Evaluating health systems' efficiency towards universal health coverage: A data envelopment analysis.

To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.

A multidimensional analysis of corporate governance mechanisms and their impact on sustainable economic development: A case study of Ghana's financial sector.

Efficiency remains pivotal to the banking sector, serving as a linchpin for resource allocation and competitive prowess. This study delves into the intricate dynamics between corporate governance and banking efficiency in Ghana, with an analytical lens on cost efficiency (CE) and total efficiency (TE). Utilizing Data Envelopment Analysis (DEA), our investigation spans over a decade (2008-2019) and encompasses a data set of 23 Ghanaian banks. The study findings unveils that rigorous corporate governance mechanisms, as quantified by the Corporate Governance Index (CGI), exert a salutary influence on both cost and total efficiencies. Moreover, a well-defined Risk Management Index (RMI) positively correlates with cost efficiency, albeit without a substantial impact on total efficiency. Conversely, the study identifies a counterintuitive effect: the current make-up of supervisory boards, as gauged by the Supervisory Board Index (SBI), inversely impacts both efficiency metrics, signaling sub-optimal governance structures. Significantly, the research also highlights a pressing concern: the average total efficiency of Ghanaian banks lags behind the global benchmarks prescribed by the World Bank. This discrepancy underscores an exigency for efficiency optimization within the sector. The study thereby offers invaluable insights for multiple stakeholders-including regulatory bodies, investment communities, and policymakers-by delineating the governance variables that can enhance or impede banking efficiency. It also identifies actionable avenues for improvement, specifically in the realms of risk management and board composition, with the potential to catalyze a transformation in Ghana's banking landscape.

Impact assessment of construction waste policy intensity on environmental efficiency based on system generalized method of moments.

With the acceleration of urbanization in recent years, China has witnessed large-scale construction across its provinces, generating massive amounts of construction waste that pose challenges to environmental protection and sustainable development. This study evaluated the impact of construction waste policy intensity on its environmental efficiency. Firstly, the content analysis method was used to analyze the construction waste policy text quantitatively. Second, this study constructed a slack-based measure (SBM) model based on data envelopment analysis (DEA), considering resource input and construction waste output to measure environmental efficiency. Finally, we built and tested an econometric model of how policies affect environmental efficiency using the system generalized method of moments (SYS-GMM). The findings indicate a non-linear U-shaped link between policy intensity and environmental efficiency. Among all five control variables, population density, urbanization level, and technological innovation enhance environmental efficiency, while economic development and highway density will lower it. This study advances the research on construction waste policies and offers some insights for the construction industry to pursue sustainable development.

Study on regional carbon quota allocation at provincial level in China from the perspective of carbon peak.

This paper constructs a carbon quota allocation index that takes into account equity, efficiency and ecological construction, and calculates carbon emissions and energy consumption data in important periods based on the expected carbon emission targets and economic and social development indicators of the Chinese government. Based on the calculated carbon emissions, the zero-sum game data Envelopment model (ZSG-DEA) is used to discuss the initial allocation of regional quotas and the optimal carbon quota scheme. The results show that:(1) there is a large gap between the optimal carbon quota and the initial carbon quota allocation in Shandong, Guangdong, Jiangsu and other provinces in 2025, and the implementation of emission reduction measures should be accelerated. (2) By 2030, the final allocation of Beijing, Tianjin, Inner Mongolia, Qinghai, Shanghai, Ningxia, Liaoning and Xinjiang will be positive. The provinces with negative final allocation should carry out the work of carbon peak as soon as possible to avoid increasing the pressure of emission reduction in the future. (3) The central region faces greater pressure of emission reduction, while the western region can accept the transfer of carbon emissions from other regions over time. The research conclusions have important policy implications for establishing a fair and effective carbon quota allocation mechanism, achieving the national total carbon emission control target, stimulating the vitality of the unified carbon market, and promoting regional coordinated emission reduction.

Exploring the association between primary care efficiency and health system characteristics across European countries: a two-stage data envelopment analysis.

