The county-level medical community has helped improve the capacity of primary care institutions and the quality of primary care services, and promoted the operational efficiency of primary care institutions through various "strengthening primary healthcare" measures.

To evaluate the efficiency of service delivery and the total factor productivity (TFP) of member township hospitals in county-level medical communities constructed in typical national pilot areas in China.

We collected the annual monitoring data and annual health statistics reports during 2018 to 2019 of county-level medical communities (involving 143 member township hospitals) in eight counties (cities) of four regions in central and western China (Anhui Province, Jiangxi Province, Guangxi Zhuang Autonomous Region and Xinjiang Uygur Autonomous Region). We used data envelopment analysis (DEA) and Malmquist inde (MI) to analyze the change in TFP of the township health hospitals before and after the pilot construction of county medical communities.

Taking the county as the decision-making unit, compared with 2018, the technical efficiency change, technological progress change, pure technical efficiency change, scale efficiency change and TFP change of township hospitals in the typical areas in 2019 were 0.977, 1.037, 0.995, 0.982 and 1.013, respectively, and the TFP of township hospitals increased by 1.3% on average. Taking township health centers as the decision-making unit, compared with 2018, the TFP of township hospitals increased by 4.5% in 2019. Specifically, the TFP of township hospitals increased by 47.83% in Anhui's A1 county, 66.67% in Anhui's A2 county, 54.84% in Jiangxi's B1 county, 59.26% in Jiangxi's B2 county, 70.00% in Guangxi's C1 county, 90.91% in Guangxi's C2 county, 78.57% in Xinjiang's D1 county, and 55.56% in Xinjiang's D2 county.

The "strengthening primary health care" measures implemented during the reform of county-level medical communities have played a role in elevating the efficiency of township hospitals. The continuous improvement in the efficiency of township hospitals relies on both the leading hospital providing targeted assistance and mobilizing the productivities and enthusiasm of the township hospitals.

县域医共体通过各种"强基层"措施助力基层医疗服务能力和质量提升，并推动基层医疗卫生机构运行效率提升。

分析国家县域医共体建设试点典型地区乡镇卫生院工作效率和全要素生产效率变动情况。

收集中西部地区4个省份（安徽省、江西省、广西壮族自治区、新疆维吾尔自治区）8个县（市）143个乡镇卫生院2018—2019年县域医共体监测数据和卫生健康统计年报数据，采用数据包络分析（DEA）Malmquist指数法分析试点前后乡镇卫生院全要素生产率变动情况。

以县（市）为决策单元，与2018年相比，2019年典型地区乡镇卫生院技术效率、技术进步、纯技术效率、规模效率和全要素生产率指数分别为0.977、1.037、0.995、0.982和1.013，乡镇卫生院全要素生产效率平均提高了1.3%。以乡镇卫生院为决策单元，与2018年相比，2019年典型地区乡镇卫生院全要素生产率提高了4.5%，安徽省A1县、安徽省A2县、江西省B1市、江西省B2县、广西壮族自治区C1县、广西壮族自治区C2县、新疆维吾尔自治区D1县和新疆维吾尔自治区D2县分别有47.83%、66.67%、54.84%、59.26%、70.00%、90.91%、78.57%和55.56%的乡镇卫生院全要素生产率提升。

县域医共体改革"强基层"措施对乡镇卫生院效率提升有推动作用，持续提升乡镇卫生院效率不仅需要牵头医院提供有针对性的帮扶，更需要调动乡镇卫生院内部生动力和积极性。