Performance And Scale Economy Analysis For Ministry's General Hospital Of China

Since the 1990s, the number and scale of China's General Hospital has been rapid development, and the servicing capacity has also been further strengthened. Along with the gradual establishment of the socialist market economic system, its shortcomings are becoming increasingly obvious, many hospitals expand the scale or increase the number of beds in order to improve their economic competition, which kept soaring in bed size, particularly in General Hospital. Hospital-scale development has become a common means in market competition, this trend cause the imbalance of the macro-structural in the medical and health resources. 80% of health resources are concentrated in the cities, of which 80% concentrated in large and medium-sized hospitals. With medical resources gathering in the large and medium-sized hospitals, health waste and inefficient use of resources are becoming seriously. Facts have proved that the expansion of hospital scale does not mean the maximize efficiency. Many hospitals do not achieve the expected results after the expansion of the size, but on the contrary, become non-economies of scale.Objective: The descriptive statistical methods to evaluate the overall efficiency and cost in different sizes of Ministry's General Hospitals was used, in order to explore for quantitative measurement the impact to hospital efficiency and cost. The efficiency score as representative indicator of medical outputs and analyze economies of scale of those hospitals.. At last provide reference for the hospital managers and health administration leaders in decisions.Data: Data of 23 general hospitals Ministry of Health of China wascollected, the data cover two years(2004 and 2005). The subject divided into 3 scales based on the numbers of hospital beds, such as small-scale (defined as 1000 and below), medium size (1000-1400), and large (defined as greater than or equal to 1400 hospital beds).Methods: (1) General descriptive statistical analysis was applied to hospital allocation of resources, use efficiency and performance. (2) DEA was used to evaluate the efficiency of samples. (3) Line regression method was used to analyze the related factors of hospital efficiency and scale-economies. (4) Cost function to explore the impact factors of cost was constructedConclusion: (1) Its negative correlation between hospital size and overall efficiency, the expansion brought the declination of overall efficiency. Among different sizes of sample hospitals, small and medium-sized hospitals are clearly better than the large size hospitals in overall efficiency. (2) Apply DEA efficiency scores as indicators of output and other variables related to the efficiency as input indicators to establish logistic regression model, shows that the efficiency of hospital scale makes of diminishing returns. It should be taken measures to control further expansion. (3) Guided by the principles of Regional health planning and the allocation of resources optimizing in order to achieving scientific development of bed scale. (4) There is a big waste of health resources utilization was made as the expansion of hospital scale. Cost function analysis showed that in the current circumstances there is a considerable void expenses about 14.7 million RMB in sample hospitals. (5) Expensive fee was caused by the increasing cost of medical. The first three factors affect the total costs (or total expenditure) are the cost of per bed-days, the average length of stay in hospital and the volume of doctors.Due to the limited financial compensation for medical institutions, their will gain this gap by increasing the social compensation (e.g. fees, etc.), thus bringing a greater cost burden for patients. (6) One of the effective ways of restricting hospital cost is reduced hospital beds in international. (7) Based on the DEA we make an analysis of economic scale, which is a useful and meaningful attempt of analysis method.Suggestion: (1) Scale expansion must match with the Regional healthplanning, and adhere to the principle of moderation. Hospital expansion is not only micro-level scale development, but also affects the macro level of regional health resources and the structure of the total.(2) Scale development stratagem should meet with the long-term program; especially pay attention to combining with short-term goals and long-term goals. Guiding the public hospitals embark on the road of connotative way. Make the unity of size, structure, quality and efficiency. (3) Hospital development should be in line with the reform of health care system and health insurance system. Along with the clear objection of urban medical reform, the implementation of the medical insurance system, and the improvement of the referral system, or along with the development and growth of community health services, the general hospitals will reduce the load of inpatients and outpatients, then the side effects of blindly expand the size of hospital will stand out. (4) Government should do well in regional health planning, optimizing the allocation of health resources, and establishing strict management procedures. (5) Hospital examination approach should be change from simple to the comprehensive performance assessment model.