Performance measurement of healthcare service and association discussion between quality and efficiency: Evidence from 31 provinces of mainland China

Abstract

Performance of healthcare service includes quality and efficiency, so there is inevitably an association between them. In general, it is believed that there is a trade-off between quality and efficiency; however, we prove that it is not completely accurate. We take the quality as an additional output to measure the healthcare service efficiency creatively, and discuss the association between quality and efficiency based on the effect of quality on relative efficiency. Firstly, we use TOPSIS method to calculate relative quality index values of healthcare service of 31 provinces of mainland China. This practice ensures the consistent comparison of 31 provinces' qualities. Subsequently, we measure the 31 provinces' relative performances and efficiencies of healthcare service with consideration of quality or not, by constructing DEA models. Then, we analyze the association between quality and efficiency from each group of the national, east, central and west, and conclude that the association between them is different along with their advantage degrees of quality and efficiency. Finally, we use the Tobit regression method to test 12 environment variables' net impacts on efficiency values both with consideration of quality or not. The results indicate that the main drivers of healthcare service efficiency are different when we take quality as an additional output or not. This article contributes to the field of performance measurement of healthcare service, puts forward a new method to integrate quality and efficiency and provides management guidelines.