Evaluation Of Medical Service Efficiency Of County-level Public Hospitals And Study On The Mechanism Of Key Influencing Factors

【Purpose】This study intends to construct a medical service efficiency evaluation model for county-level public general hospitals in Shanxi Province and evaluate the efficiency of the sample hospitals.The system dynamics model is used to analyze the mechanism of the key influencing factors of efficiency,and the countermeasures to improve the medical service efficiency of county-level public general hospitals in Shanxi Province are put forward.【Methods】(1)Literature analysis.The literature analysis method is used to summarize the relevant theories and empirical research results of the research on the influencing factors of hospital efficiency at home and abroad,so as to provide reference and basis for the construction of the evaluation index system of medical service efficiency and the index system of key influencing factors of medical service efficiency.(2)Secondary data collection.Basic information of 77 county-level public general hospitals in Shanxi Province from 2013 to2018 was collected,including human resource data: number of staff,number of doctors,number of nurses,number of other health personnel,number of managers,salary distribution plan,etc.Hospital scale data: actual number of open beds,total value of fixed assets,total value of medical equipment,etc.;Outpatient and inpatient indicators: outpatient number,emergency number,discharge number,operation number,etc.;Business situation:total hospital income,outpatient income,inpatient income,total hospital expenditure,outpatient expenditure,inpatient expenditure,etc.,and health statistics report 1-1,health statistics report 1-8 and other related health statistics annual report and monthly report.Indicators of the external environment of the sample hospital were collected,including per capita GDP,disposable income of urban and rural residents,number of urban and rural residents,financial subsidies of the county,medical insurance policies of the county where the sample hospital is located,etc.(3)Expert consultation.Fourteen experts were selected from health administration departments,universities,hospitals and other departments,and expert opinions were consulted on the evaluation indexes of the evaluation model of the medical service efficiency of county-level public general hospitals in Shanxi Province through interviews,so as to construct the evaluation index system of the medical service efficiency applicable to county-level public general hospitals in Shanxi Province.(4)Insider in-depth interview.Interview object source mainly includes: the hospital administrators,the relevant person in charge of health management experts,Wei Jian bureau and has rich research experience in hospital performance evaluation experts for a total of 40,will influence the efficiency of medical service depth interview,and the key influencing factors of the preliminary construction of medical service efficiency index system of key influencing factors.(5)Data envelope analysis.By analyzing the internal and external environment of the sample hospitals and the areas where they are located,combining with the efficiency evaluation index system obtained by previous literature analysis and expert consultation,a data envelopment analysis model that meets the actual needs is constructed to evaluate the efficiency of the sample hospitals.(6)Grounded theory analysis.Based on the method of combining the grounded theory with contingency theory,the paper analyzes the data of the insider in-depth interview and the preliminarily constructed index system of influencing factors,so as to identify the key factors affecting the medical service efficiency of county-level public general hospitals in Shanxi Province.(7)System dynamics method.The system dynamics modeling method was used to draw the flow diagram of the action mechanism of the key factors affecting the medical service efficiency of county-level public general hospitals in Shanxi Province,and the equation of the total system was set up to complete the construction of the system dynamics model.The system dynamics model is used to analyze the mechanism of the key factors affecting the efficiency of medical service.【Results】1.Evaluation of medical service efficiency and construction of theoretical models of influencing factors(1)In the aspect of efficiency evaluation model construction,this study found that the sample hospitals had significant differences in internal and external environment.In addition,based on the research involving the expected output as well as to solve the traditional DEA model to measure the efficiency value for a maximum of 1 of the problem,this study constructed the frontier SBM of common Undesirable super efficiency comprehensive DEA evaluation model on the county level public comprehensive hospitals of medical service efficiency evaluation.(2)In the study of the mechanism of the key influencing factors of efficiency,this study used the method of system dynamics modeling to draw the system flow diagram for each subsystem of the key influencing factors of efficiency,and set up the system dynamic equation of the subsystem.Based on the flow diagram of 6 subsystems and the equation of system dynamics,this study constructs the total system dynamics flow diagram and the equation of total system dynamics of 6 subsystems,and completes the theoretical model construction of the mechanism of the influencing factors.2.Calculation of Medical Service Efficiency of County-level Public General Hospitals in Shanxi Province(1)On the whole,the county-level public general hospitals in Shanxi Province from2013 to 2018 have a centrally distributed medical service efficiency value(TEm)between0.50-0.75 points,and the distribution of medical service efficiency value and its pure technical efficiency value The distribution of(PTEm)is consistent,while the scale effect value(SEm)is mainly distributed between 0.75-1.00.(2)In terms of regions,from 2013 to 2018,the average medical service efficiency of hospitals in the central region was 0.66 points,0.62 points in the south,and 0.51 points in the north.Among them,the technical gap rate(tgr)in the northern region was only 0.65,and the central region It is 0.86 in the south and 0.96 in the south,suggesting that hospitals in the northern region only achieve 65% of the optimal level of technology in county-level public general hospitals in the province,and the technology gap between the northern region and the central and southern regions is more obvious.