Medical Service Efficiency Evaluation Of The Township Health Centers In Liaoning Province

ObjectiveDepending on the base-line data of the township health centers in Liaoning province in 2005,we chose the important,typical,acquirable indicators for the operational efficiency evaluation of the township health centers(THCs).Taking the benchmarking as the guiding ideology,we evaluated the operational efficiency of the THCs in Liaoning province with data envelopment analysis(DEA) and analyzes the factors influencing the efficiency in the second stage with TOBIT regression model for providing a basis for putting forward some practical measures.Data and MethodsThe objective of this study were the base-line data of the THCs in Liaoning province in 2005 collected making use of the＜Enrollment Form of rural health agency of township level in Liaoning province＞.The data included fundamental state of the THCs,health professional,housing area,capital asserts,magnitude of the operation in 2005,business work in 2005.The main methods for this study as follow:Literature law:A lot of research papers available in English and Chinese were referred to understand the progress in this field.The efficiency evaluating indexes of the THCs were selected with use of these literatures.Benchmarking:benchmarking is a process to help the subject with looking for benchmark goals,determine the target,tracking and study and to surpass the benchmarking goals through comparative analysis continuously.The objective of benchmarking is to become the best via finding the gaps.We planed to build a good cycle mechanism for improving the operational efficiency of the THCs.Statistics methods:using the methods of cluster analysis and Data envelopment analysis to filter the efficiency evaluating indexes and do relatively efficiency evaluation for the THCs;using K-W test and TOBIT regression analysis to explore the factors impacted the operational efficiency of the THCs.ResultResults of efficiency analysis of the THCs:The average totally technical efficiency score of 632 THCs was 31.17%.The result further showed that only 5.54%THCs operated efficiently.The totally technical efficiency scores of 22(3.48%) THCs ranged from 80%to 100%(not include 100%), which were very close to their optimal scale.The totally technical efficiency scores of 477(75.47%) THCs ranged from 0 to 40%(include 40%),which were far to be efficient.The average pure technical efficiency score of 632 THCs was38.00%,only 64(10.13%) of the THCs were pure technical efficiency,the scores of 495(78.32%) of the THCs were under 60%.The result show that only 101(15.98%) out of 632 THCs were optimal scale.The scale efficiency scores of 367(58.07%) out of 632 were ranged from 80%to 100% (not include 100%),which are operating very close to their optimal scale,and the ratio of the THCs ranged from 0 to 60%(not include 60%) was 11.39%,which keep a large distance to be efficient.The Yingkou city took a higher proportion of THCs with totally technical efficiency(15.79%),the second one was Panjin City(11.11%);the Yingkou city took a higher proportion of THCs with pure technical efficiency(18.42%),the second one was Fuxin city(17.14%),the third one was Chaoyang city(12.50%);The Yingkou city took a higher proportion of THCs with optimal scale(15.79%),the second one was Panjin city(11.11%),the third one was Fushun city(10.00%).Results of the comparison about the amount of health resources and health services of the THCs:Results of the comparison about the amount of health resources.There were statistically significant differences between group 1 and group 4 but group 1 and group 3.Group 4 showed a significantly higher among the number of health technical personnel(F=14.975,P=0.000),personnel per 1000 rural population in THC(F=23.185,P=0.000),the ratio of personnel with junior college educational background(F=15.041,P=0.000),Beds Per 1000 Rural Population in THC(F=13.065, P=0.000),the house architectural area(F=12.173,P=0.000),amount of the specialized equipments(F=10.161,P=0.001).Results of the comparison about the amount of health services.The difference between group 1 and 4 was statistically significant for the variables of bed utilization ratio(F=8.747,P=0.003) and the total operation number(F=4.026, P=0.045)Results of comparison among groups about amount of the health services about surgery:We further do comparison of the operation numbers in 2005 among the four groups,for the number of birth control surgery(F=8.679,P=0.003),the difference between group 1 and group 4 is significantly,and there are no difference among the other groups of the rest variables.Analysis results of the impact factors about the totally technical efficiency of the THCs:Opened beds capacity,the number of health technical personnel,the ratio of personnel with junior college educational background,outpatient visits,the total operation number and the number of out-patients of the whole year played important roles in the evaluation of the THCs.The regression coefficient of the opened beds capacity was negativevalue,which suggested that the THCs scale were bigger,the efficiency scores were lower;the regression coefficient of the indicator of the number of health technical personnel was negativevalue,which suggested that as the number of health technical personnel increased,the efficiency scores decreased;the regression coefficient of the ratio of personnel with junior college educational background was negative value,which suggested that the higher the ratio of personnel with junior college educational background,the lower of efficiency scores;the regression coefficient of outpatient visits,the total operation number and the number of out-patients of the whole year was positive value which suggested that the higher the health service volume,the lower the efficiency scores.Conclusion1.As for the national policy system,financial investment mechanism and the practical situation of the THCs,it was meaningful to improve the efficiency of the THCs with scientific methods.2.Data envelopment analysis was suitable to evaluate the relative efficiency of the THCs,and found out the reason field the THCs inefficient.3.The operational efficiency of the THCs was low,characterized by health resources waste and extravagances,which suggested that the government should pay more attention and adopt appropriate measurement to improve the efficiency of the THCs.