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In order to strengthen the construction of China's health industry and improve the health of the people, based on the data of 31 provinces and cities in China from 2009 to 2019, the improved EBM model is used to measure the health production efficiency of each region, and Moran index is used to study the Spatio-temporal variation of health production efficiency of each province. Finally, the spatial econometric model is applied to study the influencing factors of the Spatio-temporal variation of health production efficiency. The results show that generally speaking, the average efficiency of 31 provinces and cities is above 0.7, and the average efficiency of some regions is above 1. From the perspective of time variation, the average efficiency value in the eastern region and the middle region increases from 0.816 to 0.882 and from 0.851 to 0.861, respectively. However, the average efficiency value in the western region and northeast region decreases from 0.861 to 0.83 and from 0.864 to 0.805, respectively. From the perspective of spatial distribution, HH agglomeration and LL agglomeration exist in most regions. By comparing Moran scatter plots in 2009 and 2019, it is found that the quadrants of most regions remain unchanged, and LL agglomeration is the main agglomeration type in local space. There is a significant spatial dependence among different regions. From the perspective of spatial empirical results,  Pgdp, Med , and  Pd  have a positive effect on health production efficiency. The direct effect and indirect effect of  Pgdp, Med , and  Gov  all pass the significance test of 1%, indicating that there are spatial spillover effects of the three indicators. Each region should reasonably deal with the spillover effect of surrounding regions, vigorously develop economic activities, carry out cooperation with surrounding regions and apply demonstration effect to accelerate the development of overall health production.

frontiers in public health

Spatio-Temporal Variation of Health Production Efficiency Considering Environmental Pollution in China Based on Modified EBM and Spatial Econometric Model