| PurposeThis study takes Guangdong Province,the most economically developed provinces in China,as an example,and constructs a model for evaluating the technical efficiency of public hospitals in Guangdong Province.At the same time,the level of health resource allocation in public hospitals in Guangdong Province is analyzed.On this basis,we propose countermeasures to improve the technical efficiency of public hospitals and promote the balanced allocation of health resources in Guangdong Province,which will provide a reference for improving the efficiency of public hospitals and improving the allocation of health resources in public hospitals nationwide.MethodsThe literature analysis method,systematic cluster analysis method,correlation analysis method and variability analysis method were combined to construct the input-output evaluation index system of technical efficiency of public hospitals in Guangdong Province.Secondly,the data from the statistical data such as the Guangdong Health and Health Statistical Yearbook from 2012 to 2020 were selected,and the three-stage DEA improvement model(Data envelopment anysis,DEA)and the Global-Malmquist index model based on the super-efficient SBM-DEA model(Slack-based measurement,SBM)to analyze the technical efficiency of public hospitals in Guangdong Province and its change trend from 2012 to 2020 statically and dynamically.In addition,entropy weighting and principal component analysis were applied to assign weights to various types of health resources in order to calculate the health resource density index,which is a comprehensive indicator of health resource allocation level from an overall perspective.Meanwhile,the exploratory spatial data analysis method and Dagum Gini coefficient were used to analyze the spatial distribution characteristics of technical efficiency and health resource density index of public hospitals in Guangdong Province.Results1.Theoretical model construction for technical efficiency evaluation of public hospitalsIn terms of technical efficiency evaluation model construction,this study found that public hospitals in various cities in Guangdong Province differ significantly in terms of external environment.In addition,to address the problems of input or output slack values,super-efficiency problems,and comparability of efficiency values across periods that are ignored by traditional DEA models in measuring technical efficiency,this study constructs an improved three-stage DEA model and a Global-Malmquist index model based on the super-efficient SBM-DEA model to conduct static and dynamic analysis of the technical efficiency of public hospitals in Guangdong Province.2.Measurement of technical efficiency of public hospitals in Guangdong Province(1)Efficiency measurement results of the first stageIn general,the overall technical efficiency of public hospitals in Guangdong Province between2012 and 2020 is concentrated at 0.847～0.901,the pure technical efficiency is concentrated at 0.966～1.015,and the scale efficiency is concentrated at 0.884～0.908.By region,the comprehensive technical efficiency of public hospitals in the Pearl River Delta region is concentrated at 0.808～0.904,in the East Wing region at 0.804～0.933,in the West Wing region at 0.847～0.936 and in the Mountain region at 0.878～0.948 during2012～2020.The overall ranking is Mountain > West Wing > Pearl River Delta > East Wing.(2)Results of SFA regression analysis in the second-stageThe one-sided likelihood ratio tests of the SFA regression model were all greater than the critical value(P < 0.01),indicating the reasonable construction of the SFA regression model.The effects of per capita disposable income and population density on the slack values of registered nurses,licensed(assistant)physicians and number of beds were all positive(P < 0.05).The effect of urbanization rate on the input slack values of registered nurses,licensed(assistant)physicians,and number of beds was negative(P < 0.05).The effect of resident population size on the slack values of registered nurses,licensed(assistant)physicians and number of beds was positive,and the effect of GDP per capita on the slack values of registered nurses,licensed(assistant)physicians and number of beds was negative.(3)Efficiency measurement results of the third stageIn general,the combined technical efficiency of public hospitals in Guangdong Province between2012 and 2020 is concentrated at 0.551～0.602,the pure technical efficiency is concentrated at 1.003～1.023,and the scale efficiency is concentrated at 0.545～0.590.By region,the comprehensive technical efficiency of public hospitals in the Pearl River Delta region is concentrated at 0.737～0.793,in the East Wing region is concentrated at 0.341～0.386,in the West Wing region is concentrated at 0.527～0.589,and in the Mountain region is concentrated at 0.394～0.447 between 2012 and 2020.The ranking is Pearl River Delta >West Wing > Mountainous Area > East Wing.(4)Dynamic analysis of efficiencyIn general,the Malmquist Index for public hospitals in Guangdong Province between 2012 and2020 is greater than 1.Among them,the scale efficiency improvement index and the technical improvement index are the largest,at 1.014 and 1.003,respectively.By region,the Malmquist Indexes of public hospitals in the Pearl River Delta,East Wing,West Wing and Mountainous Region are all greater than 1 between 2012 and 2020,at 1.004,1.026,1.028 and 1.026 respectively.Among them,the technical improvement index and scale efficiency improvement index of public hospitals in the East Wing,West Wing and Mountainous Region are both greater than 1.