ORIGINAL RESEARCH article
Front. Health Serv.
Sec. Cost and Resource Allocation
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1643677
This article is part of the Research TopicPublic Health Outcomes: The Role of Social Security Systems in Improving Residents' Health WelfareView all 84 articles
Sustainable efficiency and operational pathways in public hospitals: An efficiency evaluation using three-stage DEA and fsQCA
Provisionally accepted
- 1School of Management, Hunan University of Technology and Business, Changsha Shi, China
- 2Department of Industrial Engineering, School of Business, Sichuan University, Chengdu, China
- 3Hospital Management Institute, Xiangya Hospital Central South University, Changsha, China
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Background: Achieving sustainable efficiency in public hospitals is critical for healthcare system resilience amid resource constraints, yet integrated frameworks evaluating operational pathways remain limited. Methods: Utilizing 2021 operational data from 80 tertiary public hospitals in Hunan Province, China (sourced from the Public Hospital Performance Assessment Management Platform), operational efficiency was assessed through a three-stage Data Envelopment Analysis (DEA) model to eliminate environmental influences and random noise. Subsequently, fuzzy-set Qualitative Comparative Analysis (fsQCA) was applied to identify configurations of antecedent conditions driving high efficiency.The three-stage DEA analysis indicated an average comprehensive operational efficiency of 0.816 for the hospitals. Per capita GDP and fiscal subsidies were associated with higher efficiency, whereas high population density correlated with resource redundancy and reduced efficiency. Furthermore, fsQCA identified seven distinct configuration pathways enabling high efficiency, revealing that optimal hospital performance arises from specific combinations of factors rather than any single factor alone.This study advances sustainable healthcare management by demonstrating that public hospital efficiency requires balanced integration of economic, environmental, social, and governance efforts, and provides actionable, multifaceted strategies tailored to diverse institutional contexts. The novel DEA-fsQCA integration offers a methodological framework for analyzing complex efficiency drivers in health systems globally.
Keywords: Efficiency evaluation, sustainable development, DEA model, Hospital management strategy, Fuzzy set qualitative comparative analysis
Received: 24 Jun 2025; Accepted: 11 Aug 2025.
Copyright: © 2025 Li, Yuan, Luo and Fei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ruqian Fei, Hospital Management Institute, Xiangya Hospital Central South University, Changsha, China
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