| ObjectiveUsing data envelopment analysis (DEA) to analyze the operating efficiency, productivity changes and the factors affecting the efficiency of 10 tertiary children’s hospital and 10 tertiary general hospitals with same scale size in 2011--2012, through this to explore the basic characteristics of operational efficiency of children’s hospital and general hospital, and provide some scientific basis for the reform and efficiency improvement of public hospitals.Data and Methods(1) Data:Based on field surveys, financial statistical report and relevant Statistical Yearbook and other information, systematically collected the Input-Output indicators data of sample hospitals in 2011--2012 in the aspects of the human, financial and other medical resource allocation, the amount of medical services, revenue, expenditure and operating efficiency, and establish the relevant databases.(2) Methods:Include data envelopment analysis and statistical analysis. Use C2R model, Super-C2R model, BC2 model, Super-BC2 model and Cost model to calculate the technical efficency, super technical efficiency, pure technical efficiency, super pure technical efficiency, scale efficiency, cost-efficiency and allocative efficiency of sample hospitals, and use Malmquist productivity index model to calculate the productivity and efficiency changes of the sample hospitals during the study period. Use the software DEAP 2.1 and DEA-SOLVER (LV3.0) to calucate the DEA efficiency. Statistical analysis mainly include statistical description, rank sum test and multiple regression analysis, use software SPSS17.0 to do these statistical analysis.Results(1)The differences were not statistically significant between the sample children’s hospitals and general hospitals on resources investment such as the amount of staff and beds and fixed assets, the quantity of medical services such as outpatients, inpatients and admission days, operational expenditure such as total income and total expenditure (P>0.05); the outpatients and emergent patients per staff, the inpatients per staff of sample children’s hospitals and general hospitals was not statistically significant (P>0.05), while the admission days per staff of children’s hospitals were generally lower than general hospitals and the difference was statistically significant (P<0.05); the average length of stay at children’s hospitals were generally lower than in general hospitals, while the turnover rates of beds were generally higher than the rates of general hospitals, both of the differences were statistically significant (P<0.05).(2) The comparative analysis of different DEA models based on Input-Output indicators suggested that, the DEA model which had the best stability and efficiency discriminabiltity was the one which had the number of staff and the number of beds as the input indicators, the outpatient and emergent patients and inpatients to the hospital as the output indicators, it was the most appropriate evaluation model.(3) The technical efficiency, pure technical efficiency, allocative efficiency and cost efficiency of sample children’s hospitals were higher than general hospitals, and the differences were all statistically significant (P<0.05), it reflected that the resource allocation and special medical services of children’s hospital were superior to general hospital; but the difference of scale efficiency between general hospital and children’s hospital was not statistically significant (P>0.05).(4) For both sample children’s hospital and general hospital, the scale efficiency> pure technical efficiency> technical efficiency, on the whole, the scale is the key factor affecting the efficiency of all the sample hospitals.(5) During the study period, the overall efficiency of most sample children’s hospitals and general hospitals have improved, the impact of scale efficiency and pure technical efficiency on the overall efficiency were both apparent.(6) The main factors affecting the cost efficiency of the sample hospitals were the average length of stay, outpatients and emergent patients per staff; the main factors affecting the allocative efficiency of sample hospitals were the average length of stay and inpatients per staff; the main factors affecting the technical efficiency were the average length of stay, outpatients and emergent patients per staff, inpatients per staff; the main factors affecting the pure technical efficiency were the average length of stay, outpatients and emergent patients per staff, inpatients per staff.Conclusions(1) The technical efficiency, pure technical efficiency, allocative efficiency and cost efficiency of sample children’s hospitals were higher than general hospitals, the differences were all statistically significant, but the difference of scale efficiency was not statistically significant. The resource allocation, medical technique and cost control of childrens’s hospitals were superior to general hospitals.(2) The sample children’s hospitals exhibited decreasing returns to scale (DRS) in 2012, suggesting that blind expansion of the scale is likely to affect the overall efficiency of the hospital development.(3) Currently, the sample hospitals mainly rely on the development of scale to improve efficiency. Therefore, it requires to adjust the medical service price mechanism, so as to guide the hospital to take the model of connotative development.(4) The main factors that affected the efficiency of sample hospitals are outpatients and emergent patients per staff, inpatients per staff and average length of stay, and therefore the efficiency improvement should be based on those key indicators.Suggestions(1) The development of hospital scale should be under the reasonable control. Inefficient hospitals could have a moderate input increase in the amount of the staff and beds, so as to improve its efficiency. It is noteworthy that the blind expansion is infeasible. For hospitals with higher efficiency and especially the scale efficiency is valid, it is feasible to appropriately control the scale development, focus on technical efficiency, allocative efficiency and cost efficiency, optimize service processes, control the cost, strengthen the cost accounting and budget management, carry out the assessment on medical equipment and health technology, and promote hospital development mode from extended development into connotative development, in particular, focus on the improvement of health care services performance.(2) The general hospital should enhance the construction of priority and specialty department, and take full advantage of the multidisciplinary collaboration, according to its own characteristics to allocate the medical resources reasonably, gradually form a clear specialist features and regional competitive advantage, and pursuantly improve its overall efficiency. |
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