The Hidden Logic of Health System Performance: Temporal Interplay Between Institutional Pressures and Government Responses in China
1
College of Medicine, Jiaxing University, Jiaxing, China
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Health system performance in China is influenced by the interplay between institutional pressures and government responses, yet the underlying mechanisms remain underexplored.
METHODS:
Panel data from 31 provinces during 2015–2019 were used. Health system performance was evaluated using a data envelopment analysis model that incorporates non-desirable outputs. Dynamic fuzzy-set qualitative comparative analysis was employed to examine how different types of pressures and responses—assessment, peer, social, government attention, and fiscal expenditure—interact to affect performance.
RESULTS:
Three high-performance configurations were identified: social pressure–responsive, assessment pressure–driven, and multi-pressure types. These pathways indicate that different combinations of institutional pressures can produce similar outcomes. Performance configurations also experienced short-term fluctuations during reform years, and regional variations reflected differences in local resources and institutional conditions.
CONCLUSIONS:
Various pressure mechanisms and government responses can interact in diverse ways to enhance health system performance, but their effectiveness differs across regions and should be tailored to local contexts.
Health system performance in China is influenced by the interplay between institutional pressures and government responses, yet the underlying mechanisms remain underexplored.
METHODS:
Panel data from 31 provinces during 2015–2019 were used. Health system performance was evaluated using a data envelopment analysis model that incorporates non-desirable outputs. Dynamic fuzzy-set qualitative comparative analysis was employed to examine how different types of pressures and responses—assessment, peer, social, government attention, and fiscal expenditure—interact to affect performance.
RESULTS:
Three high-performance configurations were identified: social pressure–responsive, assessment pressure–driven, and multi-pressure types. These pathways indicate that different combinations of institutional pressures can produce similar outcomes. Performance configurations also experienced short-term fluctuations during reform years, and regional variations reflected differences in local resources and institutional conditions.
CONCLUSIONS:
Various pressure mechanisms and government responses can interact in diverse ways to enhance health system performance, but their effectiveness differs across regions and should be tailored to local contexts.
| eISSN: | 2654-1459 |
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