PONE-D-24-05935Research on the Dynamic Evolution of Utilization Efficiency of Medical and Health Services in ChinaPLOS ONE

Dear Dr. ZHANG,

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ACADEMIC EDITOR: The phrase "Research on” should be removed from the title. 

Revise and refine the language in the manuscript.

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Xufeng Cui, Ph.D

Academic Editor

PLOS ONE

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Additional Editor Comments:

The phrase "Research on” should be removed from the title.

Revise and refine the language in the manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The paper uses the SFA Malmquist model, the spatial econometric model, and the standard deviation ellipse method to evaluate the efficiency, productivity, spatial dependence, and dynamic evolution of medical and health services in 31 provinces of China, based on data from statistical yearbooks.

The authors declaim that the average level of efficiency and productivity of medical and health services in China is moderate and has a weak growth trend, with significant regional differences and spatial clustering. The paper also identifies the factors that affect the efficiency and productivity, such as population density, government health budget, and technological innovation.

However, this paper has some limitations, such as:

(1) The paper does not consider the quality and accessibility of medical and health services, which are important aspects of health system performance.

(2) The paper does not account for the impact of the COVID-19 pandemic on the medical and health services in 2020, which may have distorted the results and trends.

(3) The paper does not provide any policy recommendations or implications based on the findings, which may limit its practical relevance and applicability.

(4) The paper uses the SFA model and the Malmquist index to measure the MHS efficiency, but does not address the potential limitations or biases of these methods, such as the choice of input and output indicators, the specification of the production function, the assumption of homogeneity, etc.

Reviewer #2: The study titled “Research on the Dynamic Evolution of Utilization Efficiency of Medical and Health Services in China focuses on evaluating the efficiency of the Chinese medical and health system. The research investigates an important topic. However, it needs extensive revision to improve its quality. My details comments are as below.

• The abstract should present the research objectives, methods, and concise results of the study. Revise these concerns.

• The innovations, objectives, and contributions are missing from the introduction section. Revise it and write the importance of the topic, problem, objectives, contributions, and innovations.

• Rewrite the following paragraph in the introduction section for more clearance” Domestic scholars have conducted extensive researches on the medical services efficiency. Based on medical and health data of Chinese 30 provinces from 2005 to 2018, Li Yi (2021)[10] explored the MHS efficiency and its interfering factors. The results showed that the MHS efficiency had a strong trend in the East, and weak in the West and Central. The developing level of regional economy and technology education had a positive effect on medical and health, while regional aging and transportation levels would affect MHS efficiency. Zhang Mei (2022)[11] evaluated the public MHS efficiency in traditional Chinese medicine hospitals from 2012 to 2020 and found that the overall medical services efficiency in Chinese traditional medicine hospitals was at a moderate level with significant regional differences. The external environment, such as the average times and sickbeds per day that Chinese medicine hospital physicians were responsible for treatment and diagnosis, significantly affected the MHS efficiency. Luan Yunyun (2022)[12] analyzed the interfering factors and regional efficiency differences of MHS efficiency since the " China New Medical Reform", and found that the differences of medical services efficiency in the eastern, central and western regions of China were showing a downward trend. Population density, government health budget expenditures, and the non-market level of medical services significantly affected the medical services efficiency. The above research indicated that the medical services efficiency was not only related to the type of medical institution and organizational management but also significantly influenced by exogenous variables such as population density.

• Add the following latest literature on the topic of efficiency estimation. https://doi.org/10.1016/j.energy.2022.124507

https://doi.org/10.1007/s11356-022-23484-w

https://doi.org/10.1016/j.egyr.2022.12.067

https://doi.org/10.1016/j.gr.2023.07.017

https://doi.org/10.1016/j.gsf.2023.101631

https://doi.org/10.3390/f15010152

https://doi.org/10.1016/j.scitotenv.2023.168027

https://doi.org/10.1016/j.egyr.2022.07.161

https://doi.org/10.1007/s11356-022-19729-3

• Check the table numbers.

• In the methodology section add the importance of the Malmquist productivity index.

• The selection of inputs and outputs has great significance in efficiency estimation as it could impact the results. Mention the reference from where the authors choose these variables.

• Results should be backed by literature. Add more discussion and add citations to back your results.

• Add concise and comprehensive study results and more policy recommendations in the conclusion section for the medical sector of China.

• Avoid grammatical errors throughout the manuscript.

• Referencing style is inappropriate. Use proper citation style according to the Plos One requirement.

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Reviewer #1: No

Reviewer #2: No

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Dynamic Evolution of Utilization Efficiency of Medical and Health Services in China

PONE-D-24-05935R1

Dear Dr. ZHANG,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Xufeng Cui, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: I can see that Authors has carefully revised the manuscript. no more revision required. Therefore, I recommend acceptance in the current form.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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