Out-of-City Hospitalization Linked to Lower Public Hospital Efficiency in Guangdong

Researchers analyzed balanced panel data from 21 prefecture-level cities in Guangdong Province for 2018–2023. They measured public hospital efficiency using a slacks-based data envelopment analysis model and used two-way fixed-effects models to assess its association with the share of inpatient care received outside patients’ home cities. Analyses also examined pure technical and scale efficiency, and differences by local healthcare resource levels.

Higher out-of-city hospitalization rates were associated with lower overall public hospital efficiency (β = −2.492; p < 0.05). The association was stronger for pure technical efficiency (β = −3.322; p < 0.01) than for scale efficiency, and was weaker in cities with relatively abundant healthcare resources.

The findings are observational and concern city-level efficiency measures; they do not establish that cross-city hospitalization causes lower efficiency or show effects on individual patient outcomes. The authors suggest regional coordination, stronger local service capacity, and alignment of non-local reimbursement policies with tiered-care objectives as potential approaches. The study used publicly available secondary data and reported no competing interests.