Dynamic Evaluation And Promotion Of Healthcare Service Efficiency Considering Quality And Equity

Health is the eternal topic for the survival and development of human society.People’s health is the core competitiveness of the country and society.As the guarantee of people’s health,healthcare service will directly affect the development of the country and society.Under the background of new medical system reform,on the one hand,we evaluates the dynamic efficiencies of healthcare service in 31 provinces in China(except Hong Kong,Macao and Taiwan)from 2008 to 2016.On the other hand,based on the evaluation of the existing efficiency,the promotion of healthcare service efficiency is studied respectively from the perspective of resource allocation and driving factors analysis.This study is based on the perspective of healthcare service operation managemen,and the quality and equity are both considered in the research.First of all,in order to better study the trend of the development of healthcare service efficiency in China before and after the implementation of new medical system reform,based on the DSBM model proposed by Tone and Tsutsui,we construct a Dt SBM model from the perspective of optimal period efficiency.Taking the provinces as the DMUs,the model is used to evaluate the healthcare service efficiencies of 31 provinces in China from2008 to 2016.We obtain the 31 provinces’ period efficiencies,overall efficiencies,regional(Eastern,Central and Western)efficiencies and the percentages of improvement of some relatively inefficient provinces of healthcare service.The results show that,overall,from the dynamic analysis of the efficiency of healthcare service in China,the new medical system reform implemented in China in 2009 has a significant effect.In terms of regions,the east has the highest efficiency of healthcare service,followed by the west and the lowest is the central.From the analysis of the slacks of input-output indicators,we can conclude that the main causes of the relative ineffectiveness of DMUs are the serious redundancy of input indicators: the number of health care institutions,the number of health staffs and the number of beds in medical and health institutions.The dynamic efficiency measurement model Dt SBM,which is constructed,optimizes the period efficiency and more helpful to reflect the variation trend of efficiency.Secondly,the quality and efficiency of healthcare service as the two factors that constitute the performance of healthcare service,there must be a certain relationship between them.In order to more fully analyze the efficiency of healthcare service in China,we evaluate the dynamic efficiency which integrates the quality.In the process of research,in order to ensure the comparability of healthcare service quality,TOPSIS method was used to measure the quality indicators of 31 provinces in China.The indicator is used again as a kind of output to calculate the healthcare service efficiencies of 31 provinces by using Dt SBM model.The results show that: overall,the quality indicators and the relative efficiency values of the 31 provinces in China in 2008～2016 show an increasing trend,and the efficiency value with considering quality is greater than the efficiency value without considering quality.The result proves that the new medical system reform in China also has a significant role in promoting the quality of healthcare service,and the improvement in the quality of healthcare service is higher than that in efficiency.A detailed analysis of the relationship between the quality and efficiency of healthcare service across the country,the eastern,central and western of China shows that,from a macro point of view,there is a positive relationship between quality and efficiency.The new method is proposed for efficiency evaluation integrating quality,and it not only takes the quality as an organic part of efficiency,but also ensures the quality’s comparability between DMUs.Thirdly,under the background of increasing national investment in healthcare,how to utilize existing resources to increase the total supply of healthcare service is one of the key issues facing our country at this stage.We construct a resource allocation model considering equity based on efficiency and prove that the model has Pareto solution.At the same time,due to the deviation of resource allocation in the objective function,it can effectively avoid the multi-solution problem of the model when only considering the output without considering input in the objective function.Combining with the conclusions of Chapter 3 and Chapter 4,using the model without considering the quality as an example,using the constructed model to allocate the resources of healthcare service in 2016,we can find that the total output value of health care increased by 28.4402 billion yuan,the number of medical treatment increased by 1.433119941 billion,increasing proportion are 0.86%and 18.07% respectively.From the resource allocation deviation values,we can conclude that,for the developed provinces,the effect of maximizing output by increasing input is not significant,and the improvement of technical efficiency should be promoted from purely technical efficiency.However,for the relatively backward provinces,the equivalent increase in the input of key resources will bring more obvious outputs increase.That is,the improvement of technical efficiency can be realized through the increase of scale efficiency.We constructe a resource allocation model considering equity from the perspective of efficiency.The model,in the case that resoures will increase in the next period,maximizes the total outputs and considers the equity of resource allocation to DMU itself or others DMUs.Finally,in order to analyze the impact of environment variables on healthcare service more comprehensively,Tobit regression and fs QCA method are used to construct interpretation models of the healthcare service efficiency in China.In the process of research,based on the macroscopic(provincial)perspective,we selecte eight environmental variables from the aspects of people’s living standards,the government’s emphasis on healthcare service and the level of medical development(services).The net effect interpretation model of Tobit regression shows that the same variable has not exactly the same or even the opposite effect on the efficiency when quality is considered or not.The fs QCA interpretation model proves that for provinces with developed economy and healthcare service levels,the government’s emphasis and support would not affect their relative higher efficiency.However,the government’s attention and support directly determine the relative efficiency of provinces with underdeveloped economy and healthcare services.We built the net effect and configurational effect interpretation models of China’s healthcare service simultaneously.We integrate the fs QCA and DEA methods,and firstly apply it to research the healthcare service.