| Objective County-level public hospitals have a special status in China's medical and health service system.That is,the basis for connecting to higher-level medical institutions,and the leader of the medical service system in rural areas.Its service efficiency is crucial to meet the basic medical service needs of county residents.Efficiency is an important principle to be followed in the development of public hospitals.The level of efficiency is a prerequisite that directly affects the long-term and stable development of the hospital,and it is also the basic guarantee for meeting the health needs of people at different levels.By analyzing the changes in the operating efficiency of county-level general public hospitals in Anhui Province and whether the hospital's inputs have reached effective output,the purpose is to provide a scientific basis for the analysis and evaluation of the effect of the implementation of the reform policy of county-level general public hospitals in Anhui Province,and to optimize the hospital resources Configure and improve hospital operation efficiency to provide scientific decisions.Methods In this study,29 county-level comprehensive public hospitals in Anhui Province were used as research samples,and the county-level medical institution information management system platform in Anhui Province was used to systematically collect2007-2016 financial data of the sample hospitals.Combined with literature selection method,cluster analysis,correlation analysis,coefficient of variation and qualitative consultation results to select core indicators of input and output,a county-level comprehensive public hospital operating efficiency evaluation model was constructed.The RD-Malmquist index was used to dynamically evaluate the total factor productivity(TFP),pure technological change(PTC),Scale Change(SCH),and pure efficiency change(PEC),and combined with the SE-SBM model to analyze the projection values of input and output indicators of the sample hospital.Results(1)Considering the results of cluster analysis,correlation analysis,and coefficient of variation analysis,5 input indicators are finally selected,which are the number of employees,fixed assets,medical expenditures,number of beds,housing and building area,5 outputs indicators are finally selected,which are the number of outpatient and emergency department visits,the actual number of bed days occupied,drug income,and medical income.(2)From 2007 to 2016,the average TFP of the sample hospitals was 1.058,and the average TFP growth rate was 5.8%.The average growth rate of PTC reached 2.1%.SCH was 3.2%,and PEC was 0.3%.(3)During 2007-2009,the changes in TFP,PEC and SCH were consistent.From 2010 to 2016,changes in TFP and PTC were consistent,and the reason for the increase in TFP was caused by PTC.(4)From 2007 to 2016,the efficiency differences among the sample hospitals were large.The largest TFP hospital was 1.338 and the smallest hospital was 0.993.The differences between the maximum and minimum values of PEC,PTC,and SCH were0.045,0.383,and 0.353 respectively.(5)Using the SE-SBM model to calculate 15 non-DEA effective hospitals in 2016.It was found that the average redundancy rate of other input indicators except for medical expenditures in the input indicators exceeded 20%.Among them,the average redundancy rate of fixed assets and the number of beds is over 40%.Among the output indicators,the number of outpatient and emergency outpatient visits and the actual number of bed days actually occupied were insufficient in all 15 sample hospitals,moreover,the highest deficiency rate of outpatient and emergency services was 235.92%,and the lowest was 7.06%,and the highest deficiency rate of actual occupation of the total number of bed days was 74.01%,and the lowest was 0.74%.Conclusion From 2007 to 2016,the medical resources,medical service capabilities,medical expenditures,financial subsidies,and operational efficiency of 29 county-level comprehensive public hospitals in Anhui Province have been effectively improved.At the same time,the study found that there is a certain gap in the operating efficiency of county-level hospitals.Pure technology change(PTC)and scale change factor(SCH)are the main reasons for this phenomenon.Assets and liabilities and financial subsidies of some county-level hospitals need to be improved.The input of some county-level hospitals has not yet reached effective output,the resource allocation is irrational,and the utilization efficiency of medical resources needs to be improved.In the next step,local governments should implement financial input responsibilities to help county-level hospitals resolve historical debts.At the same time,they should carry out scientific and reasonable regional health planning based on the actual conditions in the county.when the government distributes health resources fairly,it must pay attention not only to the improvement of hospital efficiency,but also to reasonable control of the range of efficiency among hospitals at the same level,Only in this way can we narrow the development gap between each other.In addition to focusing on improving technological innovation capabilities,county-level hospitals should optimize technology and management concepts,strengthening the construction of medical staff,Rationally adjust the scale of development,and use information technology to advance the hospital to a quality-effective model.At the same time,county-level hospitals should focus on optimizing the allocation of resources,rationalizing the allocation of inputs and outputs,developing the new disciplines,improving service capabilities and social influence,so as to effectively improve hospital operating efficiency. |
PDF Full Text Request