Abstract: Objective:To analyze the relative efficiency and total factor productivity changes and influencing factors of county-level public hospitals in Hubei province from 2019 to 2021, so as to provide reference for the improvement of county-level public hospital,service capabilities.Methods:The development of input and output indicators of 59 sample hospitals in Hubei Province from 2019 to 2021 was described.The static efficiency values of hospitals in different years and counties were measured by Bootstrap-DEA method with repeated sampling correction, and the dynamic efficiency changes were analyzed by Bootstrap-Malmquist-DEA index model.The Tobit regression model was used to analyze the influencing factors of the comprehensive technical efficiency value.Results:From 2019 to 2021, the comprehensive technical efficiency values of the sample hospitals were 0.8243, 0.6266 and 0.7139, respectively.During the three years, the total factor productivity of 59 hospitals decreased by 6.4%, among which the technical efficiency and technical progress decreased by 1.9% and 4.4%, respectively.The comprehensive technical efficiency was positively correlated with the number of bed turnover and medical income, and negatively correlated with the average hospitalization expenses.Conclusion:The relative efficiency and total factor productivity of county-level hospitals in Hubei Province decrease first and then increase, and the development of county-level hospitals is unbalanced.Therefore, it is necessary to further optimize the resources allocation and factor input, strengthen the management and improve the technical efficiency and technological progress to realize the efficient and sustainable development of county-level public hospitals in Hubei Province.