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Objectives: Evaluating the efficiency of health resource allocations is critical to improving China's rural three-level health service network., Study Design: This was a prospective panel data study., Methods: Based on panel data of the medical and health resources of 31 provinces within rural China, collected from 2003 to 2020, this study uses a three-stage Data Envelopment Analysis-Malmquist index to analyze the evolution of efficiency and productivity., Results: The efficiency and productivity of county and county-level medical and health institutions rank highest, followed by township hospitals, whereas village clinics are shown to be in great need of improvement. A decline in technical advancement appears as a crucial factor exacerbating loss of factor productivity., Conclusions: Policy makers should further optimize the efficiency of medical resource allocation and promote the coordinated development of rural health in China., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)