Does Improved Hospital Management Enhance Healthcare Efficiency? Evidence From County-Level Hospitals in China
Author(s)
Danqing Qian, MS, MIN HU, PhD, wen chen, PhD.
School of Public Health, Fudan University, Shanghai, China.
School of Public Health, Fudan University, Shanghai, China.
OBJECTIVES: This study investigates the relationship between hospital management practices and healthcare efficiency in county-level hospitals in rural western China.
METHODS: Longitudinal panel data from 67 county-level hospitals in Guizhou Province (2015-2018) were analyzed. Hospital management practice was measured using the Development World Management Survey for Hospitals (D-WMS-H), which assesses the overall management score and scores across four dimensions: operations management, target management, personnel management, and performance management. Efficiency was assessed using Data Envelopment Analysis (DEA), including Slack-Based Measure (SBM) and Malmquist index models. Tobit regressions were applied to examine the effects of management practices on efficiency.
RESULTS: Between 2015 and 2018, the average hospital management score increased from 2.54 to 2.69. DEA-SBM analysis showed that the average Total Factor Productivity (TFP) was 0.54 in 2018, with Pure Technical Efficiency (PTE) and Scale Efficiency (SE) at 0.61 and 0.88 respectively. Malmquist index results indicated a 15% increase in TFP over the study period. Tobit regression analysis found a significant positive association between higher overall management scores and improved hospital efficiency (β = 0.125, p < 0.05), particularly in public hospitals. Further analysis showed that management practices significantly influenced SE, but not PTE. Among the four management dimensions, target management had the strongest positive effect on both PTE and SE (p < 0.05), while personnel management exhibited a significant negative association, possibly reflecting the complexity of cases managed.
CONCLUSIONS: This longitudinal study demonstrates that systematically measuring hospital management using D-WMS-H reveals efficiency drivers in rural China. The dual positive impact of target management on technical and scale efficiency underscores the importance of strategic goal-setting for resource optimization. It provides empirical evidence from a low- and middle-income country setting and offers practical insights to improve hospital performance through better management.
METHODS: Longitudinal panel data from 67 county-level hospitals in Guizhou Province (2015-2018) were analyzed. Hospital management practice was measured using the Development World Management Survey for Hospitals (D-WMS-H), which assesses the overall management score and scores across four dimensions: operations management, target management, personnel management, and performance management. Efficiency was assessed using Data Envelopment Analysis (DEA), including Slack-Based Measure (SBM) and Malmquist index models. Tobit regressions were applied to examine the effects of management practices on efficiency.
RESULTS: Between 2015 and 2018, the average hospital management score increased from 2.54 to 2.69. DEA-SBM analysis showed that the average Total Factor Productivity (TFP) was 0.54 in 2018, with Pure Technical Efficiency (PTE) and Scale Efficiency (SE) at 0.61 and 0.88 respectively. Malmquist index results indicated a 15% increase in TFP over the study period. Tobit regression analysis found a significant positive association between higher overall management scores and improved hospital efficiency (β = 0.125, p < 0.05), particularly in public hospitals. Further analysis showed that management practices significantly influenced SE, but not PTE. Among the four management dimensions, target management had the strongest positive effect on both PTE and SE (p < 0.05), while personnel management exhibited a significant negative association, possibly reflecting the complexity of cases managed.
CONCLUSIONS: This longitudinal study demonstrates that systematically measuring hospital management using D-WMS-H reveals efficiency drivers in rural China. The dual positive impact of target management on technical and scale efficiency underscores the importance of strategic goal-setting for resource optimization. It provides empirical evidence from a low- and middle-income country setting and offers practical insights to improve hospital performance through better management.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD308
Topic Subcategory
Reproducibility & Replicability
Disease
No Additional Disease & Conditions/Specialized Treatment Areas