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Peer-reviewedCC BY 4.0Frontiers in Public Health

Efficiency evaluation of secondary public general hospitals in Shandong Province, China based on three-stage data envelopment analysis

  • Shirui Shan1
  • Liang Ma1
  • Tianjiao Zhang1
  • Jingjing Li2
  • Lijun Wang1
  • Wei Xiao1
  • Keke Liu3
  1. 1General Office, Affiliated Provincial Hospital of Shandong First Medical University
  2. 2Discipline Inspection Commission Office, Affiliated Provincial Hospital of Shandong First Medical University
  3. 3Infection Control Office, Affiliated Provincial Hospital of Shandong First Medical University
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Abstract

Objective: This study aimed to evaluate the operational efficiency of secondary-level public general hospitals in Shandong Province, thereby providing scientific evidence for optimising the allocation of hospital healthcare resources.

Methods: A sample of secondary public general hospitals across 16 prefecture-level cities in Shandong Province, China, was selected. The first stage employed the Super-Efficiency SBM model to measure overall technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE). The second stage constructed an SFA regression model to analyse the impact of external environmental factors on input slack variables. The third stage recalculated efficiency using adjusted inputs and original outputs, comparing efficiency differences before and after adjustment alongside regional characteristics.

Results: The TE and PTE of Shandong Province’s secondary public general hospitals topped 1 in the majority of the first stage, while the SE often fell short of 1. The greatest mean values for TE (0.952), PTE (0.983), and SE (0.971) were found in the Lunan Economic Circle. PTE variations were the main factor influencing TE stability, and the provincial capital economic circle (TE = 0.808) and Jiaodong economic circle (TE = 0.851) displayed comparatively lower averages. Second-stage SFA regression results indicate that fiscal allocations positively correlate with hospital practising (assistant) physicians, actual bed capacity, fixed assets, and total cost redundancy ( p < 0.01), while urbanisation rates negatively correlate with fixed asset redundancy ( p < 0.01). Following adjustments to input variables in the third stage, TE and PTE for secondary public general hospitals in Shandong Province decreased significantly (TE decreased by 31.93 and 37.16% in provincial capitals and the Jiaodong Economic Zone, respectively), while SE increased slightly.

Conclusion: Secondary-level public general hospitals in Shandong Province demonstrate relatively high overall efficiency, yet remain significantly influenced by external environmental factors, indicating considerable scope for improvement. This study reveals that differentiated improvement strategies should be implemented across distinct regions based on their actual developmental circumstances, thereby propelling hospitals towards high-quality development.

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Cite

BibTeXRIS
BibTeX
@article{shan2026efficiency,
  title = {{Efficiency evaluation of secondary public general hospitals in Shandong Province, China based on three-stage data envelopment analysis}},
  author = {Shirui Shan and Liang Ma and Tianjiao Zhang and Jingjing Li and Lijun Wang and Wei Xiao and Keke Liu},
  journal = {Frontiers in Public Health},
  year = {2026},
  month = oct,
  doi = {10.3389/fpubh.2026.1933937},
  url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1933937/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Efficiency evaluation of secondary public general hospitals in Shandong Province, China based on three-stage data envelopment analysis
AU  - Shirui Shan
AU  - Liang Ma
AU  - Tianjiao Zhang
AU  - Jingjing Li
AU  - Lijun Wang
AU  - Wei Xiao
AU  - Keke Liu
PY  - 2026
DA  - 2026/10/08
JO  - Frontiers in Public Health
DO  - 10.3389/fpubh.2026.1933937
UR  - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1933937/full
AB  - Objective: This study aimed to evaluate the operational efficiency of secondary-level public general hospitals in Shandong Province, thereby providing scientific evidence for optimising the allocation of hospital healthcare resources.  Methods: A sample of secondary public general hospitals across 16 prefecture-level cities in Shandong Province, China, was selected. The first stage employed the Super-Efficiency SBM model to measure overall technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE). The second stage constructed an SFA regression model to analyse the impact of external environmental factors on input slack variables. The third stage recalculated efficiency using adjusted inputs and original outputs, comparing efficiency differences before and after adjustment alongside regional characteristics.  Results: The TE and PTE of Shandong Province’s secondary public general hospitals topped 1 in the majority of the first stage, while the SE often fell short of 1. The greatest mean values for TE (0.952), PTE (0.983), and SE (0.971) were found in the Lunan Economic Circle. PTE variations were the main factor influencing TE stability, and the provincial capital economic circle (TE = 0.808) and Jiaodong economic circle (TE = 0.851) displayed comparatively lower averages. Second-stage SFA regression results indicate that fiscal allocations positively correlate with hospital practising (assistant) physicians, actual bed capacity, fixed assets, and total cost redundancy ( p < 0.01), while urbanisation rates negatively correlate with fixed asset redundancy ( p < 0.01). Following adjustments to input variables in the third stage, TE and PTE for secondary public general hospitals in Shandong Province decreased significantly (TE decreased by 31.93 and 37.16% in provincial capitals and the Jiaodong Economic Zone, respectively), while SE increased slightly.  Conclusion: Secondary-level public general hospitals in Shandong Province demonstrate relatively high overall efficiency, yet remain significantly influenced by external environmental factors, indicating considerable scope for improvement. This study reveals that differentiated improvement strategies should be implemented across distinct regions based on their actual developmental circumstances, thereby propelling hospitals towards high-quality development.
SN  - 2296-2565
ER  -