Efficiency Evaluation On The National Project Of Public Health Services Equalization In Medical Institutions At Grassroots Level In Three Counties Of Gansu Province

Objectives To analyse the DEA effective cases of sample grassroots level of health institutions in2009-2012and discuss the cases of excess or deficiency on the input and output indicators in DEA non-effective medical and health institutions, with parts of collected core indicators on input and output of the National Project of Public Health Services Equalization in grassroots level of medical and health institutions, and to find insufficiency, sum up experience, discuss and analyse the status of implementation of the National Project of Public Health Services Equalization in samples of grassroots level of medical and health institutions in Gansu Province combined with the results of field investigations to make advice on policies.Methods A sampleing method was conducted to collect the core indicators of the equalization of basic public health services project which were divided into input indicators and output indicators from nine grassroots level of health institutions in Gansu Province. The principal component analysis methods were utilized to extract the main constituents of these indicators respectively for dimension reduction, and the data envelopment analysis method and firsthand data from field investigations were used for efficiency evaluation and comparison to draw conclusions and put forward policy recommendations for the National Project of Public Health Services Equalization in sample grassroots health institutions of the three counties in Gansu province in2009-2012.Results1. There were big gaps between different years and institution-to-institution TE values of the sample grassroots medical and health institutions. The mean values of overall efficiency of institutions and annual efficiency showed an upward trend along with the annual changes.2. As for annual efficiency values of sample grassroots medical and health institutions from2009to2012, the mean values of TE, PTE, and SE were below1, however, the underlying trend appeared to increase year after year. The mean values TE and SE changed more than PTE values and the amplitude of variation increased annually, but PTE mean values’variation was gentle in four years.3. From the point of view of TE mean values of sample counties (districts) from2009to2012, there were large differences in both horizontal and vertical comparisons and they were more prominent for Kangle County.4. From the point of view of every grassroots medical and health institutions, the Community Health Services Center of West Street in Liangzhou District was DEA effective in four consecutive years and the Health Center of Chaimen Township, the Health Center of Gangouyi Township in Huining County, the Health Center of Changcheng Township in Liangzhou District were DEA non-effective in the four years. From annual point of view, there were3DEA effective institutions in2009, accounting for33.33%of sample grassroots medical institutions,4institutions in2010(44.44%),4institutions in2011(44.44%) and6institutions in2012(66.67%).5. From the point of view of the number of grassroots health institutions with excess inputs, it was6in2009,2in2010,5in2011and2in2012, showing a general decline. Judging from the principal components of input indicators, the input excess were all derived from the second principal component (inputs in village clinics or community health centers).6. During the four years of project implementation, judging from the number of sample institutions with insufficient output, it was6in2009and3in2012, showing a general trend of decline. From the point of view of output indicators’principal components, output shortfalls existed among the principal components of the output indicators.Conclusions1. The efficiency of implementation of the National Project of Public Health Services Equalization was not high enough in sample institutions of three counties in Gansu Province in2009-2012. The implementation efficiency was of varying quality in the grassroots medical and health institutions, and there were large differences in sample counties (districts) and sample institutions.2. The improvement of the overall efficiency of the sample grassroots institutions in2009-2012was largely due to the improvement of scale efficiency after the continually increasing investment of our country, and the PTE’s improvement was inconspicuous in four years. 3. By the end of2012, there were different levels of excess of inputs and deficiency of outputs in the sample institutions of three counties in Gansu Province during the implementation of the National Project of Public Health Services Equalization. The excess of inputs existed mostly in village clinics and community health services centers and the deficiency of outputs was prevalent in12implementation contents of the National Project of Public Health Services Equalization.4. The excess of inputs in village clinics and community health services centers was actually the expression of the deficiency of both inputs and outputs, which was not only the deficiency of accomplishment of the project but also the deficiency of completion quality of the project.