Evaluation of Unified Healthcare Efficiency in China: A Meta-Frontier Non-radial Directional Distance Function Analysis During 2009–2019

In this study, we analyze the unified healthcare efficiency in China at the regional level from 2009 to 2019. To accurately evaluate the evolution of unified efficiency from both static and dynamic perspectives, we combine the non-radial directional distance function and the meta-frontier method to evaluate the unified healthcare efficiency and its dynamic changes. This new approach allows for regional heterogeneity and non-radial slack simultaneously. The decomposition of the meta-frontier non-radial Malmquist unified healthcare efficiency index (MNMHEI) can be used to identify the driving factors of dynamic changes. The results show that the unified healthcare efficiency in eastern China is generally higher than that in non-eastern China from the static perspective, implying significant regional differences. Moreover, the unified efficiency in both eastern and non-eastern regions shows similar time trends and reaches the maximum in 2012. From the dynamic perspective, the unified healthcare efficiency increases annually by 2.68% during the study period. This increase in eastern China as a technology leader is mainly driven by technological progress, whereas the increase in non-eastern China is mainly driven by a better catch-up effect. In addition, the impact of the reform on the non-eastern region is more significant for the decreasing technology gap, the stronger growth momentum of technological progress, and global innovative provinces.