist index were used to analyze the effectiveness and summarize the construction experience of advanced areas. We discuss the overall medical and health service efficiency in the county as it relates to the county medical community policy. METHOD: We referenced previous studies to select three input indicators and two output indicators that represent the medical and health services in the county. We then conducted an efficiency analysis of 10 counties in Sanming from both the static and dynamic perspectives using a combination of the traditional DEA-BCC model and DEA-Malmquist index. In addition, we measured the efficiency of the primary medical institutions in Sanming. RESULTS: The average technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE) improved from 0.814, 0.907, and 0.898 to 0.917, 0.965, and 0.948, respectively, from 2017 to 2022. These improvements reflected a better use of resources, improved management practices, and more appropriate allocations of the service capacity. The DEA-Malmquist index results showed that the total factor productivity (TFP) of the medical and health services in the counties of Sanming was 0.957 from 2017 to 2022, slightly lower than 1. This result indicated that resource allocation had not yet reached an optimal state, possibly due to the COVID-19 pandemic impact. In addition, disparities between counties persisted, and the primary healthcare institutions generally exhibited lower efficiency levels. CONCLUSIONS: The results of this study demonstrated that under the county medical community policy, the efficiency of medical and healthcare services in Sanming improved. The study results suggest that future efforts should focus on strengthening county hospitals, enhancing the capacity of primary care institutions, and promoting coordinated development across counties. The Sanming model offers valuable insights, particularly for developing countries, regarding strategies to advance integrated care reform.