(5)Spatial analysis of efficiency(1)The overall technical efficiency of public hospitals in Guangdong province showed a positive spatial correlation(P < 0.05),and the correlation of the spatial distribution of the overall technical efficiency increased.The high-high integrated technical efficiency clusters were distributed in Guangzhou,Foshan,Shenzhen and Dongguan,the low-high clusters distributed in Huizhou,and the low-low clusters distributed in Meizhou.(2)In general,the Dagum Gini coefficient of comprehensive technical efficiency of public hospitals in Guangdong Province ranged from 0.245 to 0.275 and showed a decreasing trend.By region,the Dagum Gini coefficients of comprehensive technical efficiency of public hospitals in the Pearl River Delta,East Wing,West Wing and Mountainous Region ranged from 0.191 to 0.226,0.188 to 0.221,0.121 to 0.162 and 0.110 to 0.135,respectively.(3)The disparity in the comprehensive technical efficiency of public hospitals in Guangdong Province mainly comes from the disparity between regions.The inter-regional Gini coefficient of the comprehensive technical efficiency of public hospitals in the Pearl River Delta and the East Wing and the Mountainous Region is larger than the Gini coefficient between other regions,and the inter-regional Gini coefficient of the comprehensive technical efficiency of public hospitals in the Pearl River Delta and the East Wing,the West Wing and the Mountainous Region shows a decreasing trend.3.Spatial and temporal analysis of allocation of public hospitals’ health resource in Guangdong Province(1)In general,the health resource density index of public hospitals showed an increasing trend between 2012 and 2020,from 1.051 in 2012 to 1.726 in 2020,an increase of 64.36%.By region,the health resource density index of public hospitals in the Pearl River Delta increased from 1.615 in 2012 to 2.501 in2020,an increase of 54.91%.The East Wing region grew from 0.518 to 1.039,an increase of 100.44%.The west wing region grew from 0.516 to 0.867,an increase of 67.81%.The mountainous region grew from0.347 to 0.690,an increase of 99.09%.(2)The health resource density index of public hospitals in various cities of Guangdong Province showed a positive spatial correlation(P < 0.05),and the correlation of spatial distribution of public hospital health resource density index becomes weaker.The high-high concentration areas of public hospital health resource density index were distributed in Guangzhou,Foshan,Shenzhen and Dongguan,and the low-high concentration areas were distributed in Huizhou.(3)In general,the Dagum Gini coefficient of the health resource density index of public hospitals in Guangdong Province ranged from 0.431 to 0.476 and showed a decreasing trend.By region,the Dagum Gini coefficients of public hospital health resource density index in the Pearl River Delta,East Wing,West Wing and Mountainous Region ranged from 0.337 to 0.349,0.272 to 0.298,0.034 to 0.071 and0.105 to 0.156,respectively.(4)The disparity in the health resource density index of public hospitals in various cities of Guangdong Province mainly originates from the inter-regional disparity,and the inter-regional Gini coefficient of the health resource density index of public hospitals in the Pearl River Delta and the east wing,west wing and mountainous areas is larger than that of other regions,and shows a decreasing trend.Conclusions1.In the selection of efficiency evaluation models,the issues of heterogeneity of evaluated units,input or output slack values,super-efficiency and comparability of efficiency across time need to be considered,and the three-stage DEA improvement model and the Global-Malmquist index model based on the super-efficient SBM-DEA model are recommended to evaluate the technical efficiency of hospitals.2.The relatively low scale efficiency of public hospitals in Guangdong Province is the main reason for the low overall technical efficiency.The overall technical efficiency of public hospitals in Guangdong Province was improved from 2012 to 2020 mainly due to the improvement of scale efficiency and technological progress.3.The combined technical efficiency and health resource density index of public hospitals in the East Wing,West Wing and Mountainous Region in Guangdong Province still have a large gap with the Pearl River Delta,but the gap shows a decreasing trend.Technological progress and scale efficiency improvement are the main reasons for the overall technical efficiency improvement of public hospitals in the East,West and Mountain regions.4.There is a large disparity in the overall technical efficiency and health resource allocation levels of public hospitals in various cities in the Pearl River Delta region in Guangdong Province.The comprehensive technical efficiency and health resource density indices of public hospitals in Guangzhou,Foshan,Shenzhen and Dongguan are relatively high,while those in Jiangmen,Zhaoqing and Huizhou are relatively low.5.In order to improve the technical efficiency of public hospitals in Guangdong Province as well as to promote the balanced allocation of health resources in public hospitals,the following measures should be taken:(1)to achieve a qualitative leap with high-quality development(2)to pay attention to the coordinated development of public hospitals in the Pearl River Delta region to optimize the development of health in the Pearl River Delta(3)to pay attention to the coordinated development of public hospitals between regions to make up for the shortcomings in the development of health in the province(4)identifying the shortcomings and applying precise measures to improve the medical service capacity of public hospitals. |
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