【正文】 ounty hospitals are better equipped and their quality is considered by people to be higher than that of THs, and a positive effect as the nearness of the county hospital can reinforce the technical support of the county hospital to THs, and thus help to improve their technical efficiency. Two variables measuring the economic environment of THs are retained: the rural ine per capita and the NRCMS cover rate. The development level of the township and the health insurance coverage of the population can create a stimulating environment for THs to enhance their technical efficiency. In contrast, a high level of development and a high coverage rate of the population by the NRCMS can also lower the constraint on the production process. As THs are a target of the reform of the NRCMS, it seems to be appropriate to estimate to what extent the insurance scheme can be a control tool to impact on the efficiency of THs. 5. Discussion Our results show that THs efficiency, which was in average moderate at the beginning 濟南大學畢業(yè) 論文外文資料翻譯 8 of the period, followed over the period a general declining trend to reach a rather weak level, along with the NRCMS implementation, although some THs have increased their efficiency. In addition, the heterogeneity between counties, which was great, has increased over time. If this decline in efficiency in our sample was due to a decline in overcrowding of staff, it could be seen as some kind of improvement in quality of care. However our data show that prior to the NRCMS reform, THs staff was not overbooked. Therefore our results mean a challenge for health policy makers in Weifang, in an overall context of limited resources and increasing needs, as they suggest that space for improvements in efficiency does exist at THs level, both for the curative and preventive care. However, and broadly speaking, what we have figured out in the Weifang sample is not an unusual experience as we can see from the literature. Recently, the rather low efficiency in the hospital sector in China was also stressed by Ng on a sample of 463 public hospitals (Ng, 2020). As another example, a case study of munity health centers in a district of Beijing which has adopted the Urban Resident Medical Insurance found that the number of patient visits per staff per day has declined for most munity health centers (Zhang et al., 2020). . Adopting a systemic approach International experiences show that improving health facilities efficiency is very plex with many context specific dimensions. It needs a bination of (i) strong ―macro‖ organizational incentives, (ii) a payment system integrating criteria of performance and (iii) a set of ―micro‖—. at hospital level—incentives. The issue of alignment or misalignment of incentives with the policy objectives of the health authorities is a major challenge (but it was out of the scope of this study to analyze it). Basically, these issues could be addressed in our sample within a general analytical framework inspired by the Preker–Harding approach (Preker amp。t be apanacea. To find the right balance between autonomy and traditional regulation is challenging. The Brazilian experience, for example, provides interesting elements: La Forgia and Couttolenc (2020) pared in Sao Polo traditional hierarchical directlymanaged public hospitals with indirectlymanaged autonomous public Hospitals with more flexible organization and structures were better performers regarding efficiency and quality of care. Managers really managed in a strategic way. In contrast,managers operating in traditional structures of management have administrative onlyfollowingtherules based behavior. 濟南大學畢業(yè) 論文外文資料翻譯 10 . Rationalizing THs health care supply at county level The low level of staff productivity of numerous THs in our sample raises the issue of the size of each TH locally, and that of the global capacity of the supply of TH type of care at the county level. Our data and findings suggest a substantial room to rationalize the health care supply within counties—including reducing the capacity of some TH—in order to improve THs efficiency. In that field, a related caveat merits also attention in Weifang: improving referral. Not only does a functioning referral system improve efficiency, but a weak one is a social loss in the sense that medically indicated professional referrals carry positive externalities and social benefits. This issue is particularly important for THs regarding their position above village health stations and below county hospitals. The rationalization of health care supply with its corollary, the coordination of care, requires specific information, some of it being impossible to obtain actually. NRCMS and THs will need this information to enter into contracts with each other: but who will have an incentive to produce and disseminate it, and who will do it? This crucial issue to improve THs efficiency is very much a public good issue. . Considering incentives in THs payment mechanisms as a tool Payment mechanisms seem to be not enough used by the authorities as policy instruments for encouraging the performance and better efficiency of THs in Weifang. Moving that way implies to considerably reduce the share of the ―feeforservice‖ payments and to prefer methods of payment to THs tied to their activity and performance, along with increasing the reimbursement from A consistent finding from the international literature is that an optimal balance between cost and quality requires mixed reimbursemen payment systems for hospitals. Our results suggest that THs operate under a SBC. Then it would be relevant to harden it, but with an adequate degree of flexibility and pragmatism. The zero markup policy for essential drugs, which does not allow additional margin when THs sell drugs (their main source of ine and an important fact