Study On The Optimal Scales Of Secondary Public Hospitals Based On Returns To Scale Inflexion Points

Objective:This study is focused on putting forward the optimal scales for secondary public hospitals in China and exploring the approach for measuring the optimal scales of hospitals, in order to present references for health management and decision making.Contents:Indicators evaluating the comparative efficiency of hospitals were determined, followed by efficiency assessment on the secondary public hospitals from two aspects:section data and time-series data; the optimal scale of secondary public hospital beds and staffs were proposed by the identification of inflexion points. And policy and research suggestions offered thereby.Methods:This study summarized the current research on the optimal scales of hospitals by means of literature review; Data Envelopment Analysis method was applied to analyze the status of returns to scale of secondary public hospitals in the study period; based on the theory of economics of scale, inflexion points recognition method was used to determine the inflexion points of sample hospitals; and then the optimal scales for secondary public hospitals were drawn by descriptive statistics analysis.Results:Indicators evaluating the comparative efficiency of hospitals were determined. In order to form a set of candidate indicators, indicators of evaluation studies on hospital efficiency were sorted, while considering the diversity and low measurability of hospital inputs and outputs.5indicators were developed based on the candidate indicators and the characteristics of secondary public hospitals. To be specific, there had2input indicators including beds and staffs, as well as3output indicators namely outpatients amount, inpatients amount and bed utilization rate.Secondary hospitals are not only numerous, but also play a vital role in three-level medical service system. China’s secondary hospital beds went upward at an annual growth rate of9%from2005to2012, while the growth of staffs was relatively slow. In the meantime, its capability of providing medical service increased gradually with a stable growth. Bed utilization rate improved at an annual growth rate of4%from2005to2012, and the growth hit a high point in2007.The results showed that either the average beds or average staffs presented rapid development from2002to2012, especially in recent5years. The outpatients amount and inpatients amount improved obviously, with respective growth rates of103.52%and156.92%. However, the bed utilization rate was only81.9%in2012, lower than the national average of90.7%.The cross-section analysis on sample hospitals’relative efficiency. According to the analysis in2002,2007and2012, most of sample hospitals were proved to be technical inefficient and scale inefficient. From the perspective of scale efficiency, the three places didn’t work well, but A and C were relatively poorer than B, which had a smaller size of average scale.The optimal scales for secondary public hospitals were drawn from the analysis.115strict inflexion points and60flexible inflexion points were identified through time-series longitude analysis. Through the analysis of inflexion points, the strict control standards for secondary public general hospitals were294beds,95%CI:(262,326) and483staffs,95%CI:(437,528); the flexible control standards were363beds,95%CI:(291,434) and564staffs,95%CI:(479,648).Discussions:Nowadays, the expansion of public hospitals is common in China, and secondary hospitals are no exception. However, the scale efficiency doesn’t get the corresponding improvement. It was found that32.99%of secondary hospitals had more than500beds in2012, which reached the scale of tertiary hospital. Nevertheless, the scale efficiency had been improved in a gradually slow way and kept in the low level from2002to2012. There are various factors resulting in the low efficiency of secondary hospitals. First of all, efficiency assessment for secondary hospitals was put in the marginalized position due to the absence of government supervision. What’s more, for adapting to requirements of development, it is the chasing objective of many secondary hospitals to enlarge its scale. In addition, when evaluating hospitals, patients tend to consider it from the perspective of scale, which promotes the expansion of secondary hospitals to some extent.This study analyzed the optimal scales for secondary public hospitals based on the situation of China, providing direct basis for scale controlling in eastern China, as well as valuable references for other regions in China. The control standards with independent analysis on3provinces could be applied by A, B, C respectively, which could also be used by other provinces in eastern China through clustering analysis. The control standards with systematic analysis on3provinces could be referred to cities in central and western regions. The results of this study enriched research evidences for international studies in related area and supported international comparative analysis.This study explored an approach for measuring the optimal scales of hospitals, by introducing the changing rule of returns to scale and mathematical concept of the inflexion points. The ideas and methods for further study on other types of hospital had been provided. The results of this study could be applied by the government for health management and decision making.Suggestions:Controlling the public hospital scales should be a long-term public policy, which makes a shift in public hospitals development from extensive to intensive mode. The size of optimal scales should be adjusted dynamically to support the new context and requirements. The approach for measuring the optimal scales of hospitals should be further improved, such as exploring the evaluation methods for hospital efficiency other than DEA, optimizing the design for input and output variables and so on.