| BackgroundIn the process of China’s economic transformation,the lack of government regulation and excessive emphasis on gaining revenue and pursuing benefit maximization have led to serious imbalance in medical resource allocation,unreasonable price in medical service,excessive medical treatment and so on.How to make public hospitals return to public welfare and make the people have the basic rights of medical treatment and health is a necessary premise and foundation for the healthy development of medical health cause in China.Whether the tertiary public hospitals can be public welfare-oriented and make a scientific,objective and fair assessment of their comprehensive performance directly influence its development and regulation effectiveness of health administrative department for public hospital.Therefore,it is neccessary to establish a scientific,practical,simple and feasible evaluation system that can evluates to what degree the public hospitals are public welfare oriented in a specific and measurable,manner.ObjectiveUsing the existing theory and method about the performance evaluation of public hospitals in western countries,we developed tertiary public hospital performance evaluation index system through the Delphi expert consultation method(Delphi)and field investigation and we tested the reliability and validity of index system.This study put Guangxi tertiary comprehensive public hospitals as the evaluation unit and TOPSIS and RSR method was used to construct public hospital comprehensive evaluation model.A comprehensive evaluation of Guangxi tertiary public hospital economic benefit,social benefit and comprehensive benefit was used through this model.And in the last we put forward improving performance of Guangxi tertiary comprehensive public hospital policy Suggestions.Methods1.Research objectThe research object include all 24 city level tertiary public hospitals in Guangxi Province.2.Research content(1)the building of performance evaluation index system for tertiary public hospital based on commonwealBy means of literature study and Delphi expert consultation,we chose the key performance evaluation index and synthesize balanced scorecard and performance prism model and build a performance evaluation index system for tertiary public hospitals in Guangxi by using the Delphi method and analytic hierarchy process(AHP).(2)The test of reliability and validity of performance evaluation index system for tertiary public hospital.Based on the survey data of performance status quo,the research tested the reliability and validity of the questionnaire designed according to the evaluation index system.(3)The performance investigation of Guangxi tertiary general public hospitalAccording to the established evaluation index system,we designed the performance evaluation questionnaire for tertiary public hospitals and then used the questionnaire to investigate the performance of Guangxi tertiary general hospital.(4)The comprehensive performance evaluation of tertiary public hospital based on commonwealBased on the status of performance tertiary public hospital in Guangxi findings by using TOPSI analysis and on the status of performance tertiary public hospital in Guangxi findings using TOPSIS analysis,three general public hospitals in Guangxi were the overall efficiency of public hospitals,evaluation of economic and social benefits,a comprehensive analysis of the performance of Guangxi three general running of public hospitals,horizontal comparison between the efficiency of the hospital.RSR index score for each use to sort and classify,to reflect the public welfare and efficiency characteristics of each hospital.Also,we used RSR to rank and classify the comprehensive score of each dimension and find out the data characteristics of every hospital and classification.3.Research techniques(1)Document research: to establish a comprehensive evaluation based nonprofit tertiary public hospital indicator system as the starting point,analysis and evaluation of the relevant domestic and foreign literature and policy documents relevant state departments to determine the performance evaluation framework for public hospitals.(2)Delphi(Delphi)Delphi method: In the framework of performance evaluation based on the use Delphi expert consultation further screening evaluation,and ultimately determine the performance evaluation system in public hospitals.(3)Questionnaire survey: According to the relevant literature performance evaluation index system construction and other domestic and abroad,to complete the design performance questionnaire,said 24 public hospitals,three general performance status quo questionnaire.(4)The Reliability and Validity test: The internal consistency reliability of the questionnaire to evaluate the various indicators,evaluation is Cronbach αcoefficient;using content validity and construct validity of the questionnaire validity testing.(5)Three general public Hospital Performance Evaluation Methods: TOPSIS and RSR analysis method,the above-mentioned three general 24 public hospitals comprehensive benefits,economic and social evaluation.Results1.Performance Evaluation System Based on tertiary public hospital(1)Through literature research,and public hospitals,according to three general nature and commitment to social functions and draw balanced scorecard and performance prism appraisal theory,finance,internal processes,learning and development and stakeholders in four aspects as a level of indicators,according to causality and logic levels of the factors set 11 secondary indicators and 73 third-level indicators.(2)By two Delphi expert consultation to finalize the four-level indicators,three comprehensive performance evaluation system 11 and 58 secondary indicators three indicators of public hospitals,which include level indicators financial,internal processes,learning and development,and stakeholders;two indicators,including asset utilization,operational expenditure,solvency,quality of medical services,medical service efficiency,learning ability,capacity development,government responsibility,patients,third-party paying agencies and hospital staff.