The Research Of Causes And Suitable Model Of Hospital Bed Capacity Development In China

Over the past decade, the bed volume of large hospitals in China has increased by 180%, the number of hospitals with more than 800 beds has increased by 400%。 The structure or health care system is shaped like an inverted triangular. The large hospitals are crowded with patients while small hospitals stay lonely. Both large and small facilities could not function with their comparative advantages. In this way, there exists the lack of the health care resources as well as the waste of them. At the meantime, the characteristics of asymmetric information lead the patients to pursuit higher price and swarm into large hospitals, even with the ails. Thus, the health care costs keep increasing. It is suggested by health statistics published both domestically and aboard that, the number of hospitals only counts for 2-3% of all the health care facilities, but its expenditure can reach up to more than 50%.This figure in our counties was 77% in 2013. Accordingly, if this problem cannot be properly solved, the efficiency, quality and the accessibility of the health care system would be compromised, the inefficiency costs would also be difficult to control. The Government and hospital managers pay large attention to this issue, and set up a series of research project on it in order to address the difficult position fundamentally. This study in this paper is one of the project.The objective of the study is to clearly describe the reality of developing trend of hospital beds, to analyze the determinants of hospital bed supply behavior deeply and systematically and to examine an optimal model, the research try to provide evidence-based conclusions for policy makers, public hospital reform, and resource allocation.There are 6 parts in this research. The first part describes the reality and trends of hospital capacity development. The second part examines the determinants which influence the behavior of hospital bed supply. The third part is demand analysis and research of economies of scale. The fourth part is to summarize the international experiences. The fifth part is to summarize the model of hospital bed development and suggest an optimal model by comparison. The sixth part are policy suggestion.The methods of this study include:literature review, questionnaire analysis, Delphi method, statistical regression and forecast, productivity function, data envelope analysis and cost-effectiveness analysis, as well as health policy and health economics theory.Main Results:In past decades, the hospital beds of tertiary hospital has increased by annually 14%, increased from 0.6 million to 16.7 million, accounts for 42% rising from 35%.The numbers of tertiary hospital increased from 987 to 1787, by 89%, and the average bed size increased from 631 to 935. The hospitals with more than 800 beds increased from 243 to 1212, increased by 400%. The number of outpatient visits per bed in tertiary hospital increased from 665 to 741. The inpatients per bed increased from 24 to 33. The ratio of staff and bed decreased from 1.33 to 1.17, the ratio of doctor and bed decreased from 0.42 to 0.33. Beds of 44 sample hospitals increased from 728 to 1268 in 2001-2010. The outpatient visits and inpatients increased by 198% and 227%。 The number of surgery and rescues increased by 100% and 79%. The result of linear correlation analysis suggests that the numbers of outpatients,inpatients, surgery,rescues, bed utilization rates and infection rates has positive relationship with bed capacity. The result of linear regression shows:bed= 0.0174 inpatient+27.3597 alos+0.0023 income+0.0079 surg+0.0636 rescue. Inpatients make the largest contribution. The R2 is 88.16%(P<0.0001).A "two-circle" model was built up to present and explain factors which had influences on hospital beds supply. In this model, the triangle represents the bed scale of the hospital. And the circles inside and outside represent the internal management factor and external factors including demand, market characteristics and health system policies, respectively. The numbers of beds supplied by hospitals are determined by these restrictors. The model was built up based on literature review and broadly considering the actual situation in China. The result of the empirical study suggests:before and after 2009, the inpatients in sample hospitals increased by 37.6%, the health care costs adjusted by CPI increased by 77.2%. The number of inpatients and the costs among different types of health insurance has significant difference(P<0.05). The surgery costs of 7057 Appendicitis operation decreased from 19.5% to 14.5% in 10 years,.733 Appendicitis operation through laparoscopy decreased from 28.8% to 11.7% in 5 years. The isolated health insurance system can affect the behavior of patients significantly, the incentive provided by price system was negative.The forecast from three methods indicates in 5 future years, the number of hospital bed will increased 6-6.5 million. The Cobb-Douglas productivity function suggests that hospitals shows economies of scale in 2009 and 2010 (P<0.0001). Through data envelope analysis,13% of the hospital shows increasing returns to scale with an average scale of 459,33% hospitals shows constant return to scale with an average scale of 1123,54% hospitals shows decreased return to scale with an average scale of 1008. When the variable income was added in to the output indicator, the result changed:4% of the hospitals were in the state of increasing returns to scale,26% shows constant return to scale,70% of the hospitals shows decreased return to scale. The average scale of three groups hospitals are 790,1072 and 1361, respectively. There are significant difference among three groups(P<0.0001). The model and variable chose can influence the results.Compared with WHO members, the total number of hospital beds in our country ranked first. Beds per 10000 population was slightly higher than middle-high income countries. Multi-level health care system and regional health care planning are not that good in China. The international experiences includes:(1) Control the bed efficiency through Acts; (2) Lower the ALOS by management improvement; (3) Communities and clinics share the health care burden for large hospitals;(4) Make regional health care planning;(5) Mandatory grading treatment and its incentives;(6) Integrated delivery system and hospital consolidation and merger;(7) Payment system reform based mainly on DRGs. The trend on time tree also suggested that the period we are going through now have abundant similarities with Taiwan in 1980s. It probably gives us good lessons to learn.According to the literature, the models of bed increasing in our country can be summarized in 5 sorts:increasing in a single entity; establishing branches; set up alliances or coorperation with each other; reconstruction within several health care facilities; vertical integration. Using theory of economies of scales, comparative advantages, transaction costs, and theory of levels of integration to evaluation the 5 models, it is suggested that vertical integration is the opitimal model for hospital beds regulation and development.At the same time, we have set up a decision tree analysis structure inorder to implement cost-effectiveness analysis. The gross calculation shows vertical integration can achieve positive anticipated results.We proposed nine suggestions based on the results and discussion of the research. In terms of current situation and contributing factors, there are four suggestions:(1) forecasting the trends of health services demand promptly in order to regular and making plans.(2) Making the second allocation in terms of the regional need and demand based on their own situation.(3)Implementing radical payment system reform to change the internal incentives.(4) Setting mandatory evaluation rules by means of administrative power. There are three suggestions in terms of suitable model for public bed capacity development:(1 Constructing the "vertical integration " model under the uniform planning through government planning. (2) The priority is to reform the large superior city hospital, so that the key link is grasped.(3)Applying the key characteristics of vertical integration model into the single entity. Finally, in terms of the internal management of public hospitals, there are 2suggestions. (1)Gradually realize the radical transformation from development relying on scale and the amount of services to the management focus on quality and efficiency. (2) Forming the governance regime within the hospital which can match the external health policy appropriately so that the incentives inside and outside the hospital would be consistent.Innovation point:(1) It’s the first time to systematically summarize and compare the forms of bed capacity development in large hospitals.(2) Summarize the theory interpretation model which characterized by "two-circle" to explain the determinants of the hospital bed capacity planning.(3)Improve the regular one-fold method of "proper scale" and set up the multidimensional comprehensive research system.