Comparison of the efficiency of residential care between provinces and municipalities in China from 2012 to 2016.
Table 3 summarized the annual mean TE, PTE and SE of the sample LTCFs from 2012 to 2016. The average TE, PTE and SE for the 5-year period were 0.909. 0.928 and 0.979, respectively, and TE, PTE, SE of nursing homes are significantly different among different years, as shown by the mean rank and Kruskal-Wallis test. The TE and PTE of nursing homes improved from 2012 to 2014, but declined since 2014. This result implied that in 2014, if LTCFs were running efficiently, then facilities should have increased their outputs by 15.70% with the same volume of inputs. (table 3).
Table 4 showed that the traditional CCR model, BCC model, and SE model were used to count the number of nursing homes with effective TE, PTE and SE in various provinces and municipalities. As shown in figure 3, the number of nursing homes with effective TE, PTE and SE in all provinces decreased from 2012 to 2014. Then, the number gradually rose since 2014. The number of nursing homes with DEA-effective provinces and municipalities were at the lowest in 2014, while a trend showed an initial decrease and then an increase in the process.
SBM model was used to calculate the changes in the DEA efficiency value of the LTCF in various provinces and municipalities across the country
Figure 2 presented the distribution of SBM efficiency values in China's LTCFs. The results showed that the efficiency of LTCFs in the western region changes rapidly.
Several western provinces and municipalities have developed rapidly, with their LTCFs having an effective TE from 2015 to 2016. The changes in the efficiency of LTCFs in provinces and municipalities in the Eastern region are second to the changes of LTCFs in the West. Among them, the LTCFs in Beijing, Tianjin and Guangdong have been technically efficient from 2012 to 2016. The increase in the efficiency of LTCFs in the Western provinces and municipalities is greater than the Eastern region, while in the Central region is the worst. On the other hand, the LTCFs in Heilongjiang, Jilin, Shandong, Hunan, and Henan provinces have all shown to be non-efficient by 2016.
In addition, LTCFs in the western provinces have improved in TE, while the efficiency of LTCFs in the Central and Eastern provinces has declined in 2014 and in 2016. It was notable that from 2012 to 2016, LTCFs in Hebei, Inner Mongolia, Shanxi, Anhui and Yunnan provinces have never reached an effective TE.
Malmquist productivity index
It can be seen that under the overall evaluation model, the TFPC of LTCFs in 10 provinces and municipalities increased from 2012 to 2016. The average growth of LTCFs in Tibet was the highest, reaching 81.6%. In 21 provinces and municipalities, the TFPC of the LTCFs decreased, with the largest decline in Guizhou. As for the TEC, TEC of LTCFs in 10 provinces (Guizhou, Anhui, etc.) has declined, TEC of LTCFs in 7 provinces (Liaoning, Xinjiang, Fujian, etc.) improved. Among them, Fujian has the largest increase in efficiency. The TC of LTCFs in 8 provinces and municipalities has improved, but the extent of the improvement is small, only Tibet has the largest progress, reaching 79.2%. PTEC of LTCFs in 6 provinces (Hainan, Guizhou, Anhui, Yunnan, etc.) have declined, and PTEC of LTCFs in 8 provinces and municipalities (Liaoning, Fujian, Xinjiang, Chongqing, Gansu, etc.) improved, Fujian Province had the largest increase. The sech of LTCFs in 7 provinces (Tibet, Xinjiang, etc.) increased, with the largest increase in sech in Tibet. Etc.), but Hunan Province had the largest decline in sech of LTCFs (refer to table 5).
Table 6 showed that, from 2012 to 2016, the average TEC was 1.001, and the index increased or decreased by 1.1% to 26.4% in each year, with a large change range, among which the increase in 2015 was up to 26.4%. The average value of TC is 0.983, with an increase or decrease rate of less than 4% per year. After 2015, the trend of steady rise remains stable. The average PTEC was 1.003, with a sharp increase of 19.8% in 2015.The average value of SEC is 0.988, which is in a stable development state. The average value of TFPC was 0.984, and the maximum increase of TFPC in 2015 was 31.8%. As shown in figure 3, the five efficiency values of LTCFs in combined total of 31 provinces and municipalities reached the lowest in 2014 and the highest in 2015. During this period, the results showed a trend that initially went upward and then eventually downward.
DEA Classification was used to cpmpare the DEA efficiency value of the LTCFs in Eastern, Central and Western regions
The regions were divided into three major classifications, namely Eastern (developed), Central (generally developed), and Western (underdeveloped) regions, which refers to the regional division in the China Health Statistics Yearbook.
Table 7 presents the means of TE of nursing homes in East, Central and West were 0.98, 0.93, 0.91 respectively, with a decrease range of 2%, 7% and 9%, respectively; the means of PTE of nursing homes in Eastern, Central and Western regions were 0.98, 0.95, 0.94 respectively, with a decrease range of 2%, 5% and6%, respectively; the means of SE of nursing homes in Eastern, Central and Western were 0.99, 0.99, 0.96 respectively, with a decrease range of 1%, 1% and 4%, respectively
Table 8 presented PTE is significantly difference (P=0.043, <0.05), while TE and SE do not differ significantly among the nursing homes of Eastern, Central and Western regions from 2012 to 2016, as shown by the mean rank and Kruskal-Wallis test. The Mean rank of PTE and SE is the highest in the nursing homes of Eastern region, while the highest rank of TE is in Western region.
As shown in the figure 4, the efficiency values of the three regions all showed a trend of an initial decline, and then an increase, as the agency efficiency value reached the lowest point in 2014. The Eastern region, in 2014, also showed a slight decline at first, and then gradually increase. On the other hand, as the Central region showed a decreasing trend throughout 2014, the Western region showed an initial decrease which eventually increased on that same year.
Projected value of non-DEA effective nursing homes based on input-oriented in 2016
Based on input-oriented (assuming that the output is unchanged), the CCR model was used to calculate the projected value of non-effective LTCFs in all provinces and municipalities in terms of inputs, the number of adjustments (actual value-projected value) , and adjustment ratio[(adjusted number / actual value) ×100% ]of 15 non-effective LTCFs in provinces and municipalities in terms of investment are calculated.(Table 9)
The results indicated that in 2016, the non-efficient LTCFs in all provinces and municipalities, the number of institutions, the number of employees by end of the year, the total value of assets, the number of social workers, and the number of beds at the end of the year have been redundant in varying degrees. If the original output of 31 provinces and municipalities of China is maintained, and the input structure and DEA is effectively optimized, it will result in the following: the number of beds in China's LTCFs can be reduced by 360038.9, the number of institutions can be reduced by 3464.9, and the number of social work can be reduced by 497, the total value of assets can be reduced by 87,0381.7 yuan, and the number of employees can be reduced by 3,5465.9.
The efficiency values calculated by SBM and BCC models were used as the Tobit influencing factors in regression analysis
The LTCFs with a greater number of women, social workers, and annual older people have a greater efficiency value. Also, age gets to have an effect on the efficiency value. The results showed that more people within the age range of 35 and below, and 46 to 55 in the LTCFs of nursing homes, a lower efficiency value is. However, if the LTCFs with the greater number of people over the age of 56, the efficiency value will be higher. (refer to table 10)