| Objective:Since the implementation of the new medical reform in 2009,China has made great efforts to develop the health service delivery system in rural areas,and promoted the construction and improvement of Township Health Centers(THCs).In this context,the efficiency evaluation of THCs is of great significance to improve the construction and service of THCs.Based on the analysis of the basic situation and operation efficiency of THCs in different functional areas of Hubei Province in 2017,this study summarized the overall level and operation efficiency of THCs in various areas of Hubei Province,analyzed the possible problems of THCs,and provided a scientific basis for further improving the operation efficiency of THCs in different functional areas.Methods:The data were from the 2017 health statistics report of Health Commission of Hubei Province.According to the main functional areas of Hubei Province,different counties(cities)were divided into three categories,including 848THCs in 63 counties(cities).Literature analysis and cluster analysis were used to select the input and output indexes of THCs.Descriptive analysis method was used to make a descriptive statistical analysis of the population,finance,materials,medical care and public health services of THCs in various regions,and the results were compared with the national data.T test was used to compare the input-output indicators of the overall effective group and the overall ineffective group of THCs.The BC~2 and C~2R models of data envelopment analysis were used to evaluate the overall efficiency,pure technical efficiency,scale efficiency and returns to scale status of THCs in three areas of Hubei Province.Results:(1)In terms of human resources,in 2017,the proportion of health technical personnel(86.82%)and the proportion of licensed(assistant)doctors(36.08%)in the staff of THCs in Hubei Province were slightly higher than the national level of THCs(84.64%and 34.26%).In the third category of functional areas,the average number of authorized personnel,employees and health technicians in each township health center is lower than those in the first and second categories.(2)In terms of construction and facilities,the average building area and business room area of each township health center in 2017 were 6520.46 square meters and4133.99 square meters respectively,and the average levels of the three functional areas were also higher than the national average level(2896.28㎡,2169.22㎡).There were 67.20 beds in each township health center on average,60.68 in the first class area,68.72 in the second class area and 67.65 in the third class area,all of which were higher than the national average(35.35 beds).On average,each township health center had 23.01 sets of equipment above 10000 yuan,among which the third category area had the lowest number(21.66 sets),but it was higher than the national average.(3)In terms of assets and liabilities,the average assets and liabilities of each township health center were 15.0929 million yuan and 4.8219 million yuan,which were higher than the national average levels(8.195 million yuan and 2.1020 million yuan).Among the three areas,the third area had the most debt per township hospital,which was 5.5203 million yuan.The asset liability ratio of all THCs was 31.95%,higher than that of the national THCs in 2017(25.65%).(4)In terms of income and expenditure,the average total income and expenditure of each township health center in 2017 were 12.2168 million yuan and 12.2899million yuan,both higher than the national average level of THCs(7.535 million yuan and 7.3609 million yuan).The average income and expenditure of each township health center in the first,second and third categories decreased in turn.Of all THCs,424(50%)had a positive balance,39(4.60%)reached a balance of 0,and 385(45.40%)had a negative balance.In the first,second and third categories,44.74%,44.27%and 46.86%of the THCs were in negative balance.(5)In terms of medical and public health services,the annual frequency of diagnosis and treatment,discharged patients in each township health center were higher than the national average,and the two indicators were the highest in the second category of three functional areas.In 2017,the average number of permanent residents served in each township health center was 39684,the cumulative number of urban residents’health files was 33396,the number of vaccinators in the national immunization program for children aged 0-6 years was 6192,the number of health management for children aged 0-6 years was 2594,and the number of health care services for the elderly aged over 65 years was 3179.Among these indicators,the first,second and third categories of regional THCs decreased successively.(6)In terms of operation efficiency,the average overall efficiency,pure technical efficiency and scale efficiency of THCs were 0.716±0.121,0.752±0.131 and0.955±0.06,respectively.4.72%of THCs were overall effective,and 95.28%of THCs were non-overall effective.There was no significant difference in the overall efficiency of THCs in the three functional areas(P>0.05),but the average overall efficiency of THCs in the first category was the highest,and the lowest in the second category.Compared with the overall effective group,there was no significant difference in the input index of THCs in the non-overall effective group(P>0.05),but the amount of medical services and public health services in the non-overall effective group was significantly lower than that in the overall effective group(P<0.05).Conclusions:The infrastructure of THCs in Hubei Province was relatively adequate,but there was a general phenomenon of debt in different degrees,which was slightly different in different functional regions.In 2017,THCs generally had difficulty in balancing their income and expenditure,and the loss of THCs in the third category of areas was relatively serious.Data envelopment analysis showed that the overall efficiency and the pure technical efficiency of the medical and health services of THCs in Hubei Province were relatively low,and the scale efficiency was relatively high.The average overall efficiency of THCs in the first,third and second functional areas was successively reduced.To improve the efficiency of medical and health services in THCs,we should increase financial input,optimize the allocation of health resources,improve the organizational management and technical level of THCs,and pay attention to public health services.Innovation:At present,most of the THCs service evaluation mainly from the administrative division,geographical location division(eastern,central,western,etc.)to classify and compare.From the perspective of functional areas in Hubei Province,DEA was used to evaluate the overall efficiency of THCs in different functional areas,which had certain characteristics in research perspective and research methods. |
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