(3)According to the results of convergence analysis of medical service efficiency,there is no obvious gross convergence of the medical service efficiency of hospitals in the three regions,but there is obvious gross convergence of the medical service efficiency of hospitals in the three regions(P < 0.001)and conditional gross convergence(P < 0.001).3.Identification of key influencing factors of medical service efficiency This study by grounded theory and contingency theory to identify the Shanxi Province county level public comprehensive hospital medical service efficiency is the key influence factors,including open coding,a total of 17 categories,spindle type code,a total of six main categories,respectively,environmental factors,economic factors,technical ability,human resources,strategies,factors,scale factor.The research results of selective coding suggest that each factor has a dynamic complementary characteristic,that is,changing one factor will lead to corresponding changes in other factors.4.Key mechanisms and empirical research In the subsystem of environmental factors,residents’ economic status will have an impact on residents’ frequency of seeing a doctor.Such a gap may affect the medical service efficiency of regional hospitals with a large proportion of rural residents.In addition,medical services in densely populated areas are less efficient.In the subsystem of economic factors,the income and expenditure of the county-level public general hospitals in Shanxi Province will basically offset each other in 2023,and with the development of time,the county-level public general hospitals in Shanxi Province will face the situation that the income cannot cover the expenditure.In addition,the income and expenditure of the hospital will have an impact on the hospital’s material procurement and performance pay.If the hospital’s income and expenditure cannot be changed,it will put great pressure on the operation of the hospital and eventually affect the development speed of the hospital.In terms of the effect of intervention targets,the medical service efficiency of hospitals in the southern region is expected to reach 0.74 in 2023,which is basically the same as that of hospitals in the central region,which is 0.78.From 2019-2023,the medical service efficiency of hospitals in the northern region will gradually increase steadily.It is estimated that by 2023,the medical service efficiency of hospitals in the northern region will be 0.67 points.From 2019,the medical service efficiency of hospitals in different regions will gradually stabilize,avoiding the fluctuation state of medical service efficiency.Moreover,from 2022 to 2023,the medical service efficiency of hospitals in northern regions will grow rapidly.Although there is still a gap between hospitals in northern regions and those in other regions,the gap has gradually narrowed.【Conclusions】1.The efficiency evaluation indicators of county-level public general hospitals need to consider not only the quantitative indicators of output,but also the medical quality indicators;in the selection of the efficiency evaluation model,it is necessary to pay attention to the heterogeneity of the unit being evaluated and consider adopting Common frontier models to evaluate the efficiency of their medical services.2.The main reason for the low efficiency of county-level public general hospitals in Shanxi Province is the low pure technical efficiency.The medical service efficiency growth rate of hospitals with low initial efficiency will be higher than that of hospitals with high initial efficiency.The medical service efficiency of all sample hospitals Will gradually approach its own steady state level over time.3.The key influencing factors of the medical service efficiency of county-level public general hospitals in Shanxi Province are dynamically complementary,that is,changing one factor will cause corresponding changes in other factors.4.The best way to improve the efficiency of medical services in county-level public general hospitals in Shanxi Province is to first clarify the interaction mechanism between the influencing factors,screen the important exogenous variables that are artificially easy to change in the system,and conduct comprehensive interventions.5.In order to improve the medical service efficiency of county-level public general hospitals in Shanxi Province,the following measures should be taken: 1.Reasonable allocation of health resources to ensure the balanced development of regional health.2.Strengthen the training of talents at county-level hospitals and increase the potential of existing talents.3.Prevent hospital financial risks and strengthen hospital financial management system.4.Promote reform of medical insurance payment methods and guide the transformation of medical behavior.5.Ensure the quality of medical services and improve the efficiency of medical services.【Innovation and Limitation】1.Research innovation:(1)Construction of comprehensive dea evaluation model of medical service efficiency in county-level public general hospitals This study introduced the first comprehensive DEA model using the common frontier model combined with SBM-Undesirable super efficiency in the field of medical and health.In the current research on the evaluation of medical service efficiency,the concept of the common frontier model has not been introduced.The common frontier model can effectively avoid internal factors.The heterogeneity of the evaluated hospitals caused by the difference in external environment and makes the measurement results more accurate.What’s more important is that previous research can only estimate the technical capabilities of each hospital by measuring the pure technical efficiency of the hospital.The DEA model in the study not only measures the pure technical efficiency of each hospital,but also analyzes the degree of achieving optimal medical technology in each hospital and each region by measuring the technical gap ratio(TGR),which has a significant impact on the government’s accurate sinking of high-quality health resources.Significance.(2)Study on the mechanism of key influencing factors of medical service efficiency By using the method of system dynamics modeling,this study first explores the factors affecting medical service efficiency between the mechanism of action,this study by building the key factors affecting the system dynamics model,shows the factors that affect the logic behind the relationship,and by changing the corresponding targets,in Shanxi Province at the county level public comprehensive hospital problem may happen in the future for early warning,and possible problems puts forward relevant policy Suggestions.(3)Applied research on countermeasures for improving medical service efficiency The focus of this study on the influencing factors of medical service efficiency is not the factors that have the greatest impact on the efficiency of medical services,but from the perspective of the key influencing factor mechanism,focusing on the exogenous artificial adjustment of the influencing factor mechanism flow chart Variables.By combining multiple exogenous human-adjustable variables,a scheme for improving the medical service efficiency of county-level public general hospitals in Shanxi Province is proposed,which is more operable for practice.2.Limitation The sample size of this study is 77 county-level public general hospitals in Shanxi Province.The sample size is relatively small,and the research’s scalability is limited.The index system for the evaluation of medical service efficiency is not yet perfect.Due to limited conditions,no cases have been applied.Relevant technologies such as the combination index cmi adjust the input-output indicators.Finally,due to the lack of relevant research literature,no further research has been conducted on the subsystems of each influencing factor in this study.