ArticleBMC health services research2026
How do economic capital, digital technology, and spatial structure drive health performance in the digital age? -An fsQCA study on provincial-level health resource utilization efficiency in China based on the TOE framework.
Article in BMC health services research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAgainst the backdrop of the coordinated advancement of the “Healthy China” and “Digital China” initiatives, enhancing the utilization efficiency of healthcare resources has become a core issue in achieving universal health coverage. Currently, provinces across China face significant challenges in allocating medical resources. Conducting in-depth research into the current state of resource utilization efficiency and its underlying mechanisms holds critical practical significance for optimizing resource allocation and driving high-quality development of the healthcare system.
methodsThis study employs a data envelopment analysis model to measure the efficiency of healthcare resource utilization at the provincial level in China. Utilizing a fuzzy set qualitative comparative analysis method, it systematically examines the synergistic effects of different antecedent conditions to reveal the diverse pathways driving high resource utilization efficiency.
resultsData analysis reveals a complex picture of healthcare resource utilization efficiency in China: (1) In 2021, China’s average comprehensive healthcare resource utilization efficiency stood at 0.918. However, only 35.5% of provinces achieved DEA efficiency, indicating that nearly two-thirds of provinces still face resource misallocation issues. (2) Among these, 14 provinces exhibited increasing returns to scale (under-investment in resources), while 6 provinces showed decreasing returns to scale (over-investment in resources), reflecting structural imbalances between resource allocation and actual demand. (3) fsQCA configuration analysis identified five efficient driving pathways: H1(Digital-Economic-Spatial Constraint Type) reflects cumulative disadvantages across multiple dimensions; H2 (Economy-Digital Synergy) and H4 (Urbanization-Driven) demonstrate how different factor combinations achieve functional equivalence through divergent pathways; H3 (Comprehensive Factor Balance) and H5 (Full Factor Empowerment) collectively outline the evolutionary path from “factor-driven” to “innovation-driven” development.
conclusionAchieving high-level efficiency in healthcare resource utilization does not rely on a single optimization approach, but rather results from the coordinated allocation of economic capital, digital technology, and spatial structures. Research reveals the existence of a “multiple concurrent” equivalent driving model, offering diverse pathways for regions with varying developmental conditions. Policy formulation should abandon a one-size-fits-all approach and instead adopt differentiated strategies aligned with local resource endowments and developmental stages. This systematic thinking will drive comprehensive improvements in healthcare resource utilization efficiency. CLINICAL TRIAL NUMBER : Not applicable.
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