| BackgroundTraditional Chinese medicine as a very important part of national wealth, contains extremely adequate philosophical thought and humanistic spirit, shows our Chinese cultural soft power on great extent.For a long time, traditional Chinese medicine and west medicine completed and largely developed each other, which contributing to protecting and improving people’s health formed Public health and medicine industrial critical feature and excellent advantage. The clinical curative effect of traditional Chinese medicine is reliable, prevention and health care effects is unique, curative methods are flexible, and curing expense is relatively low. Especially, traditional Chinese medicine has showed dramatic advantage with the change of healthy version and medical pattern.At the county level of the hospital that is an important component of medical service agencies in our country, plays an role of faucet in the medical service industry, and it should improve the capacity of basic traditional medical services to satisfy urban and rural residents’demand. The foundation of hospital at the county level is in rural areas. vast peasantry has enormous demand of traditional Chinese medicine, so that the county level of the hospital gradually became the center of rural health curing and prevention. And it’s also responsible for primary rural medical care. At the county level of the hospital conducting as main power in rural traditional medical service, relates to the wax and wane of rural Chinese medical development, is vital to the whole traditional Chinese medical industry.But the county level of the hospital exists many problems at present. Chinese medical services’efficiency is low, configuration Management is unreasonable, lack of governmental finance support and so on.As for the research of hospital medical efficiency mainly concentrate on certain reason what influence medical service most and comments on medical association’ service. However, few research on efficiency of traditional Chinese medical service. What’s more, medical efficiency greatly influenced by it’s inner factor.This research come up with four questions:(1) what’s the present situation of the county hospital of traditional Chinese medicine health service?(2) How’s the efficiency of the county hospital of traditional Chinese medicine health service?(3) What is the key factors that influence efficiency of traditional Chinese medicine health care services?(4)How to improve the efficiency of hospital of traditional Chinese medicine medical service?ObjectivesThe overall objective of this research is to analysis medical service efficiency of traditional Chinese medicine, through the analysis of Shandong Province County Chinese medicine hospital medical service present situation. And according to the environmental impact of the research on the theoretical construction of the evaluation index system of factors analysis, quantitative analysis of the influence factors of medical service efficiency of traditional Chinese medicine, improve medical service efficiency of Chinese policy recommendations.The specific objectives of the study:1. Specific analysis of the current situation of medical service of Shandong Provincial Traditional Chinese Medical Hospital2. According to the problems in the current situation, using the method of data envelopment analysis of Shandong province101County Hospital of traditional Chinese medicine of traditional Chinese medical service efficiency, focuses on the analysis of the overall technical efficiency(TE), pure technical efficiency(PTE) and scale efficiency(SE) analysis. CRS model of comprehensive efficiency of use, using VRS model to analyze the pure technical efficiency and scale efficiency, and to make quantitative analysis on the main problems of non-effective County Hospital of Chinese medicine hospitals exist in the input and output.3. According to the above research and the factors influencing Shandong Province Chinese medical service efficiency, determine the evaluation index system of impact factors by using the method of literature study, expert consultation and AHP.4. Based on the index system of the influencing factors, we can use Tobit regression method to make a regression analysis, to find out influence factors of hospital efficiency of, and make a analysis on the correlation between the level of each index and efficiency to carry out systematic theoretical analysis of influence factors of hospital efficiency.Methods This research is a cross-sectional study design. The samples of research are hospitals for the county (city) of public TCM from Shandong province, in total101hospitals. In this study, data is from the Health Bureau of Shandong province and Shandong Provincial Administration of traditional Chinese medicine, which survey was the province’s basic situation of Chinese census carried out in2010.That survey was a comprehensive survey.1. The method of data envelopment analysis (DEA)For the selection of DEA model, the study use CRS model and VRS model CRS and VRS model does not require the production function firstly set up the hospital andineffective distribution rate items, but can the method of data envelopment analysis to construct the best practice to compare the decision unit and the best decision unit, and calculate the efficiency value of each unit. CRS model can determine the technical efficiency of hospital (TE), also called the comprehensive efficiency,which have the ability