| BackgroundThe health care and medical care is tending to be concerned with the rapid development of society and economy. Since the new century, the problems of high cost and difficult admittance of hospital,housing and school attendance, have been compared as three hills in new period. As a result, the phenomenon of poverty due to illness became growing serious, which was a serious challenge for individuals and public hospitals that was bad to the development of society and economy in our country. In our country, the main subject of health care is public hospitals, which is founded by the government or collectivity. Public hospitals are very vital for the construction of medical and health system. In China, the public health and health care service are mainly provided by public hospitals. According to the particularity of public hospitals, State Council issued "the advisement of county-level public hospital comprehensive reform pilot" (No.33, issued by national office 2012) in 2012, in order to improve the reform of county-level public hospitals. County-level public hospitals reform, which is related with the construction of health care system reform in our country, is associated to the construction of livelihood. On the purpose of improving the process of county-level public health in Shandong province positively and steadily, the public government of Shandong province issued "general office of Shandong province people’s government on the county level public hospital comprehensive reform pilot work of the implementation opinions" in 2012, to improving the reform of county-level public hospitals. According to related studies researched, the previous researches about public hospitals reform was mainly focus on the theory, and the empirical studies mainly discussed the requirements for medical services with lack of analysis of public hospitals.This study applied the quantitative analysis method to discuss the impacts of county-level public hospitals reform on the implemented hospitals and the problems have to be solved by the hospitals after the public hospitals reform implement from the perspective of public hospitals at the county level through T test, variance analysis and data envelopment analysis, in order to making reasonable policy recommendations for the further public hospitals reform.ObjectiveOn the basis of analyzing the data of two years before and after county-level public hospitals reform among 73 studied hospitals in Shandong province, the hospital basic situation, the comprehensive indexes (the masses benefit index, hospital development index, the medical staff encouraged index and the government can afford index), the hospital financial situation and hospital efficiency were analyzed to understand relevant situation after the reform of public hospitals and provide reasonable suggestions according to the shortage.MethodsThrough the literature study method to determine the research direction and thought, quantitative analysis was carried out on the data using statistical methods and management methods. After the collect data by Excel, two annual data were compared by T test, rank and variance analysis using SPSS 16.0 on the basis of the efficiency of the hospital evaluated by Deap 2.1 and significant level of alpha with 0.05.Results and conclusions1.After the reform of public hospitals, medical treatment fee increased and reimbursement ratio increased, but only the reimbursement ratio of the general hospital improved significantly. Average out-of-pocket costs of outpatient per time increased and Average out-of-pocket costs of inpatient per time decreased, but both of them were not significant. From the view of he first year, reform of public hospitals at the county level did not achieve the target of controlling medical expense and the patient did not significantly reduce the personal burden.2.After the reform of public hospitals, the hospital drug income decreased significantly and the basic drug proportion rises obviously so the drugs "zero bonus" policy and the basic drug system was effective. Due to the particularity of other hospitals, the use of basic drug in other hospital situation was not optimistic.3.After the reform of public hospitals, medical workers salary and merit pay all grew significantly. Personnel expenditure accounts for business expenses increased. Hospital internal performance evaluation system had been preliminary established which did good to motivate staff service consciousness and was conductive to improve the quality of medical services.4.After the reform of public hospitals, the hospital balance decreased significantly. The balance of hospital of Chinese medicine increased but still ’lived’ beyond its income.5.After the reform of public hospitals, three kinds of hospital’s input indexes and output indexes increased. Production technical efficiency of general hospital and Chinese medicine hospital increased and production technical efficiency of other hospitals decreased. Production technical efficiency of general hospital was the best, followed by Chinese medicine hospital, other hospitals was the worst. Problems of the production technical efficiency of public hospitals at the county level still existed, so the hospital needed reasonable planning to reduce the waste of the medical resource.SuggestionReasonable planning the development of the hospital and reducing waste of medical resources;The hospital should set reasonable services charge system and the government should increase financial support to reduce patients economic burden at the same time protecting the interests of the hospital.formulating scientific, objective and fair performance appraisal system and improving the distribution of medical staff incentive mechanism. Giving priority to use the basic drugs when patients need. Using the market mechanism to improve the production efficiency of the hospitals. Promoting the traditional Chinese medicine, taking advantage of the traditional Chinese medicine and Stimulating the patient’s demand of traditional Chinese medicine. |
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