The astonishing economic achievements of China in the past few decades have remarkably increased not only the quantity and quality of medical services but also the inequalities in health resources allocation across regions and inefficiency of the medical service delivery. A descriptive analysis was used to compare the inequities in inputs and outputs of the provincial medical service systems, a non-radial super-efficiency data envelopment analysis model was then used to estimate the efficiency, and a regression analysis of the panel data was used to explore the determinants. The inputs and outputs of most provincial medical service systems increased gradually from 2009 to 2014. Overall, the eastern region allocated more human and capital resources than the other two regions, and produced more than 50% of the total outpatient and emergency room visits, whereas the western region produced more inpatient services (about 30% of the total volume of inpatient services) according to the distribution of the population. The average efficiency scores of the provincial medical systems in China’s mainland were 0.895, 0.927, 0.929, 0.963, 0.977 and 0.968 from 2009 to 2014, with a slight average improvement of 1.60%. The efficiency score of each provincial medical service system varied greatly from one another: Tibet (1.475 ± 0.057) performed extremely well, whereas several others including Heilongjiang (0.579 ± 0.001) performed poorly. Furthermore, the proportion of high-class medical facilities was negatively associated with efficiency, whereas the proportion of the vulnerable population, the per capita Gross Domestic Product, the proportion of the illiterate population and the improvement of primary health care had positive effects on efficiency. Inequity in health resources allocation and service provision existed across the regions, but not all the gaps have begun to narrow since 2009. The difference of efficiency was great among provincial medical service systems but minor across regions, and the score changed very little over time. More importantly, the central region held the lowest average efficiency score in the past 6 years, while the western region held the largest average efficiency score at the first 5 years, which should receive enough attention of the government and decision-makers. In practice, efficiency was related to many complicated factors, indicating that the improvement of efficiency is a complex and iterative process that requires the strong cooperation of many sectors.

Background: The national-level China Healthcare Security Diagnosis-Related Groups (CHS-DRG) reform in China has been underway for 6 years. However, the marginal benefit of controlling medical insurance fund expenditures has been decreasing, mainly due to the emergence of game behaviors among healthcare providers. The study aimed to explore the internal driving factors, effects and their interrelationships of DRG downcoding, upcoding and ambiguous cases to propose the intervention measures based on the hot cheese model. Methods: This study was conducted through semi-structured interviews with 22 participants from various positions in hospitals in Shaanxi Province, China. The hot cheese model was introduced for qualitative analysis to systematically analyze the manifestations, subjective and objective driving factors, and internal and external effects of DRG coding abuse. Results: The subjective, objective drivers and effects of DRG coding abuse were revealed, and a hot cheese model was established, consisting of three defensive layers: layers of hospital organization environment, doctor-filled first page of medical records, and medical record/insurance department review. Conclusion: DRG upcoding should be distinguished between subjective and objective driving factors for targeted intervention. The potential effect of DRG downcoding and ambiguous cases should not be underestimated. Future research should focus on intelligent early warning by natural language processing on pre-coding of medical record texts.

Risk management is essential for maintaining the quality and safety of helicopter emergency medical services (HEMS) worldwide. The scarcity of consolidated