The efficiency situation of public hospitals in underdeveloped regions of China under the “National Examination” model --- evidence from Guangxi Zhuang Autonomous Region of China

Promoting the efficient operation of medical institutions is of vital importance for ensuring the accessibility of health services to the population, and it is also a key goal of health service system reforms in various countries. In recent years, in order to alleviate the problems of “difficulty and high cost of medical treatment” among the population and promote the sustainable development of the medical and health system, the Chinese government has implemented a nationwide performance evaluation policy for public hospitals, known as the “National Examination” model. The aim is to enhance their public welfare nature and better coordinate social and economic benefits. This study takes Guangxi Zhuang Autonomous Region of China as an example, aiming to assess the efficiency level and influencing factors of public hospitals in underdeveloped areas of China under this policy context. A five-year longitudinal survey was conducted from 2019 to 2023 on 41 tertiary public general hospitals in the region, and 39 hospitals were included in the final sample after data cleaning. Descriptive statistics were used to present changes in hospital inputs and outputs. The Super Efficiency–Slack-Based Measure model and the Global Malmquist Index were applied to assess static and dynamic efficiency, respectively. Subsequently, the influencing factors of the hospital efficiency of the sample were analyzed through OLS regression and bootstrap truncated regression, and the results were compared. The mean technical efficiency index was 1.05, the mean technological progress index was 1.06, the mean pure technical efficiency index was 1.06, the mean scale efficiency index was 1.00, and the mean total factor productivity index was 1.10. In the analysis of influencing factors, the recovery rate of medical insurance funds was significant in both OLS regression and bootstrap truncated regression ( P < 0.05), while the proportion of personnel expenditure in business expenditure was significant only in OLS regression and the sensitivity test of bootstrap truncated regression ( P < 0.1). The research found that during the implementation of the “National Examination” model, the efficiency of the sample hospitals improved. However, problems such as insufficient efficiency in hospital scale, persistent financial imbalances, and inadequate investment in human resources still persist. Strengthened governmental financial support, improved public-welfare compensation mechanisms, and expanded health financing channels are recommended to address these challenges.