BACKGROUND: Primary care is widely seen as a core component of resilient and sustainable health systems, yet its efficiency is not well understood and there is a lack of evidence about how primary care efficiency is associated with health system characteristics. We examine this issue through the lens of diabetes care, which has a well-established evidence base for effective treatment and has previously been used as a tracer condition to measure health system performance. METHODS: We developed a conceptual framework to guide the analysis of primary care efficiency. Using data on 18 European countries during 2010-2016 from several international databases, we applied a two-stage data envelopment analysis to estimate (i) technical efficiency of primary care and (ii) the association between efficiency and health system characteristics. RESULTS: Countries varied widely in terms of primary care efficiency, with efficiency scores depending on the range of population characteristics adjusted for. Higher efficiency was associated with bonus payments for the prevention and management of chronic conditions, nurse-led follow-up, and a financial incentive or requirement for patients to obtain a referral to specialist care. Conversely, lower efficiency was associated with higher rates of curative care beds and financial incentives for patients to register with a primary care provider. CONCLUSIONS: Our results underline the importance of considering differences in population characteristics when comparing country performance on primary care efficiency. We highlight several policies that could enhance the efficiency of primary care. Improvements in data collection would enable more comprehensive assessments of primary care efficiency across countries, which in turn could more effectively inform policymaking.

Non-homogeneity in the efficiency evaluation of health systems.

BACKGROUND: An international comparison of health system performance is a popular tool of health policy analysis. However, the efficiency evaluation of health systems is a practical example of an international comparison in which non-homogeneity is expected. The objective of this paper is to evaluate the efficiency of health systems by models in which a degree of non-homogeneity among countries is considered. METHODS: We study the problem of non-homogeneity of health systems in the theoretical framework of the data envelopment analysis (DEA), which is a popular method of efficiency evaluation with hundreds of applications from various fields. DEA assume the homogeneity of production units and the homogeneity of the environment in which the production units operate. Hence, we compiled a summary of 14 recommendations on how to deal with the non-homogeneity in the DEA models. The analysed sample includes 38 OECD member countries. The data are from the year 2019. RESULTS: As an example, we evaluated the health system efficiency of the Czech Republic. We used the DEA models with the neighbourhood measure of distance and the constraint limiting the comparison of countries with different levels of economic development. The health system inputs were the numbers of physicians, nurses, and hospital beds. In the production of the intermediate outputs (doctor consultations, inpatient care discharges), the Czech Republic should look at Poland, Slovakia and Slovenia. In the production of health outcomes (life expectancy), the peer countries are France, Italy and Switzerland. CONCLUSIONS: The results of the DEA analysis are only indicative because no single analytical method can determine whether a health system is better or worse than others. We need to combine different methods, and DEA is one of them. We consider DEA as an exploratory method, not a method providing definitive answers.

Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province.

Objective: This article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China. Methods: The efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result. Results: The bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, -0.0003, -0.0316, and - 0.0041 respectively, which were statistically significant (p < 0.05). Conclusion: There was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.

Road Safety Efficiency on Interurban Roads in Spain.

The slowdown in economic development caused by traffic accidents in Spain, together with the disparity in the risk of death or injury due to traffic accidents in its provinces, makes it necessary to evaluate their road safety performance. Therefore, the objectives of the present research are, on the one hand, to find out the level of road safety efficiency of Spanish provinces in the period 2014-2018. On the other hand, it is also aimed to determine to what extent the annual efficiency change is originated by pure changes in efficiency or by technological changes. To achieve both objectives, the nonparametric technique of Data Envelopment Analysis and the Malmquist Index have been used based on the consideration of the Safety Performance Indicators (SPI) as the inputs of the process. The research findings show changes in the level of road safety efficiency in each of the years of the study period. Thus, it is possible to identify a geographical delimitation of the causes that generate changes in efficiency in recent years. A contraction in efficiency and technological progress is identified in part of the Spanish provinces in the north, northeast, and south of Spain.

