Background: Despite the growing literature on the efficiency and productivity of the Chinese healthcare system, less attention has been given to examining the undesirable outputs linked to healthcare services, including environmental pollution. Taking the atmospheric environmental pollution resulting from the incineration of medical waste as an undesirable output of the healthcare system, this study analyzed the growth and decomposition of Total Factor Productivity (TFP) of healthcare services across 31 Chinese provinces during the period 2005–2016. Methods: The Meta-frontier undesirable super-efficiency slack-based measure (SBM) model and the Global Malmquist-Luenberger (GML) Index were employed to analyze the growth and decomposition of TFP using the Max DEA software. Results: The results revealed that the years 2009 and 2015 marked significant changes in TFP of healthcare services in Chinese provinces. During the study period, the rate of technological change (TC) slowly declined, whereas the rate of efficiency change (EC) steadily increased. With the national average being the benchmark, the results indicated that: the TFP of 17 provinces and cities exceeded the average, the EC of 16 provinces and cities exceeded the average, the TC of 9 provinces and cities exceeded the average, and the value in the Technology Gap Ratio (TGR) changes of 13 provinces and cities were above the national average. Conclusions: (1) The TFP of the healthcare services across China continued to decline slowly during the study period. (2) The effect of technical catch-up in the eastern, central, and western regions of China was significant across the three regions, whereas the effect of technical innovation was negative. (3) The TFP varied considerably among the Chinese provinces. These findings suggest that, under existing environmental constraints, relevant government departments should improve technical innovation in the supply of healthcare services and medical waste treatment, increase technical efficiency in the factor of healthcare production, strengthen regional health planning, and balance the development of regional healthcare.

Digital economy is being closely integrated with agricultural development and tapping into its unique potential to alleviate agriculture’s carbon emissions To explore the mechanism of how digital economy reduce the agricultural carbon emissions, this paper constructs a systematic evaluation method with extend STIRPAT model and panel data drawn from 29 provinces (or municipalities and autonomous regions) in the Chinese mainland from 2013–2020. The results show that the development of the rural digital economy has a significant negative influence on agricultural CEs, and this result is still valid given robustness tests. Second, the alleviation of CEs based on the rural digital economy is more significant in the higher technological investment zones than that in the lower technological investment zones, and the central and eastern regions also have more significant CEs reduction effect. Third, the influence mechanism analysis shows that agricultural green technology change is an effective means to promote the rural digital economy’s CEs reduction effect. This paper not only provide new empirical evidence for understanding nexus between digital economy and agricultural carbon reduction, but also give constructive policy implication to improve agricultural green development.

The purpose of this paper was to analyze the influence mechanism of the new round of Collective Forest Rights Reform (CFRR) on farmers’ production efficiency from the perspective of forestland transfer. Based on the panel data of field investigation in Jiangxi Province, a panel logit model was used to verify whether the new round of CFRR has affected farmers’ forestland circulation behavior. The results showed that the new round of CFRR has played a significant role in promoting forestland circulation. Secondly, the non-parametric DEA method was used to estimate the technical, scale, and comprehensive efficiency of households. DID and panel quantile models were constructed to analyze the impact of forestland inflow policy and forestland outflow policy effects on rural household productivity. The regression results showed that the effect of forestland inflow has had a significantly positive impact on scale and comprehensive efficiency, but it only had a significant effect on technical efficiency in the 0.1 quartile. The effect of forestland outflow was not found to be significant for technical, scale, and comprehensive efficiency, but it was found to be negative for technical efficiency in the 0.75 quartile and negative for scale efficiency in the 0.5 and 0.75 quantiles.

Telemedicine is an innovative approach that helps alleviate the health disparity in developing countries and improve health service accessibility, affordability, and quality. Few studies have focused on the social and organizational issues involved in telemedicine, despite in-depth studies of and significant improvements in these technologies. This paper used evolutionary game theory to analyze behavioral strategies and their dynamic evolution in the implementation and operation of telemedicine. Further, numerical simulation was carried out to develop management strategies for promoting telemedicine as a new way of delivering health services. The results showed that: (1) When the benefits are greater than the costs, the higher medical institutions (HMIs), primary medical institutions (PMIs), and patients positively promote telemedicine with benign interactions; (2) when the costs are greater than the benefits, the stability strategy of HMIs, PMIs, and patients is, respectively, ‘no efforts’, ‘no efforts’, and ‘non-acceptance’; and (3) promotion of telemedicine is influenced by the initial probability of the ‘HMI efforts’, ‘PMI efforts’, and ‘patients’ acceptance’ strategy chosen by the three stakeholders, telemedicine costs, and the reimbursement ratio of such costs. Based on theoretical analysis, in order to verify the theoretical model, this paper introduces the case study of a telemedicine system integrated with health resources at provincial, municipal, county, and township level in Guizhou. The findings of the case study were consistent with the theoretical analysis. Therefore, the central Chinese government and local governments should pay attention to the running cost of MIs and provide financial support when the costs are greater than the benefits. At the same time, the government should raise awareness of telemedicine and increase participation by all three stakeholders. Lastly, in order to promote telemedicine effectively, it is recommended that telemedicine services are incorporated within the scope of medical insurance and the optimal reimbursement ratio is used.