Implementation efficiency of the hierarchical diagnosis and treatment system in China: A case study of primary medical and health institutions in Fujian province.

The hierarchical diagnosis and treatment system is at the core of China's new round of medical reforms. We evaluated the operational efficiency of the hierarchical diagnosis and treatment system in primary medical and health institutions in Fujian Province. We used the data envelopment analysis algorithm to calculate 'input-output' data from 2016 to 2018 and established an index system. Regarding results for efficiency value, the implementation efficiency of Xiamen was 1.15, Fuzhou was 1.10, Zhangzhou was 1.09, Ningde was 1.06, Quanzhou was 0.98, Nanping was 0.96, Putian was 0.94, Longyan was 0.92, Sanming was 0.86, and Pingtan was 0.82. There were few and insufficient doctors providing services; in 2018, the number of practicing (assistant) doctors per 1000 permanent residents in primary medical institutions in Fujian was only 0.799. Outpatient and emergency service visits were increasing yearly; in Fujian, they increased by 8.39% from 2016 to 2018. From the incentive system of hierarchical diagnosis and treatment, the redundancy rate of each city was generally high, with only that of Nanping (3.28%) and Longyan (0.00%) being lower. In general, for the hierarchical medical system to succeed, we should start with innovative management policy and explore ways to adapt to local circumstances (such as population, economy, etc.).