Assessing the performance of industrial water resource systems in China with total constraints on water consumption and pollution emissions.

To promote sustainable water resource management, the Chinese government has enacted restrictive policies and targets in terms of total water usage, water intensity, and pollution emissions. While data envelopment analysis (DEA) has been extensively adopted in assessing industrial water resource systems, previous studies have not integrated the realistic constraints on total water consumption and total pollution emissions into a unified framework. This paper examines the system as a two-stage process of water use (WU) and water pollution abatement (WPA), where fixed-sum constraints are imposed on both water consumption and pollution emissions. To address such two-stage DMUs with fixed-sum inputs and fixed-sum outputs, we propose a novel two-stage fixed-sum DEA approach and apply it to evaluate the performance of industrial WU-WPA systems for 29 provinces in China from 2014 to 2018. The results are as follows. From the overall efficiency perspective, the industrial WU-WPA system in China is overall efficient, but provincial overall efficiency polarizes with 19 provinces evaluated as overall inefficient. From a time perspective, overall efficiency shows an increasing then decreasing or descending trend nationally and across the 16 provinces; on the national average, WPA efficiency shows an increasing and then decreasing trend, while WU efficiency demonstrates consistent improvement over time and surpasses WPA efficiency after 2016. In terms of the four areas, regional disparities in the overall efficiencies are converging; for both the whole system and the sub-stage, the eastern area performs the best, followed by the western, northeastern, and central areas. Based on the empirical results, suggestions for improving industrial water resource management are given at the national, regional, and provincial perspectives respectively.

Efficiency and productivity analysis of maternal and infant healthcare services in Sub-Saharan Africa.

The paper examines the efficiency and productivity of Sub-Saharan African (SSA) countries towards maternal and infant healthcare services between 2015 and 2019. Data envelopment analysis is utilised to evaluate efficiency, and Malmquist-Luenberger's (ML) productivity estimation is employed for productivity analysis. The results indicate inefficiency in SSA maternal and infant healthcare services. Average efficiency is pegged at 85%, and 60% of the countries evaluated had below-average efficiency. Effects of socioeconomic dynamics of countries were analysed. Preliminary estimations on the impact of Gross domestic product (GDP), education, urban population, and total population on efficiency are not significant. Although GDP and education sometimes show that they influence efficiency positively. Sensitivity analysis indicates efficiency to be more responsive to health expenditure, as well as to nurses and midwives. ML Productivity decomposition into technical efficiency change and technological change indicates improvement in technical efficiency as the principal driver of efficiency and productivity. Policy recommendations are made in line with the findings, requirements, and constraints of SSA countries.

The government-production nexus of energy efficiency in China's construction industry: regional difference and factor analysis.

For decades, the construction industry has contributed significantly to China's economic growth. The heavy energy consumption inevitably leads to the release of large amounts of carbon emissions. Improving energy efficiency has been a crucial solution for mitigating the environmental impacts while boosting its green economy in the construction industry. Measuring the energy efficiency in the construction industry considering the quality of government sector is still limited. Using panel provincial data in China from 2011 to 2020, this paper proposes a two-stage dynamic data envelopment analysis (DEA) framework integrating the government sector with the production sector in the construction industry, and calculates energy efficiency. The spatial Durbin model is used to analyze the driving forces of energy efficiency. The research findings include (1) the energy efficiency in the eastern region is higher than that in the central and western regions. The mean values of energy efficiency in the eastern, central, and western regions are 0.42, 0.34, and 0.37. (2) Even though governance efficiency is lower than production efficiency, there is a positive correlation between governance efficiency and production efficiency with a correlation coefficient of 0.48. Improving governance efficiency is a significant step to increase the production efficiency and further increase energy efficiency of the construction industry. (3) Digital transformation has a positive effect on governance efficiency but has no effect on production efficiency. The government-production nexus framework provides implications for clarifying the role of government intervention in improving energy efficiency.

Research on equity of medical resource allocation in Yangtze River Economic Belt under healthy China strategy.