(3)Experts actively coefficient Delphi expert consultation was 100 percent;the extent of the authority of two expert advisory 0.819 and 0.856,respectively;coefficient 2 coordination expert advice for 0.242 and 0.469,the difference was statistically significant(P <0.05);the use of expert consultation and AHP method of combining empowerment index,the value of the test CR random consistency judgment matrix are less than 0.10,that the index weight coefficient no logic errors,weighting results can be accepted.2.Reliability and validity of the test results tertiary public hospital Performance Evaluation SystemIndex System overall Cronbach α coefficient was 0.76,Cronbach αcoefficient of each dimension are more than 0.6,wherein the Cronbach αcoefficient learning and development dimension of the highest(0.8361).It shows the index has a good reliability.Evaluation framework and evaluation of this study after two expert consultation and deliberation,has been recognized by experts,while on-site investigation,data collection process has also been recognized by the evaluation unit can be considered in this study questionnaire designed a more better content validity.Use Spearman correlation coefficient between each dimension index system were correlation analysis it showed that the correlation coefficient between 0.22-0.56 each dimension,indicating construct validity index system is good.Therefore,this study design questionnaire has good construct validity.3.Guangxi comprehensive tertiary public hospital performance status quo survey results(1)Guangxi tertiary public hospitals in three public general hospitals based.Series empty hospital problem exists,through recruit its own staff to address deficiencies.Hospital health workforce shortages medical technicians and registered nurses.Tertiary general hospital beds expansion significantly.(2)Guangxi tertiary public hospitals per capita average daily attendance of 11.53 bear clinic in 2014;inpatient bed days per capita daily assume 4.05,higher than the national average(8.40,2.80)over the same period;the average length of stay for those discharged 9.68 days,below the national average(10.70days)over the same period;the average bed occupancy rate was 103.21%,higher than the national average(101.80%)over the same period.(3)the quality of medical services in 2014 three general good public hospitals,which surveyed sterile surgical hospital grade healing rate over 90%;basic nursing pass rate was 100.00%.(4)A comprehensive survey of three public hospitals in 2014 to study in the proportion of hospital personnel in total health workers averaged 23.75%;the proportion of investment in research hospital spending an average of 20.08%.(5)In 2014,hospital revenue per capita average was 31.1 million;operating income proportion of total hospital revenue averaged 92.87%,;business expenditure proportion of total hospital expenditures averaged 45.39%.The average asset-liability ratio was 58.84%.(6)In 2014 the proportion of investment in government hospitals hospital revenue averaged 7.35%;there are 15 hospitals(62.5%)participation in public emergencies and major catastrophic events medical treatment 115 times the average number of times each hospital to participate 7.67 times.(7)In 2014 hospital outpatient medical costs an average of 92.27 Yuan,the lower than the national average level($233.9);Medicines of outpatient service time is an average of 48.50%,compared with a national average level(48.4%).Check the expenses of outpatient service times are 21.38% average cost,the same period is higher than the national average(20.90%).Hospital patients,the average per capita medical expenses is 3825.02 Yuan,the significantly lower than the national average level($10409.50);Hospitalization time all medicines accounted for an average of 37.54%,lower than the same period the national average(38.30%);Inspection charge is about 9.25% average hospitalization time all costs,the same period is higher than the national average(9.00%).(8)In 2014,hospital in patient Satisfaction average of 94.70%,outpatient satisfaction average 94.28%.(9)In 2014,the hospital employee satisfaction average 94.15%;the proportion of hospital expenses labor costs average 26.15%;health staff turnover rate averaged 4.04%;operating income of each worker on an average of 324,500 Yuan.4.The performance evaluation results based on the comprehensive of commonweal tertiary public hospital(1)Using TOPSIS and RSR method,the overall efficiency of 24 public hospitals in Guangxi three general,economic and social benefits of a comprehensive evaluation,the evaluation results into lower,middle and lower,and on the upper four grades.24 tertiary public hospitals,the overall efficiency of the hospital,"inferior" have a,4.17%;the overall efficiency of the hospital "in the lower" there are 10,accounting for 41.67%;the overall efficiency of the "upper-middle" the hospital has 11,accounting for 45.83%;comprehensive benefits as "fine" in hospital two,accounting for 8.33%.Evaluation of the results of hospital classification economic and social benefits and comprehensive benefits evaluation results are the same.(2)Using the RSR method,24 tertiary public hospitals into four categories:"low efficiency,low public service type","low efficiency,high welfare type","low welfare,high efficiency" and "high efficiency,high Public welfare.”Among them,the "low efficiency,low Public Welfare," the hospital has five,accounting for 20.83%;"low efficiency,high-welfare model" of the hospital has six,accounting for 25.00%;"low welfare,high efficiency type," the hospital 6,accounting for 25.00%;"high efficiency,high Public welfare," the hospital has seven,accounting for 29.17%.Conclusion1.Balanced Scorecard and performance prism model theory,in a prominent social-oriented taking into account the economic benefits,and reflect the major interests of the Government,the rights of patients and other stakeholders,enabling scientific and comprehensive public hospital performance measure objectively reflect the extent of public interest in public hospitals.2.Performance Evaluation System tertiary general public hospitals by Del Phi expert consultation screening to determine a reasonable structure,strong representative;after reliability and validity,the index system has good internal consistency,good content validity and construct validity,it can be used to evaluate three general public hospital performance.3.TOPSIS and RSR method Guangxi 24 public hospitals in three general comprehensive evaluation of the performance of the overall efficiency of the hospital,the economic and social benefits to sort and classify the different types of hospitals can be found in a comprehensive,economic and social differences in efficiency,thereby contributing to public welfare and proposed the development strategy based on three general equilibrium efficiency in public hospitals. |
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