Analysis On The Operation Efficiency And Influencing Factors Of Township Hospitals In Hubei Province

ObjectiveThe functions of township hospitals have been transformed from basic medical care to basic medical care and basic public health services since a new round of deepening reform of the medical and health system in 2009.The functions of medical and prevention and health care have been gradually implemented.The state has greatly increased the infrastructure and service capabilities of township hospitals through a large amount of financial investment with deepening the reform of the medical and health system after the "Eleventh Five-Year" and "Twelfth Five-Year Plan".The new service framework model and functional connotation have basically taken shape.The efficiency of town hospitals has become a hot topic of common concern of academia and government.In this study,we introduced the three-stage DEA and Bootstrap-DEA models to evaluate the vertical efficiency of rural hospitals in Hubei Province from 2014 to 2016 and the operational efficiency of rural counties(cities and districts)over the same period in county-level cities.To build a model of efficiency evaluation suitable for the functional orientation of township hospitals after the new medical reform combined with the environmental impact variables and to explore the relevant factors that affect the operation efficiency of township hospitals so as to enhance the efficiency and improve the fairness of the reform and development of township hospitals in the 13th Five-Rejuvenation "strategic plan to better solve the rural basic medical and public services in the development of unbalanced inadequacy issues and provide theoretical support and practical guidance.Method1.Through the professional literature review team of China National Knowledge Infrastructure,Wan fang Database,PubMed and other domestic and foreign medical institutions related databases,etc.to search the article on the efficiency evaluation of township hospitals between 2000-2016.After organizing the article,we establish a indicators pool,and finally decided to select the indicators after being discussed by the experts.Among them,input indicators include:number of health technicians,number of health technicians,number of beds available,number of equipment above RMB0,000 and area of commercial buildings;output indicators:divided into two basic outputs of basic medical treatment and basic public health,Number of emergency patients,number of discharged patients and standardized electronic health records,number of children aged 0-6 health management,number of health management for aged 65 and above,number of standardized management of patients aged 35 and over with essential hypertension,age 35 and Type Ⅱ diabetes patients regulate the number of management.2.Questionnaire method.The township hospitals in 61 counties and cities of 17 cities or states of Hubei Province(including 4 straight tube cities and one forest area)were selected as the research objects.The data of the data come from the Hubei Province Health and Family Planning Commission to survey the basic information of township hospitals in 2016.The data of environmental information are from the Statistical Yearbook of Hubei Province in 2014-2016 and the Briefing of Health and Family Planning Development in Hubei Province in 2014-2016.3.Expert review confirmed conclusions.17 health management family planning commissions of cities and counties in Hubei Province were invited to take charge of the management experts of grass-roots health work in the region for a long time.In the research group,they repeatedly stated the efficiency evaluation concept of county-based units and based on realistic functions.Based on personal experience,the recent subjective evaluation of the operation efficiency of the township hospitals in the counties(cities)and districts was conducted,and the results were compared with those of the present study to verify the validity and reliability of the results.4.statistical methods.After data proofing into Exce;2010,then we sort out the data and lock the database.Efficiency was analyzing by using DEAP 2.1,front4.1,and R 3.2.1 software respectively.The data were processed by three-stage DEA,and the interference factors were excluded.Then the processed data were imported into the Bootstrap-DEA model for secondary correction.The true efficiency of Hubei township hospitals was calculated and the influencing factors of efficiency were analyzed.Results1.Bootstrap-DEA model constructionThis topic based on the literature and expert law to form a framework and model indicators.Indicators in the framework of the input indicators:the number of health technicians,the actual number of beds,more than ten thousand yuan of equipment,business space area;output indicators:divided into two basic medical and basic public health output,including emergency room The number of discharged patients and the number of standardized electronic health records,the number of children aged 0-6 health management,the number of health management for aged 65 and above,the number of patients with hypertension and age 35 and older norms of management,35 and older Ⅱ Type of diabetes patients regulate the number of management.After the Bootstrap-DEA model was corrected,the efficiency values of all township hospitals were less than 1,less than the efficiency values before rectification.2.Research results and expert review consistency test.According to the Bootstrap-DEA model,this study calculated the total operating efficiency of township hospitals in 61 counties(cities,districts)in Hubei Province and sorted them within the city(state)according to their cities(prefectures).On this basis,the chief health chiefs of these 11 city(state)health and family planning commissions are invited to take charge of the health work in rural areas in the region based on their long-term experience in the rural health work in this region and counties(cities,towns and villages)The current overall efficiency of hospitals for subjective evaluation ranking.Comparing the two sort results,the overall operating efficiency values of 47 township hospitals in 61 counties(cities and districts)are in line with the overall compliance rate of 77.05%,indicating that the conclusions of this study are consistent with the overall operation of township hospitals The situation is basically