Objective: This study aimed to assess the fairness of medical resource allocation in the Yangtze River Economic Belt, based on the Healthy China strategy. It aimed to identify the issues with resource allocation fairness and provide optimization suggestions. Methods: To assess the allocation fairness from a geographical population perspective, the study used the Health Resource Concentration and Entropy Weight TOPSIS methods. Additionally, the study analyzed the allocation fairness from an economic level angle, using the Concentration Curve and Concentration Index. Results: The study found that the downstream area had higher resource allocation fairness than the midstream and upstream areas. The middle reaches had more resources than the upper and lower reaches, based on population concentration. The Entropy Weight TOPSIS method found that Shanghai, Zhejiang, Chongqing, and Jiangsu had the highest comprehensive score index of agglomeration. Furthermore, from 2013 to 2019, the fairness of medical resource distribution gradually improved for different economic levels. Government health expenditure and medical beds were distributed more equitably, while general practitioners had the highest level of unfairness. However, except for medical and health institutions, traditional Chinese medicine institutions, and primary health institutions, other medical resources were mostly distributed to areas with better economic conditions. Conclusion: The study found that the fairness of medical resource allocation in the Yangtze River Economic Belt varied greatly based on geographical population distribution, with inadequate spatial accessibility and service accessibility. Although the fairness of distribution based on economic levels improved over time, medical resources were still concentrated in better economic areas. The study recommends improving regional coordinated development to enhance the fairness of medical resource allocation in the Yangtze River Economic Belt.

Assessing resource allocation based on workload: a data envelopment analysis study on clinical departments in a class a tertiary public hospital in China.

OBJECTIVE: Today, the development mode of public hospitals in China is turning from expansion to efficiency, and the management mode is turning from extensive to refined. This study aims to evaluate the efficiency of clinical departments in a Chinese class A tertiary public hospital (Hospital M) to analyze the allocation of hospital resources among these departments providing a reference for the hospital management. METHODS: The hospitalization data of inpatients from 32 clinical departments of Hospital M in 2021 are extracted from the hospital information system (HIS), and a dataset containing 38,147 inpatients is got using stratified sampling. Considering the non-homogeneity of clinical departments, the 38,147 patients are clustered using the K-means algorithm based on workload-related data labels including inpatient days, intensive care workload index, nursing workload index, and operation workload index, so that the medical resource consumption of inpatients from non-homogeneous clinical departments can be transformed into the homogeneous workload of medical staff. Taking the numbers of doctors, nurses, and beds as input indicators, and the numbers of inpatients assigned to certain clusters as output indicators, an input-oriented BCC model is built named the workload-based DEA model. Meanwhile, a control DEA model with the number of inpatients and medical revenue as output indicators is built, and the outputs of the two models are compared and analyzed. RESULTS: Clustering of 38,147 patients into 3 categories is of better interpretability. 14 departments reach DEA efficient in the workload-based DEA model, 10 reach DEA efficient in the control DEA model, and 8 reach DEA efficient in both models. The workload-based DEA model gives a relatively rational judge on the increase of income brought by scale expansion, and evaluates some special departments like Critical Care Medicine Dept., Geriatrics Dept. and Rehabilitation Medicine Dept. more properly, which better adapts to the functional orientation of public hospitals in China. CONCLUSION: The design of evaluating the efficiency of non-homogeneous clinical departments with the workload as output proposed in this study is feasible, and provides a new idea to quantify professional medical human resources, which is of practical significance for public hospitals to optimize the layout of resources, to provide real-time guidance on manpower grouping strategies, and to estimate the expected output reasonably.

Assessment of national circular economy performance using super-efficiency dual data envelopment analysis and Malmquist productivity index: Case study of 27 European countries.

