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Volume 13
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10.3390/systems13080675
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

The Impact of Rural Energy Poverty on Primary Health Services Efficiency: The Case of China

by
Xiangdong Sun
1,
Xinyi Zheng
1,
Shulei Li
2,
Jinhao Zhang
3 and
Hongxu Shi
1,*
1
School of Economics and Management, Beijing University of Chemical Technology, Beijing 100029, China
2
School of Management, Capital Normal University, Beijing 100048, China
3
School of Agricultural Economics and Rural Development, Renmin University of China, Beijing 100872, China
*
Author to whom correspondence should be addressed.
Systems 2025, 13(8), 675; https://doi.org/10.3390/systems13080675
Submission received: 23 June 2025 / Revised: 27 July 2025 / Accepted: 7 August 2025 / Published: 8 August 2025
(This article belongs to the Section Systems Practice in Social Science)
Versions Notes

Abstract

Primary healthcare is vital to achieving universal health coverage, as emphasized by Sustainable Development Goal 3 (SDG 3). However, energy poverty remains a critical yet overlooked barrier to the efficiency of primary healthcare services in rural China—precisely the focus of this study. It employs panel regression models and threshold analysis methods using data from 31 Chinese provinces for the period 2014–2021, sourced from the EPSDATA data platform. Robustness checks are performed using bootstrap procedures, accompanied by detailed mechanism analyses. The empirical results demonstrate that rural energy poverty significantly reduces primary healthcare efficiency, particularly in provinces initially characterized by lower healthcare performance. The mechanism analysis identifies four critical transmission channels—off-farm employment, internet intensity, food safety, and health education—through which rural energy poverty undermines healthcare outcomes. Furthermore, threshold regressions uncover nonlinear relationships, indicating that the negative impacts of rural energy poverty intensify when household medical expenditures exceed 10.9%, the old-age dependency ratio surpasses 22.61%, and the rural energy poverty index is higher than 0.641. In theoretical terms, this study identifies rural energy poverty as a critical determinant of primary healthcare efficiency, thereby addressing an important gap in the existing literature. At the policy level, the findings emphasize the necessity for integrated measures targeting both rural energy poverty and primary healthcare inefficiencies to achieve SDG 3 and sustainably promote equitable, high-quality healthcare access in rural China.
Keywords: sustainability; public health; DEA; GMM sustainability; public health; DEA; GMM

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MDPI and ACS Style

Sun, X.; Zheng, X.; Li, S.; Zhang, J.; Shi, H. The Impact of Rural Energy Poverty on Primary Health Services Efficiency: The Case of China. Systems 2025, 13, 675. https://doi.org/10.3390/systems13080675

AMA Style

Sun X, Zheng X, Li S, Zhang J, Shi H. The Impact of Rural Energy Poverty on Primary Health Services Efficiency: The Case of China. Systems. 2025; 13(8):675. https://doi.org/10.3390/systems13080675

Chicago/Turabian Style

Sun, Xiangdong, Xinyi Zheng, Shulei Li, Jinhao Zhang, and Hongxu Shi. 2025. "The Impact of Rural Energy Poverty on Primary Health Services Efficiency: The Case of China" Systems 13, no. 8: 675. https://doi.org/10.3390/systems13080675

APA Style

Sun, X., Zheng, X., Li, S., Zhang, J., & Shi, H. (2025). The Impact of Rural Energy Poverty on Primary Health Services Efficiency: The Case of China. Systems, 13(8), 675. https://doi.org/10.3390/systems13080675

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