| Objective:To understand the status of government health investment for county hospitals of Guangxi and the development of those hospitals in 2010-2012, to analysis the relationship between the health investment and the development of county hospital, and further to evaluate the efficiency of those hospital. By exploring some status and problems about government investment and hospital development, just to put forward some countermeasures and suggestions for providing the references for the reform of county-level public hospitals.Methods:Questionnaire survey was conducted in 41 hospitals in Guangxi and investigation of satisfaction in 5 of those hospitals and descriptive statistics analysis method was employed to analysis of survey data on the status of health investment and the development of county hospitals, and correlation and regression analysis were carried out between the total of inputs and the development of hospitals. Data envelopment analysis (DEA) was used to measure the efficiency of 41 cases of county hospitals.Results:(1) Health investment:the government health spending accounted for 5.95% of government spending in 2012, while the government health investment accounted for 12.54% of the government health spending. The difference of the government health spending in each county was large and its the maximum difference of 4.14 times. In 2012, the central finance and county finance were the main finances of the county public hospital investment, mainly concentrated in the subsidies of the large medical equipment and basic public health services, and the finance has slowed down the health investments on the county People’s Hospital and the Chinese Medicine Hospital, while increase the investments on the Maternal and Child Health Care Hospital.(2) Hospital development:comparing with 2010, (i) there increased by 20.22%,34.89% and 22.60% averagely in the emergency number, number of discharged patients and hospital operation cases, and increased by 42.13% in the actual hospitalized bed days, while 18.29% in the actual opened beds in 2012. (ii) There decreased by 0.50% and 0.75% averagely in the rescue success rate of emergency and hospitalized patients, and 0.62% averagely in improvement rate, but increased by 0.09% averagely in the incidence of nosocomial infection in 2012. (iii) There are 17.82 averagely medical disputes cases, which increased by 15.87% in the occurrence of medical disputes in 2012. (iv) The average hospital total revenue was 82.7779 million yuan in 2012, increased by 59.94%. (v) In 2012, the average hospital outpatient and emergency patient’s total fee, drug fee and examination fee per time increased by 21.45%,17.58% and 101.14%, while the average hospital discharged patient’s total fee, drug fee, examination fee per time and hospitalization expenses everyday increased by 19.88%, 15.92%,26.05% and 25.11%.(vi)The overall evaluation of the hospital patients is higher than that of patients after the medical reform, and the degree of relief "Difficult Medical Treatment" was greater than that of "Expensive Medical Treatment", (vii) The average hospital nursing staff accounted for 47.43% of the medical technical personnel in 2012, and the "low professional title, low education and young" trend was present in medical technical personnel.(viii) The amount of government investment and the index of hospital development was not related (r=-0.098, P> 0.05), while the amount of government investment and the comprehensive score of the influencing factors on the development of hospital was not related (r= 0.252, P>0.05).(3) Data envelopment analysis:15 (36.59%) cases of these 41 hospitals could be categorized as effective hospitals.The averaged total efficiency, pure technical efficiency and scale efficiency were 0.899,0.953 and 0.944 respectively.16 (39.02%) hospitals of them had lower pure technical efficiency. The returns to scale were decreasing in 17(41.46%) hospitals, while increasing in 7(17.07%) hospitals. The difference between the People’s Hospital and the Maternal and Child Health Care Hospital are statistical significance (P<0.05) in scale status, mostly People’s Hospital were in the status of decreasing returns to scale, and Maternal and Child Health Care Hospital were in the status of constant returns to scale.Conclusion:(1) increasing the amount of health financial investment, while reasonable orientating financial investment focus; (2) establishing the long-term supervision mechanism and financial investment mechanism, while reforming the way of the investments; (3) optimizing the allocation of health human resources, while improving the ability of hospital services and the quality of medical treatment; (4) expanding the adjustment range of medical service price, while reducing the medical burden of patients and improving the patients satisfaction; (5) strengthening the research of input and output of county-level hospitals, while enhancing the utilization rate of resources and controlling the scale of hospital development. |
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