The global commitment toward carbon neutrality and net zero emissions has substantially pressed the needs for all countries to accelerate the adoption of the circular economy paradigm. Tracking the national progress in terms of circular economy performance would provide valuable insights that could aid the effective design of improvement strategies toward sustainability. The current research proposes the combination of super-efficiency dual Data Envelopment Analysis and Malmquist productivity index to provide a full ranking and measure productivity changes in terms of circular economy of 27 European countries. The assessment involved six circular economy indicators encompassing waste generation per capita, waste intensity of the economy, recycling rate of waste in both overall and specific types of waste, i.e., packaging waste and biowaste, and circular material use rate. Our study indicates about one-half of the European countries were efficient in terms of circularity in 2018, where Netherlands, Germany, Austria, and Belgium were the front runner. The proposed approach suggests the European countries enhance their overall circular economy performance by prioritizing improvements strategies through promoting the recycling of biowaste and the circular material use rate. The MPI results over 2012-2018 indicate that Luxembourg exhibited the highest circularity advancement by 6%. Overall, the European countries have slightly enhanced their progression towards circular economy around 0.2% improvement. This suggests the European countries strengthen their policy and regulatory frameworks in support of the transition towards circular economy and encourage progressive movements in such a collaborative manner with the relevant stakeholders to build the momentum for change.

Fiscal decentralization, local government environmental protection preference, and regional green innovation efficiency: evidence from China.

Green technological innovation has gained in importance in regional policy making towards gaining competitive advantage and sustainable development. This paper used the data envelopment analysis method to calculate regional green innovation efficiency in China, and empirically tested the effect of fiscal decentralization through Tobit model. The regression results show that the local governments with higher fiscal autonomy would prefer to strengthen environmental protection; thus, the regional green innovation efficiency was improved. After the guidance of relevant national development strategies, these effects became more apparent. Our research provided theoretical support and practical guidance for promoting regional led green innovation, improving environmental quality, achieving carbon neutrality, and promoting the high-quality and sustainable development.

Layer-by-layer investigation of the black box: A case of assessing the industrial water-related system in China.

The essence of efficiency measurement is to model and estimate the performance of a complex system in a comparable form, and the key to modeling is to make the model as close to reality as possible. Based on data envelopment analysis (DEA) methods, this research proposes a layer-by-layer investigation framework for the black box. To illustrate the rationality of this logical framework, this paper presents a triple-opened dynamic recycling model with a series-parallel structure that allows us to assess the efficiency of the industrial water-related system in China. We obtain and compare the system efficiency under different scenarios for opening the black box. The results show that: (1) China's efforts to improve the performance of the resource use sub-stage through industrial production technology and management have been effective. (2) The performance of China's industrial water-related system strongly relates to the water supply subunit with a positive linear correlation. (3) The water supply subunit is the main foot-dragger in the system, and the government needs to place particular attention on improving the performance of labor in this subunit.

Assessment of airline industry using a new double-frontier cross-efficiency method based on prospect theory.

Cross-efficiency method (CEM) is a well-known technique based on data envelopment analysis that provides policymakers with a powerful tool to measure the efficiency of decision-making units. However, there are two main gaps in the traditional CEM. First, it neglects the subjective preferences of decision-makers (DMs), and therefore, cannot reflect the importance of self-evaluation compared to peer-evaluations. Second, it ignores the importance of anti-efficient frontier in the overall evaluation. The present study aims to incorporate the prospect theory into the double-frontier CEM to deal with these drawbacks while considering the preferences of DMs towards gains and losses. To address these drawbacks, this paper utilizes an aggregation method based on the prospect theory and consensus degree (APC) to reflect the subjective preferences of DMs. The second issue is also addressed by incorporating APC into the optimistic and pessimistic CEMs. Finally, the double-frontier CEM aggregated using APC (DAPC) is obtained by aggregating two viewpoints. As a real case study, DAPC is applied to evaluate the performance of 17 Iranian airlines based on three inputs and four outputs. The findings demonstrate that both viewpoints are influenced by DMs' preferences. The ranking results achieved for more than half of the airlines based on the two viewpoints are significantly different. The findings confirm that DAPC deals with these differences and leads to more comprehensive ranking results by considering both subjective viewpoints simultaneously. The results also show that to what extent DAPC efficiency for each airline is influenced by each viewpoint. In this regard, the efficiency of IRA is most influenced by the optimistic point of view (80.92%), and on the other hand, the efficiency of IRZ is most influenced by the pessimistic viewpoint (73.45%). KIS is the most efficient airline, followed by PYA. On the other hand, IRA is the least efficient airline, followed by IRC.

