Study On The Performance Evaluation Index System For Public Non-profit Hospital In China

Background:Study on the hospital performance evaluation system in China has gradually come into a mature era since the year 2000 when WHO first released the health system performance evaluation framework. Hospital as a main component of the national health system, takes many responsibilities of the medical care and health promotion especially when it has to face challenges from the hospital classification intonon-profit hospital and profit hospital, china's entry into WTO, medical care opening market in China. However hospital in traditional healthcare system typically known as low efficiency in medical services and huge waste in health resources has become on the target since the reforming and opening up in health policies in China recently, thus hospital performance evaluation and monitoring have been a critical task to those health policy makers and hospital managers. Objective:The study on public non-profit hospital performance is to construct a performance evaluation index system based on four aspects: medical care management, hospital economy, hospital development, hospital responsiveness introduced from business Balanced-Scored Card (BSC) performance management concept. The study also analyses the hospital performance in ZHEJIANG province in terms of the efficiency index from Data Envelopment Analysis (DEA) and the relationship between efficiency index and the former newly-developed performance index system by TOBIT regression. Finally a policy suggestion on further modifying to current hospital performance index system is put forward to enhance the hospital efficiency integrating the BSC concept so as to improve hospital core competition. Research method:Delphi method: a professional panel, including 20 professionals in hospital teaching or hospital manager has been selected based on their practices knowledge and fame in hospital management. The hospital performance evaluation index system including Four aspects service quality and effectiveness, financial condition, study/creative ability, hospital development and hospital responsiveness has been discussed in two rounds of expert consultation to form agreement.Econometric methods: Data Envelopment Analysis (DEA) is used to measure the hospital performance status in ZEHJIANG province with four input indices: hospital bed number, hospital staff number, permanent assets in total value, medical care expense;four output indices: outpatient and emergency visits, inpatient visits, yearly bed day occupation, medical care revenue. The operation is accomplished on the program software DEAP2.1 established by Tim Coelli, a professor from departmentof econometrics University of New England of Australia. TOBIT regression analysis, combined with the DEA measurement, is further applied to evaluate the performance index system. Research results:1. The performance evaluation index system based on service quality and effectiveness, financial condition, study/creative ability and hospital responsiveness according to two rounds of expert consultation has come into being aiming at adapting to the reforming health service system in China.2. the result from DEA analysis show that only sixteen(10.96%) of 146 hospitals in class 2 were identified technically efficient of Constant Return to Scale (CRS) while the figure is eighteen (34.62%) of 52 hospitals in class 3;eighty-four (57.53%) hospitals of 146 hospitals in class 2 were measured in the status of the Increasing Return to Scale (IRS) and 48 (28.77%) of them were in terms of Decreasing Return to Scale (DRS) while the correspondence are only thirteen (25%) (IRS) and eighteen (34.62%) (DRS) of 52 hospitals in class 3 respectively.3. the results Through DEA analysis and TOBIT regression show that The performance evaluation index system on service quality and effectiveness, financial condition has acceptable characteristics of stability, reliability and availability with the simulation on hospitals in the ZHEJIANG province, the hospital performance index system including the selected 26 indicators based on weighted shows satisfactory reference indices of yearly workload per person, bed efficiency, average inpatient staying period, success rate in saving dying patient and recovery rate on service quality and effectiveness and yearly professional revenue per person, yearly expense per person, balance rate and debt rate on financial status in decision-making, however it has some obvious defects and obstacles in application on hospitals in class 3.Conclusion:The results suggest hospital performance index system is effective but should be further modified. The BSC concept should be adopted in hospital performance management focusing on improving operation efficiency to enhance the core force forhospital competition.