Construction And Empirical Study On Financial Performance Evaluation Index System Of County-level Public Hospitals In Guangxi

Objective:Drawing lessons from the existing theories and methods of performance evaluation at home and abroad,through literature research,Delphi expert consultation and on-site investigation,a scientific and feasible financial performance evaluation index system for county-level public hospitals in Guangxi is developed.Taking county-level public hospitals in Guangxi as evaluation units,a comprehensive financial performance evaluation model for county-level public hospitals in Guangxi is constructed by factor analysis method.This paper evaluates the financial performance of county-level public hospitals in Guangxi and analyses the main factors affecting the performance.Finally,it puts forward evidence-based policy recommendations for financial performance evaluation of county-level public hospitals in Guangxi.Methods:1.Through literature research,drawing on the existing performance evaluation theory at home and abroad,the theoretical framework of financial performance evaluation of county-level public hospitals is put forward.Using Delphi expert consultation method,20 experts in related fields were selected for two rounds of expert consultation to determine the financial performance evaluation index system of county-level public hospitals.2.According to the financial performance evaluation index system of county-level public hospitals,the questionnaire of financial performance of county-level public hospitals was designed.Fifteen county-level public hospitals in Guangxi were selected by stratified cluster random sampling method as evaluation units to investigate the financial performance of county-level public hospitals in Guangxi.3.Based on the survey data of financial performance of county-level public hospitals in Guangxi,the internal consistency reliability was analyzed by Cronbach alpha coefficient,and the structural validity and reliability and accuracy of the evaluation index system were analyzed by factor analysis.4.Based on the survey data of financial performance of county-level public hospitals in Guangxi,this paper uses factor analysis method to construct the financial performance evaluation model of county-level public hospitals in Guangxi,and comprehensively evaluates the financial performance of the above15 county-level public hospitals in Guangxi and analyzes the main factors affecting their performance.5.According to the results of the investigation of financial performance and the comprehensive evaluation of financial performance,combined with the analysis of the relevant policy environment of the country and Guangxi,this paper puts forward some policy suggestions to improve the financial performance of county-level public hospitals in Guangxi.Results:1.Delphi expert consultation method was used to conduct two rounds of expert consultation,select indicators and determine the index system.The positive coefficients were 90.0%and 100.0%,the authoritative coefficients were0.88±0.03and 0.88±0.01,and the coordination coefficients were 0.547 and 0.661,respectively（P<0.001）.Finally,the financial performance evaluation index system of county-level public hospitals is established,which includes 8first-level indicators and 36 second-level indicators.The eight first-level indicators are solvency（0.1334）,revenue and expenditure structure（0.1329）,patients’medical expenditure level（0.1305）,operational capacity（0.1267）,medical service quality（0.1245）,medical service efficienc（0.1224）,development capacity（0.1148）and cost-effectiveness（0.1148）.2.The results of the financial performance evaluation of county-level public general hospitals show that:（1）the operational capacity of county-level public hospitals has been improved,but because of the lack of new growth point,the growth rate has slowed down and the stamina is insufficient.（2）Public hospitals at county level have high asset-liability ratio,poor liquidity ratio and liquidity liquidity ratio,and face greater financial risks.（3）The problem of insufficient government health investment exists in County-level Public hospitals,and the support of county-level public finance to county-level public hospitals needs to be improved.（4）County-level public hospitals pay attention to the improvement of the quality of medical services and the efficiency of medical services,and the utilization rate of beds is high.（5）The overall proportion of drugs and hospitalization fees in county-level public hospitals is relatively low,but there is a tendency of higher proportion of outpatient drug fees and abuse of inspection and laboratory tests.3.Based on the field survey data,the reliability and validity of the index system were tested.（1）The internal consistency reliability of the evaluation index system with Cronbach alpha coefficient was used.The results show that the overall Cronbach alpha coefficient is 0.804,and the Cronbach alpha coefficient of the first index is between 0.705 and 0.786.（2）Factor analysis was used to analyze the structural validity.According to the standard of over 70%cumulative contribution rate,the principal components were extracted.The first three principal components were extracted and their cumulative contribution was 77.92%.The three principal component factors reflect the content of operation ability,cost control and service effect in the financial performance of county-level public hospitals.The result of factor analysis is similar to the index system.4.The comprehensive evaluation model of financial performance of county-level public hospitals is composed of management ability factor,cost control factor and service effect factor:F _{comprehensive}=0.4637 F _{management ability}+0.3044F _{cost control}+0.2319F _{service effect}.The score of management ability factor is higher,followed by service effect factor,while the score of cost control factor is lower.According to the comprehensive evaluation model,the financial performance of county-level public general hospitals in Guangxi was evaluated comprehensively.According to the comprehensive scores of financial performance,there are four hospitals（24.4%）with poor comprehensive performance,eight hospitals（53.33%）with middle performance and three hospitals（20.00%）with good performance.Conclusion:1.The financial performance evaluation index system of county-level public hospitals constructed by Delphi method in this study.After two rounds of expert consultation,the positive coefficient of experts,the authoritative coefficient of experts and the coefficient of expert consultation system are all high,and the index system is scientific and credible.2.The financial performance evaluation index system of county-level public hospitals constructed in this study has good internal consistency reliability and structural validity.3.The results of the financial performance evaluation model of county-level public hospitals constructed by factor analysis method are basically consistent with the results of the current performance survey,which shows that the comprehensive model has better rationality.Policy recommendations:1.Promote the construction of fine cost management system in county-level public hospitals and improve the cost control ability.2.Perfect the internal control system and process,strictly check and verify the fund management,and reduce the financial risk.3.Optimize the income structure of hospitals,change the concept of development,and prevent the formation of an income model based on inspection and acceptance.4.Optimize the compensation mechanism and enhance the support of county public finance to county-level public hospitals.