Hierarchy performance assessment of industrial solid waste utilization - tracking resource recycling and utilization centers in China.

The massive production and accumulation of industrial solid waste (ISW) have led to environmental pollution and natural resource underutilization. China's efforts to build trial industrial waste resource utilization centers provide strong support for sustainable development. However, these centers and the factors driving ISW utilization have yet to be evaluated. This paper utilizes context-dependent data envelopment analysis models without explicit inputs (DEA-WEI) to evaluate the overall utilization performance of 48 industrial waste resource utilization centers in China from 2018 to 2020. It also builds a Tobit model to assess which indicators and waste types affect overall ISW utilization. The results show overall ISW utilization performance of centers in the sample has improved, with the average value falling from 1.7193 in 2018 to 1.5624 in 2020. However, there are clear regional performance gaps, with East China having the highest utilization performance (1.3113) while the Southwest had the lowest (2.2958). Finally, this paper proposes measures to improve the overall utilization of industrial waste resources based on an analysis of the factors driving solid waste utilization.

Resource Allocation Efficiency of Urban Medical and Health Financial Expenditure Under the Background of Employees' Health.

Introduction: The study proposes a method based on difference-in-differences (DID) to improve the resource allocation efficiency of medical and health financial expenditure to better guarantee the health level of enterprise employees. The DEA method is utilized to measure the comprehensive technology, pure technology, and scale as the resource allocation efficiency values of urban medical and health financial expenditure. Methods: The proposed method includes the use of DEA to measure the resource allocation efficiency values of urban medical and health financial expenditure. The benchmark regression model and DID model are used to analyze the impact effect, robustness, and parallel trend of the policy. Results: The study shows that the proposed method effectively evaluates and analyzes the impact of medical comprehensive reform on the resource allocation efficiency of urban medical and health financial expenditure. The comprehensive medical reform can improve the comprehensive efficiency and scale efficiency of urban medical and health financial expenditure, leading to improved resource allocation efficiency of urban employees' medical and health financial expenditure. The results also indicate a significant positive effect on the time trend, which can have a long-term impact and effectiveness. Discussion: The proposed method can provide useful insights into the resource allocation efficiency of medical and health financial expenditure, which can help improve the health level of enterprise employees. The study suggests that comprehensive medical reform can be an effective way to improve resource allocation efficiency and guarantee the health of employees in urban areas. Further research can be conducted to evaluate the impact of medical reform on other aspects of health care, such as quality and accessibility.

From the Perspectives of Pollution Governance and Public Health: A Research of China's Fiscal Expenditure on Energy Conservation and Environmental Protection.

Improving the scale and effectiveness of China's energy conservation and environmental protection fiscal expenditure is crucial to enhancing the capacity of ecological and environmental governance of China, considering the dual perspectives of pollution governance and public health. This article first explains the mechanism by which national energy conservation and environmental protection fiscal expenditure can improve pollution control and promote public health. Secondly, this article scrutinizes the current status and limitations of China's fiscal expenditure, highlighting the contribution of fiscal expenditure in the construction of ecological civilization from the standpoints of environmental governance and public health. Additionally, this study empirically uses DEA to measure the efficiency of the government's fiscal expenditure. Conclusions found that: First, environmental protection fiscal expenditure is mainly focused on technological transformation and pollution control, while relatively little is spent on public health protection. Second, the efficiency of environmental protection fiscal funds is relatively low. These suggestions aim to optimize the positive impact of energy conservation and environmental protection fiscal expenditure for improving pollution governance and promoting public health.