| Objective: In 2012,the 18 th National Congress of the Communist Party of China proposed to uphold the development of both traditional Chinese medicine(TCM)and Western medicine and support the development of TCM.In recent years,the Chinese government has increased its support for TCM and TCM hospitals,leading to a rise in the total amount of TCM medical resources and acceleration in the development of TCM.The report of the 20 th National Congress of the Communist Party of China in 2022 further emphasized that TCM hospitals are the cornerstone and a crucial component of TCM medical services in China.The complementarity and mutual promotion of TCM and Western medicine have resulted in significant advantages in China’s medical and health services.For a long time,the focus on the development of TCM has primarily been on increasing the total supply,while inadequate attention has been paid to the efficiency of health resource allocation in TCM hospitals,which serve as the cornerstone of TCM medical services.Improving the efficiency of medical and health resource utilization and allocation equity in TCM hospitals is an essential means of better meeting the people’s demand for high-quality medical and health services.Therefore,in the context of TCM’s favorable development,increasing research on the efficiency of resource allocation in TCM hospitals is of immense significance to promoting TCM’s development in China.The purpose of this study is to scientifically evaluate the efficiency of health resource allocation in TCM hospitals in China,analyze the equity of health resource allocation in TCM hospitals from multiple perspectives,predict the growth trend of human,material,and financial resources in TCM hospitals in a scientific way.The study aims to identify the key factors that affect the efficiency of health resource allocation in TCM hospitals,analyze the main problems affecting the equity of health resource allocation in TCM hospitals,and accurately understand the dynamic changes in the supply-side of TCM medical resources in China.The study also proposes reform measures and countermeasures to optimize the allocation of TCM medical resources and solve the problems of unbalanced and insufficient development of TCM.Methods: First,according to the requirements for selecting evaluation indicators for hospital efficiency input-output evaluation based on data envelopment analysis(DEA)model,TCM physicians,pharmacists,registered nurses,number of actual beds,medical business costs,and government financial allocations are selected as input indicators for TCM hospital efficiency.The output indicators are the number of TCM outpatient visits,number of discharged patients,medical income,and income from TCM-related medicine.Through correlation analysis,DEA model is used to dynamically and statically evaluate the efficiency of health resource allocation in TCM hospitals in 30 provinces and cities in China from 2012 to 2020.Second,based on DEA model,the efficiency value of health resource allocation in TCM hospitals is taken as the dependent variable,and Tobit panel data regression model is used to construct a multiple linear regression model to analyze the factors affecting the efficiency of health resource allocation in TCM hospitals and identify the key factors.Finally,using equity analysis method,the Lorenz curve is drawn,and the Gini coefficient is calculated to analyze the equity of health resource allocation in TCM hospitals based on population and geography.The Theil index of human,material,and financial resources allocated according to population distribution is calculated to analyze the main problems affecting the equity of health resource allocation in TCM hospitals.Using the grey forecasting model and taking TCM physicians,registered nurses,pharmacists,the number of actual beds,medical business costs,and government financial allocations as the prediction units,the growth of health resources in TCM hospitals is predicted from three aspects: human,material,and financial.Based on the industry layout theory,suggestions are proposed to improve equity and optimize the allocation of TCM medical resources.Results: First,the results of the DEA model show that Beijing,Shanxi,Liaoning,Heilongjiang,Zhejiang,Henan,Hunan,and Guangdong have consistently maintained effective comprehensive technical efficiency,pure technical efficiency,and scale efficiency in TCM hospitals.There is a significant difference in comprehensive technical efficiency among different regions,with Shanghai having the lowest comprehensive and pure technical efficiency in 2020,with a lowest value of 0.475 and 0.628,respectively.Ningxia had the lowest scale efficiency,with a lowest value of 0.711 in 2014.The pure technical efficiency of TCM hospitals in western provinces such as Guizhou,Gansu,Qinghai,and Ningxia has always been effective,with increasing returns to scale,while the scale efficiency of hospitals in eastern provinces such as Shandong and Jiangsu has not reached effectiveness and has decreasing returns to scale.The scale returns of hospitals in Chongqing,Jiangxi,and Sichuan in central and western regions have increasing returns,but the pure technical efficiency is relatively low.Second,the redundancy analysis shows that ineffective allocation of TCM hospital medical resources exists in eastern,central,and western regions,particularly in Sichuan.There is a surplus of TCM physicians and TCM pharmacists,with an average surplus of 1154.76 and433.44,respectively.Jiangxi has the highest surplus of registered nurses,with an average of 391.49,while Hebei and Fujian only had surplus in 2020.Guangxi has the highest surplus of hospital beds,with an average of 5008.51,much higher than other provinces.The medical business costs and government financial allocation redundancy are more prominent in Shanghai,Jiangsu,and