Can hierarchical healthcare system improve public health efficiency? Evidence from 27 eastern Chinese cities

Healthcare policies have the potential to impact the environment by improving public health efficiency. It is unknown whether the Hierarchical Healthcare System (HHS), an important healthcare policy in China, can impact the environment in the same way. This study addresses two research questions to investigate its impact on public health efficiency. The first question explores the influence of the HHS on patient triage, and the second question examines its effect on the efficiency of medical resource utilization. Using empirical data from 27 cities in eastern China and employing a Time-varying Difference-in-Differences, this study establishes a relationship between the HHS and health efficiency. The findings reveal that the implementation of the HHS significantly reduces the number of patient visits to upper-level hospitals while leading to a substantial increase in patient visits to lower-level hospitals. Furthermore, the HHS is shown to reduce hospitalization time for patients at lower-level hospitals. Based on these comprehensive results, this study concludes that the HHS enhances public health efficiency and contributes to the reduction of environmental pollution.