ObjectiveSocial　healthcare　expenditure　is　a　crucial　component　of　global　healthcare　expenditure.　Assessing　the　relative　efficiency,　dynamic　changes,　and　influencing　factors　of　province-level　social　investment　in　China　would　facilitate　the　continued　and　stable　development　of　healthcare　services.MethodsBased　on　the　Malmquist　Data　Envelopment　Analysis　and　Tobit　regression　model,　this　study　pursued　panel　data　from　2012　to　2020　for　a　set　of　31　provinces　and　cities　in　China　to　estimate　the　efficiency　of　social　health　expenditure　and　explore　the　factors　that　influence　the　efficiency.ResultsAll　provinces　experience　a　decline　in　the　total　factor　productivity　change　index　in　the　period　2012-2020.　The　average　value　is　0.917,　which　implies　a　deterioration　of　8.3%　per　year.　Most　provinces　show　increased　efficiency　change　but　experience　declines　in　technical　progress,　except　Sichuan,　Guangdong,　and　Shandong.　Although　efficiency　change　shows　an　upward　trend,　the　positive　impact　is　offset　by　technological　regression,　leading　to　a　decline　in　overall　productivity.　Population　density　and　urbanization　level　are　found　to　be　associated　with　expenditure　efficiency　in　opposite　directions.　Higher　levels　of　urbanization　are　associated　with　higher　efficiency　scores　and　the　opposite　impact　is　observed　for　population　density.ConclusionsThis　study　shows　that　there　is　still　much　room　for　improving　the　efficiency　of　province-level　social　health　expenditure　and　reinforcing　the　imperatives　to　increase　investment　in　technological　progress　in　health　to　foster　the　efficiency　of　social　healthcare　expenditure.　Policy　reforms　and　adjustments　tailored　to　the　specific　conditions　of　different　regions　may　be　necessary　for　better　alignment.