consistent.3.The efficiency of township hospitals in Hubei Province is low and the overall efficiency is in a rising trend from 2014 to 2016.The efficiencies of township hospitals in Hubei Province during 2014-2016 were respectively(0.559、0.625、0.773).The corrected efficiency of Bootstrap-DEA model was lower than that of the traditional study and the overall efficiency was in a rising trend.According to the distribution standard of efficiency values,only 16(26.2%)township hospitals were more than 0.7(39 less than 0.6)in 2014,20(32.8%)township hospitals were more than 0.7(23 were less than 0.6)in 2015 and the efficiency was poor.In 2016,the efficiency of township hospitals in 47 counties(77.1%)was above 0.7 and the efficiency was above the standard.4.The total factor productivity index of township hospitals across the province from 2014 to 2015 and from 2015 to 2016 were(0.966 and 0.965).The total factor productivity was less than 1 and total factor productivity of township hospitals was reduced.The total factor productivity index of township hospitals across the province between 2014-2015 and 2015-2016 was respectively 0.966 and 0.965.The technical efficiency change indices were 1.115 and 1.169,with technical advances of 0.884 and 0.837.Total factor productivity is less than 1,and total factor productivity reduction is mainly caused by technological change.5.The efficiency of township hospitals in Hubei Province is affected by factors such as per capita GDP,population density,compensation ratio within the new rural cooperative medical policy.The impact of GDP per capita on the input slack during 2014-2016 was positive(for example,the slack for health technicians was respectively 0.197,0.077,0.124),and the population densities and geography reflecting the amount of slack(For example,-0.09,-0.09,-0.02 for the saty of technicians),the in-hospital compensation ratio within the scope of the new policy of reaction policy has a negative impact on the input slack(for example,health technology Staff slack were respectively-3.608,-25.617,-11.158).Conclusions1.The efficiency value based on the bootstrap-DEA model is lower than the efficiency value of the traditional DEA model,the accuracy and accuracy of the model is higher.In the traditional efficiency study,more township hospitals have an efficiency value of 1,indicating that these township hospitals are performing well and do not need to make any improvements to maintain the original efficiency,which deviates from the actual situation.After removing the influence of environmental variables and correcting by Bootstrap-DEA,the efficiency values of all township hospitals were less than 1,which were less than their pre-corrective efficiency values.The accuracy and accuracy of the efficiency were higher,which was more in line with the actual situation.Therefore,the efficiency value based on the bootstrap-DEA model is lower than that of the traditional DEA model,and the accuracy and accuracy of the model are higher.2.In 2014-2016,the operating efficiencies of township hospitals in Hubei province were respectively poor,bad and qualified.The efficiency was in an ascending stage and the utilization rate of resources had more room for improvement.According to the distribution standard of efficiency value,excellent(0.9-1),good(0.8-0.9),qualified(0.7-0.8),poor(0.6-0.7),poor(0.6 less).According to the results of the study,the comprehensive(technical)efficiencies of township hospitals in Hubei province between 2014 and 2016 were 0.559,0.625 and 0.773,respectively.Their operating efficiencies were poor,poor and qualified respectively,and their efficiency was on the rise.Great room for improvement.3.The total factor productivity is declining,and technological progress is the main reason for decline in total factor productivity.According to the results of the study,total factor productivity of township hospitals in Hubei Province decreased,technological efficiency rose and technological progress decreased.According to the decomposition of total factor productivity,technological progress was the main reason for the decline in total factor productivity.Emphasis should be placed on improving medical technologies and Talent quality.4.The efficiency of township hospitals in Hubei Province is affected by factors such as per capita GDP,population density,compensation ratio within the new rural cooperative medical policy.The impact of GDP per capita on input slack was positive at a level of 1%.In regions where the level of economic development is better,the greater the excess investment in the system of township health centers,the lower the efficiency is.The effect of population density on input slack is negative,which is significant at the level of 1%.The greater the population density,the smaller the investment in the health care system,the more conducive to its efficiency.The influence of the compensation ratio on the slack in investment in the policy of agricultural cooperation and development was negative,and both passed the significance test of 1%.The improvement of the compensation ratio within the NCMS policy is conducive to the improvement of efficiency.Suggestions:In the "Thirteen Five" central government is no longer on the township hospitals infrastructure investment in the context of the development of township hospitals can not blindly pursue the expansion of scale and equipment updates,the development of ideas should focus on the overall operating efficiency On the upgrade.It is necessary to deepen the reform of institutional mechanisms and improve the system design of personnel,distribution and performance appraisal to fully stimulate the vitality of the internal operation of township hospitals;to rationally allocate health resources and enhance the construction of informatization and to enhance the efficiency through information technology;to strengthen the building of a contingent of qualified personnel and attract and Keep appropriate talents and improve the professional level of the health technicians;optimize the support policies of drug supply,medical insurance reimbursement,price setting and so on,and increase the proportion of grass-root diagnosis;also carry out the third-party evaluation of the operation efficiency of township hospitals,Constantly adjust the management tools to promote the operation efficiency of township hospitals continuously improve.