to maximize output hospital in a given input conditions. But CRS model cannot explain inefficiency determined by pure technical inefficiency or scale inefficiency. So the study use VRS model to further analyze the technical efficiency into pure technical efficiency(PTE) and scale efficiency (SE). The DEA model used in this paper is output oriented which means to understand the efficiency output in certain circumstances.Variable selection is so important that can affect the quality of the model. So we use pastor Et al. more effective screening method of variable DEA research which based on strict mathematical argumentation.2. Construction methods of influence factors systemAfter studying of literature analysis, we can determin the factors index system,and determine the factors that influence the index system based on two Delphi method, and use the analytic hierarchy process (AHP) to determine the index weight of influence factors. 3. Methods of data analysisBy Using descriptive statistical analysis,the paper analyze the current status of traditional Chinese medicineof traditional in Chinese Medical Hospital, analyze the input-output index description and comparison, and analyze the basic features of the influence factors. By using Tobit regression, we can make a quantitative analysis on the influence factors.In this paper, the analysis process is divided into three parts. The first part, we make a descriptive analysis about the Chinese medical service present situation in county hospital. The second part, we use data envelopment method to calculate the county hospital of Chinese medical service efficiency and void analysis projecton analysis through the aspect of input-output. The third part, we use Tobit regression to analyze the influential factors.Results1. basic situation of Chinese medicine services in medical institutionsThere are123public TCM hospitals (Integrative medicine of Chinese and Western medicine, ICWM hospital) in Shandong Province, including2provincial,17municipal,101county (city, district) levels.The personnel of TCM hospital in Shandong:The number of staff in Shandong TCM hospital is36433, including31075health and technical personnel;5713medical practitioners (assistant) of TCM, accounting for18.38%of the practicing (assistant) doctors; the education level of TCM service personnel was mainly undergraduate with the percentage of40.94, and the master’s degree or above accounted for10.38%; the Personnel titles was mainly intermediate, accounted for43.26%, and the senior titles accounted for22.52%. The number of TCM service personnel in provincial general hospital (specialized hospital) was8455, including6241of Chinese medicine specialty and2214of Chinese pharmaceutical specialty, the number of practicing (assistant) doctors was74768, including6119TCM practicing (assistant) doctors, accounting for8.18%. Medical service:13.26%outpatient services and11.80%of hospital services were held by the public TCM hospitals in Shandong Province. The patients in expert outpatient service accounted for23.59%of its total diagnostic person number in public TCM hospitals.2. DEA (Data Envelopment Analysis) analysis of efficiency of TCM medical servicesThis study analyzed the TCM health service efficiency in101county level hospitals in Shandong province using CRS model and VRS model of DEA method, the indicators were from input and output indicators with correlation of TCM.The results show that,First, the overall efficiency of TCM medical service is not high in county level hospital.From the data we can see that he overall efficiency of TCM medical service is not high, if in certain inputs, the target values of output had big gap, and if in certain outputs, the inputs would have waste. There were51comprehensive efficiency county level TCM hospitals and the average overall efficiency was50.50%.55county level hospitals had pure technical efficiency, and the proportion was54.46%. The Average scale efficiency was96.40%, and52hospitals had scale efficiency with the percentage of46.53%.Second, the economies of scale existed in county level hospitals.The medium-sized hospital whose actual beds was between151-200had the lowest efficiency, then the efficiency increased with the increase of bed, especially that the efficiency of more than500-bed hospital at the county level are all effective.Third, from the point of returns to scale, the vast majority of the hospitals were in diminishing returns to scale, the returns to scale of large and medium-sized hospitals were not increasing.Fourth, from the results of projection analysis of input and output index, the input indicators were more than the target value and the output indexes didn’t reach the target, which meant that the hospital should improve the medical services of TCM from the quality, rather than the pursuit of scale expansion and the renewal of medical equipment.3. The factor analysis of TCM medical service efficienciesThrough the analysis of influence factors on TCM medical service efficiencies in101TCM county level hospitals using tobit regression analysis, and from the external factors and the internal factor we can see:The administrative land area (square kilometers) and policy support were the main external macro factors influencing the efficiency. In three models, the influence coefficient of support level and the percentage of financial aid were positive, so the support of the hospital and the hospital financial aid had positive correlation with