Abstract
OBJECTIVES: China’s fiscal subsidies structure has gradually evolved since the implementation of the New Healthcare Reform. Fiscal subsidies for the healthcare insurance system and basic public health programs have been steadily increasing. Whether such subsidies have effectively improved the service efficiency of Primary Health Care Institutions (PHCIs) requires further investigation. METHODS: This study employs data from China Health Statistical Yearbook, China Statistical Yearbook, and other relevant websites for the period 2010–2021. The Data Envelopment Analysis (DEA) was used to measure the Technical Efficiency (TE), Pure Technical Efficiency (PTE) and Scale Efficiency (SE) of PHCIs. Further, a panel Tobit model was applied to assess how fiscal subsidies in both the health insurance system and basic public health programs affect the efficiency of PHCIs. RESULTS: The efficiency of medical services in PHCIs is on a downward trend, while the efficiency of public health services shows an upward trend with fluctuations. Fiscal subsidies in the healthcare insurance system significantly improved the basic medical services efficiency of PHCIs but adversely affected public health services efficiency. In contrast, subsidies for basic public health programs improved public health services efficiency of PHCIs but adversely affected basic medical services efficiency. The division management mode of fiscal subsidies is not conducive to improving the comprehensive services efficiency of PHCIs. CONCLUSIONS: Fiscal subsidies in both the healthcare insurance system and public health programs demonstrate suboptimal efficiency, characterized by poor coordination and integration, ultimately failing to significantly enhance the efficiency of PHCIs.