Chongqing.The average redundancy of medical business costs in Shanghai is 186.1 million yuan,and the redundancy of government financial allocation is 67.3 million yuan.There is no waste of financial resources in Gansu,Qinghai,and Ningxia,areas with relatively low economic development levels.Third,the Tobit regression model results show that the proportion of TCM physicians per10,000 people is positively correlated with the comprehensive technical efficiency,pure technical efficiency,and scale efficiency of TCM hospitals at a significant level of 5%.The urbanization rate and the proportion of medical income to total income are positively correlated with scale efficiency at significant levels of 5% and 10%,respectively.The proportion of operating expenses to total expenses,the average daily outpatient visits per physician,and the average length of stay are negatively correlated with comprehensive technical efficiency and scale efficiency.The average hospitalization cost per patient is negatively correlated with comprehensive technical efficiency at a significant level of 5%.The proportion of medical income and government financial allocation to total income are negatively correlated with pure technical efficiency at significant levels of 10% and1%,respectively.The per capita GDP is negatively correlated with all three efficiencies.Fourth,the Lorenz curve and Gini coefficient show that the allocation of medical resources in TCM hospitals in 30 provinces and cities in China is below the absolute fairness line in terms of six indicators of population and geographic distribution.The curves of medical business costs and government financial allocation deviate significantly.The Gini coefficient for distribution of TCM physicians,pharmacists,registered nurses and hospital beds by population distribution is generally below 0.2,while the Gini coefficient for distribution of hospital beds by geographic distribution exceeds 0.4,and the Gini coefficient for distribution of TCM physicians,medical business costs,and government financial allocation by geographic distribution exceeds0.6.The Theil index for resource allocation by population distribution shows that the indices for human and financial resources are decreasing,while the index for material resources is increasing,mainly due to regional differences.Fifth,the six investment indicators will increase from 2021 to 2025 by the results of the grey prediction model for the medical and health resources in TCM hospitals.The average annual growth rate of TCM physicians is 6.753%,TCM pharmacists is 3.703%,registered nurses is 8.184%,hospital beds is 6.685%,medical business costs is 10.066%,and government financial allocation is 18.534%.The trends in the number of physicians,pharmacists,nurses and hospital beds are similar to those from 2012 to 2020,with actual medical business costs in 2019 exceeding the predicted value,and actual government financial allocation in2020 exceeding the predicted value.Conclusion: First,at the current stage,the efficiency of medical resource allocation in most of China’s provinces and cities with TCM hospitals is on an increasing trend.However,there are significant differences in the comprehensive technical efficiency values among different regions.The comprehensive technical efficiency values are lower than the pure technical efficiency values,and the pure technical efficiency values are lower than the scale efficiency values.Improper development scale of TCM hospitals is not conducive to the improvement of comprehensive technical efficiency,and extensive development methods are not conducive to achieving high-quality development of TCM hospitals.There are still some provinces and cities where medical resource allocation is ineffective,indicating a problem of inadequate utilization of health resources and a serious phenomenon of waste of medical and health resources.Second,among the factors affecting the efficiency of medical resource allocation in TCM hospitals,the number of TCM physicians,the proportion of business activity expenses,the proportion of average medicine expenses per hospitalized patient,the average daily outpatient visits and hospitalized bed days per doctor are critical factors.Among them,the number of TCM physicians is positively correlated with the three efficiencies,while the remaining four influencing factors are negatively correlated with the efficiency of medical resource allocation in TCM hospitals.To improve the efficiency of TCM hospitals,it is necessary to increase the number of TCM physicians differently according to the redundancy situation in different regions.Meanwhile,it is necessary to reduce business activity expenses,lower drug expenses for hospitalized patients,reduce the average daily outpatient visits per doctor,shorten the hospitalized bed days to improve the efficiency of TCM hospitals.Third,the equity of medical resource allocation in TCM hospitals in China according to population distribution is better than that according to geographical distribution,as there are significant differences in the geographical distribution of TCM medical resources.The equity of medical business costs and government financial appropriations is poor,with significant differences in unequity among different regions.The unequity of government financial appropriations affects the efficiency of medical resource utilization in TCM hospitals in different regions,failing to achieve unity between equity and efficiency.To improve the equity of medical resource allocation in TCM hospitals in China,the government needs to fully consider the differences in population,geography,and economy among different regions,focus on improving the unequity of resource allocation within regions,and realize the optimal allocation of TCM medical resources in China. |
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