| The county hospital is the medical center within the scope of county and the core of the Three-layer Rural Health Care Network, which undertakes heavy responsibility to protect people's health. Its operating efficiency directly influences more than billion people's healthy level. At present stage, because of the government financial compensation insufficiency, the county hospitals are driven by profit-making obviously. Generating profits is the main purpose of the county hospital, missing the public welfare seriously. The main way of generating profits is not to enhance the diagnosing and treating technology, but is to expand the hospital scale blindly, which leads to irrational allocation of health resource and the lower ratio of resource utilization. The technology efficiency of the county hospital is low, and the scale efficiency is decreasing progressively. The new medical reform plan released in the April,2009. It stipulated explicitly that increasing the government investment, strictly controlling the hospital scale, improving the service quality, and fully using limited health resources to raise the medical service efficiency. Under this policy background, the input-output study of the county hospital in Shandong Province has the significant practical significance. It not only can discover the problems which the county hospitals have and explore the feasible measures, but also provide the basis for the government finance compensation standard.Research ObjectiveTo evaluate the input-output efficiency of the county hospital in Shandong Province, analyze the problems which the inefficient hospitals have, explore the primary factors which determine the hospital efficiency, and advance the specific recommendations, in order to provide the guidance for the hospital administrators to improve the input-output efficiency and provide the basis for the government finance compensation standard.Research MethodsThis study choses 140 county hospitals of Shandong Province as the object (including county people's hospitals, county-level municipal people's hospitals and district people's hospitals), excluding 40 district people's hospitals which are relatively close to or within the urban areas. The study investigates a total of 100 county hospitals. The survey data comes from hospital statistics data in 2009 in the Health Information and Statistics Center of Shandong Province, including human resources information, material resources information, revenues information, expenditures information, hospital outputs information and medical quality information.Data Analysis MethodsThe study used Excel to establish a database for entry, collation and proofreading, using input-output ratio to describe the basic situation of the county hospital. Using data envelopment (DEA) analysis to evaluate the overall efficiency, scale efficiency of the county hospital, through the projective value to analyses the input-output problems of inefficient hospitals, using the Tobit regression analysis to explore the main factors that determine DEA scores, then gaining the factor scores through factor analysis to evaluate the hospital efficiency, using multiple linear regression analysis to explore the main factors that determine factor scores. Using these three methods for mutual authentication and develop the decision tree model of hospital efficiency, under which put forward specific proposals.Research Results1,input-output ratio analysisThe rate of utilization of hospital beds was (90.00+19.00)%, The number of bed turnover was (44.63±11.18) times. The average of hospital stay was (7.41± 1.50)days. The business income per bed per day was (491.18±109.03) Yuan. The business income per patient per time was (86.18±28.60)Yuan. The out-patient medical cost per capita was (145.54±40.83) Yuan. The inpatient medical cost per discharged was (3644.86±1127.57) Yuan. The unit cost was (381.05±109.15) Yuan. Average daily visits per doctor were(4.61±1.86) times. Average daily hospital bed days per doctor were (2.21±0.65) days. The number of surgery per doctor per year was (26.02±8.88) times.2,DEA analysis53 county hospitals were higher efficient in terms of DEA Analyses among 100 county hospitals.47 inefficient hospitals had excess inputs and/or deficient outputs. The rate was 53.0%. There were 53 county hospitals whose scale efficiency were invariant,3 scale efficiency increasing, and 44 scale efficiency decreasing. The main factors that determine DEA efficiency score were the number of hospital staff, the average length of hospital stay, financial assistance income, medical income, drug income, medical expenditures, pharmaceutical expenditures, personnel expenditures, out-patient numbers of, the numbers of people discharged from hospital, mortality, the proportion of medical staff, and the proportion of medical staff with Bachelor degree or above.3,factor analysis43 county hospitals were relatively higher efficient among100 county hospitals. The rate was 43.0%. Multiple regression analysis showed the main factors that determine the factor scores were medical service income, the numbers of inpatients discharged from hospital, the proportion of medical staff with Bachelor degree or above, pharmaceutical expenditures, mortality, the numbers of equipment over ten thousand, financial assistance revenue, and the space area for medicine.4,three methods verifying resultsEach of the three methods had the respective scope of application. The results were slightly different but basically the same. The three methods showed that the input-output efficiency of 100 county hospitals in Shandong Province was low. Tobit regression analysis and multiple regression analysis have shown that the main factors that determine hospital efficiency were medical income, the numbers of people discharged from hospital, the proportion of people with Bachelor degree or above, pharmaceutical expenditures, mortality.Conclusions and recommendationsThe overall efficiency of county hospitals in Shandong Province is still low. The invalid hospitals have had excess inputs and deficient outputs. The main factors that determine hospital efficiency were medical income, the numbers of people discharged from hospital, the proportion of people with Bachelor degree or above, pharmaceutical expenditures, mortality, and financial assistance income. The County hospitals should improve hospital input-output efficiency by changing hospital development model according to regional health planning requirements, perfecting the employment mechanism to introduce, retain and appoint high-level technical personals, increasing government financial assistance, and changing business model. |
PDF Full Text Request