the medical service efficiency of TCM hospitals, and the two indicators had passed the test of significance in the three models. This indicated that the support to the hospitals can promote the TCM hospitals’ medical service efficiency.From the external micro factors influencing hospitals and also the competitive factors we can see that the percentage of health technical personnel was influence factors on the three efficiency values, and all had statistical significance, and the regression coefficient was negative. This showed that the high the percentage of health technical personnel the lower the efficiency got, and the more the personnel got, the greater the pressure of the hospital, and the easier it was to develop a more profitable way of western medicine diagnosis and treatment.And from the inner competition factors we can see that most of the indicators had no significant impact on efficiency, only the proportion of TCM drug income and TCM spending accounts for the proportion of drug expenditure had influence to the overall efficiency and pure technical efficiency, and all the indexes had not significance to the scale efficiency. This showed that competition factors were not the main factors that influence efficiency of medical services of traditional Chinese medicine, in other words, the good development of western medicine can’t represent the TCM medical efficiency would certainly be affected.Conclusion and policy implicationLots of problems have found in county level traditional Chinese medicine hospitals of Chinese medical services from the hospital’s internal factors analysis. First of all, the overall efficiency of county level traditional Chinese medicine hospital is not high. Secondly, economies of scale exist in county level traditional Chinese medicine hospitals. Thirdly, the Enthusiasm of Health professionals to provide Chinese medicine in county level traditional Chinese medicine hospitals is not high.We can see from the analysis of the external environment firstly, the better economic development the lower medical services efficiency of county level traditional Chinese medicine hospital.From the Tobit regression we can know that the impact of economic development indicators on traditional Chinese medicine service’ efficiency is negative.Secondly, the support efforts of Chinese medicine can effectively improve the efficiency of Chinese medical services in county level traditional Chinese medicine hospitalWe can also see from the tobit regression, the indicator of support efforts to Chinese medicine has the impact to the efficiency of Chinese medical services and the impact is positive, that means, the support of Chinese medicine can improve the efficiency of Chinese medical service in Chinese medicine hospital.The recommendations Policy based on the conclusions of this study are following:Measures for the hospital internal factors:Firstly, the county level traditional Chinese medicine hospital should strengthen its medical services’ level As can be seen from the study, all inputs and outputs indicators of the Chinese medicine hospitals are reaching the target value, that means, Chinese medicine hospitals did not achieve the best outcomes under the existing scale of investment in the existing conditions. In the interview many officials in Chinese medicine department complaint that the TCM hospitals did not pay attention to traditional Chinese medicine departments, because of the poor economic benefit in Chinese medicine department. Secondly county level traditional Chinese medicine hospitals should be "Equal emphasis on traditional Chinese and western","Equal emphasis on traditional Chinese and western" is the country’s health policy, hospitals should take this principle, improve the Chinese medicine’s involvement in major diseases, improve service quality and clinical efficacy in Chinese medicine hospital, expand the indicators’range. To strengthen scientific research efforts in Chinese medicine, give full play to the advantages and expertise of Chinese medical technology to form their own core competitiveness in Chinese medicine hospital. Hospital of TCM should focus on their specialties.Measures for the hospital external factors:Firstly, the government should expand the support efforts on the Chinese traditional medicine hospitals. Chinese medicine hospitals are a non-profit public medical institutions, is part of the Government to implement certain welfare policies, lack of government investment is not conducive to reflect the public TCM hospitals’ welfare, and it is difficult to promote the development of the Chinese medicine services. Lack of government investment will inevitably lead to the hospitals’pursuit of the interests and have to survive from the drug treatment. Financial investment for Chinese medical services has a significant impact on the efficiency.Secondly, the government should support from the policy. Except financial investment, policy support should be more, for example, the use of Chinese medicine services should be compensated and such as the Chinese medicine doctors in TCM hospitals should be given supports on the economy and the professional title. The westernization phenomenon in TCM hospitals also should be controlled, TCM hospitals should return to the "Chinese" characteristics. Developing a scientific evaluation system can control the phenomenon of westernization phenomenon in TCM hospitals. |
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