Dynamic Linkages Between Digital Health and Healthcare Value Chains: Evidence From a 3-Stage Network DEA Model

Healthcare Value Chains (HVCs) describe the full production flow from resource input to service delivery. However, existing literature lacks a clear analytical mechanism to evaluate how Digital Health (DH) transforms these stages. This gap may lead to the misconception that any DH investment automatically enhances efficiency, overlooking the strategic pathways through which DH affects performance. To address this issue, this study proposes a 3-stage production process evaluation framework encompassing Managerial Efficiency, Technical Efficiency and Economic Efficiency to systematically assess the impact of DH on HVCs. Using longitudinal data from 38 Taiwanese hospitals between 2015 and 2021, a non-oriented 3-stage Slack-Based Measure Data Envelopment Analysis (SBM-DEA) model and a Benchmarking Matrix were employed to capture efficiency variations and identify best-performing institutions. The analysis reveals that alliance hospitals with fragmented DH systems underperform, often lagging behind stand-alone hospitals due to insufficient system integration. Conversely, specialised hospitals demonstrate superior Managerial and Technical Efficiency, reflecting the advantages of operational focus and streamlined workflows. The Benchmarking Matrix effectively identifies optimal reference groups, providing actionable insights for alliance hospitals to enhance coordination and functional alignment. This study advances HVC theory by establishing a structured analytical model that elucidates the multi-dimensional effects of DH on healthcare performance. The proposed framework not only clarifies the mechanisms linking DH adoption to efficiency improvement but also offers strategic guidance for enhancing resource utilisation and value creation within healthcare systems.