Appraisal Research On County Hospital Productivity During Economic Transition

Hospital productivity is the health resources consumed in producing health services in certain quality and quantity. In our country most health resources are concentrated in hospitals. So the hospital inefficiency is the main cause of the health resources wasting. Thus how to solve the problem of hospital inefficiency has become the important aspect of health reform.County hospital has a significant status and a special role, which plays an important role in satisfying the health service demand of rural people. In August 2006, the health ministry and three other national departments issued "The planning of building and developing rural health service system", which pointed out that county hospital is the guiding centre of medical and professional skill in the whole county, the flagship of the rural health service system. Studying the county hospital productivity is significant for perfecting the rural health service system.Objectives1. To describe the basic character of input and output in county hospitals of the whole nation and to analyze the reasons of the changes.2. Using unidimensional ratio and data envelopment analysis to appraise county hospital productivity during economic transition.3. To analyze the input and output projection value of the incompletely effective DMUs. 4. To analyze the relationship between the results of unidimensional ratio and data envelopment analysis.5. Based on the above analysis, policy options were put forward. MethodsBased on the analysis of the basic character of input and output of county hospitals, unidimensional ratio and data envelopment analysis were used to analyze the county hospital productivity in each province during economic transition. Taking the data of 2005 for example, analyze the input and output projection values of the incompletely effective DMUs. Finally analyze the relationship between unidimensional ratio and data envelopment analysis.Results1. From 1993 to 2005, the scale of county hospitals in each province was enlarged rapidly, which displays slow increases in the number of hospital staff and quick increases in the value of fixed assets. Compared with east area and middle area, west area lagged behind in the number of hospital staff and the value of fixed assets.2. From 1993 to 2005, the average number of outpatients and emergency cases reduced first, and then increased in county hospitals of the whole nation. The average number of patients who were discharged from county hospitals also reduced first, and then increased.3. The average professional income and the average professional expenditure in county hospitals of the whole nation gained a quick rise from 1993 to 2005. In most provinces, the professional income and expenditure were not balanced and there was a deficit in each year. The share of government subsidy in total income did not change much in all the provinces, except a few provinces.4. Judged by the average level of the whole nation, the workload per worker decreased wave upon wave. In the same period, the unit cost increased quickly. 5. Judged by the overall level of the whole nation, the complete efficiency scores decreased a little from 1993 to 2005 during economic transition. The complete efficiency scores of most provinces which lied in the east area were high. The average scores of middle area changed a little. The complete efficiency scores of the provinces which lied in the west area were uneven.6. The scale efficiency scores of most county hospitals were less than 1 in 1993 and more than 1 in 2005, changing from increasing return to scale to decreasing return to scale.7. Judged by the technique efficiency, the county hospitals of the whole nation achieved technique efficiency in each year, except 2003.8. The results analyzed by the input and output projection values in 2005 told us that "input surplus" and "output insufficient" in varying degrees existed in all the incompletely effective DMUs.9. There was a significantly positive relationship between the average workload of workers and DEA scores. But there was no relationship between the unit cost and DEA scores.Conclusions1. There was geographical distribution inequity in health resources. East area possessed more health resources than middle area and west area. The health resources utilization efficiencies in the middle area and west area were lower than that of east area. Thus health planning should be carried out and health resources should be allocated reasonably.2. In comparison with the outputs, the inputs of most county hospitals were at the state of "relative surplus", which leaded to the decreasing return to scale in county hospitals. In the future, control the hospital scale, raise the management level and heighten the internal building of county hospitals.3. Because of the narrow coverage of the medical insurance, the ratio of fee for service was high and the health service demand was restrained to a certain extent. Speed up the reform of medical insurance system and strengthen the resistance to disease risk.4. Uphold the leading role of government and adopt market mechanism properly, decreasing medical service prices and increasing medical service quality and efficiency.