【正文】 performance unless managers have sufficient regulated autonomy and authority to alter hospital behavior. More autonomy would be a robust driver to foster the efficiency of THs and make managers more accountable. However, regarding international experience, it is clear that THs autonomy won39。 efficiency and for patients39。 potential additional effects on efficiency behavior in different production technologies, efficiency scores of the curative DEA model are introduced into the regression of the determinants of preventive efficiency, and viceversa. . Environmental factors The structural characteristic of the township is measured by the density of the population in the township. It can influence the demand addressed to the THs and thus the volume of medical services they delivered. The relationship of the TH with its environment is measured by two sets of variables. The density of village health stations(measured by the number of village health stations per 10,000 households) and the distance of the TH to the nearest county hospital reflect the geographical environment of THs. The density of village health stations can have two opposite effects on the efficiency of THs. A negative effect may be expected as village health stations and THs might pete for the delivery of preventive activities and basic medical consultations. A positive effect may occur when village health stations refer some patients to the TH level (Puenpatom amp。 activities should not harm the quality of services. . The DEA models As the purpose is to model the production function of the DMUs, DEA requires the specification of the inputs used to produce the outputs, the orientation of the model, the nature of the returns to scale and the temporal dimension to run the DEA model. THs deliver two main kinds of medical activities: curative and preventive healthcare services, which are characterized by two different production processes with two different objectives. Thus, two distinct DEA models are defined. The model characterizing the production process of curative activities consists of one output and three inputs. THs delivered a large set of curative activities. Therefore, the number of outputs used in the DEA framework needs to be minimized,3 but the diversity of activities has to be taken into account. A posite index is calculated using a workload equivalent weighting system4 suggested by a Chinese experts mittee5 and already used in a previous study (Audibert et al., 2020). Two main categories of input enter in the curative production process of THs: staff and equipment. The former are measured by the number of curative staff members, while equipment includes the number of operational beds and a posite index which gives the endowment of the TH in equipment. It is puted from principal ponent analysis and incorporates the number of operational Xrays, echographs, endoscope and The objective assigned to THs is to maximize the volume of healthcare delivered,. an output orientation is relevant. The model characterizing the production process of preventive activities consists of one output (the total volume of vaccinations delivered) and one input (the number of staff for preventive activities), as only human resources are used to produce preventive activities. The level of production is previously defined by the government. The input orientation appears more suitable as THs can minimize their use of preventive resources in order to produce the target volume of preventive activities In both models, the casemix was not taken into consideration because of the lack of data. Yet, the potential bias occurrence is not an important limitation to this specific study as THs are homogeneous in terms of disease treated (source: personal munication from Weifang Health Bureau). They are located in the same prefecture and face similar disease 濟南大學(xué)畢業(yè) 論文外文資料翻譯 6 patterns. They belong to the same hierarchical level in the Chinese health delivery system and have therefore mon missions defined by the , according to our data, severe cases are treated in county hospitals and THs mainly deal with respiratory and cardiovascular pathologies, diabetes and injuries. Inpatient activity represents a weak share of the curative activities delivered by THs (less than 5% of patients on average). 4. Determinants of technical inefficiency In line with the existing literature and the discussion with our Chinese partners, this paper focuses on two kinds of factors which can contribute to explain the efficiency level of THs: the internal characteristics of THs and the characteristics of the environment in which THs are situated. Two Tobit models are estimated, one for efficiency scores calculated from the curative DEA model and one from the preventive DEA model, as explaining factors may differ for both estimations. . Internal factors The position of the staff (balance between qualified and unqualified staff), the staff work load and staff incentives are considered as important channels for technical efficiency (Puenpatom amp。Jacobs, Smith, amp。rsund, Lovell Knox, amp。 Du, 2020。 Das, 2020), and two recent studies which examined hospital efficiency in China using a Data Envelopment Analysis (DEA) approach (Hu, Qi, amp。 efficiency is crucial, with regard to their strategic position in the healthcare delivery chain and the changes they experienced over the preceding years, but also in a context of scarce resources, of vertical and horizontal petition and health insurance reform. By targeting THs more than other health facilities in Weifang Prefecture, on which this study is focused, the NRCMS can influence the activity and the efficiency of 濟南大學(xué)畢業(yè) 論文外文資料翻譯 3 these facilities. The main channels are the likely increase in demand induced by insurance and the implementation of contracts. Therefore, identifying th