| BackgroundChina’s health career has been rapidly developed along with rising economic power since the Reform and Opening. As market mechanisms was gradually introduced in medical and health fields, the public characteristic in these fields were ignored. Due to the lack of scientific management, theoretical guidance and long-term blind expansion of health resources, many problems are brought up as imbalance of medical services and demand, irrational allocation of health resources, low efficiency and excessive growth of medical costs. These problems are also found in the development process of medical and health services in Shandong province, which had a serious impact on increasing productivity of healthcare. In addition, how to solve the inefficiency of healthcare had become common issues both in developed and developing countries. As one of the most important part of health economic evaluation, healthcare efficiency can effectively measure the reasonableness of health economics policies. So it is of great practical significance to assess the efficiency of medical institutions in Shandong province.ObjectivesThe objective of analyzing the basic operation status of medical and health institutions and the input-output efficiency of health resources in Shandong province from 2008 to 2013 is to understand the running status of the medical and health institutions in recent years. Furthermore, by making comprehensive analysis and research focused on the utilizing condition and influencing factors of health care resources at all levels (classes), recommendations according to the actual situation can be proposed, to further enhance the social and economic benefits of medical institutions and provide references for government policy.MethodsThe data for this study comes from the Shandong Province health financial database from 2008 to 2013, the input and output indicators were selected through literature preferred method and expert consultation method, using Excel2010, SPSS 16.0, DEAP2.1 for data processing and descriptive analysis, through the Malmquist index model to evaluate efficiency of medical institutions in Shandong provmce.Main Results1、In 2013, the total number of medical and health institutions in Shandong province is 2266,compared to 2008 increased 84; the beds of institutions increased 96114. The city’s hospital has the largest growth rate of beds,which was 36.2%;the total number of the province’s health and technical staff is 316,543,compared with 2008,increased 106241people,the growth rate is 50.52%.2、From 2008 to 2013, the fixed assets of medical institutions in Shandong province is a growing trend, fixed assets rose from 37.657 billion to 37.657 billion. Total revenue and total expenditure presents synchronous growth trend, the average annual growth rates were 20.01% and 119.92%. Compared to the total expenditure, income structure change trend is obvious. Among them, the financial subsidy income has increased steadily, the proportion increased from 7.21% in 2008 to 11.58% in 2013; Medical income and other income proportion have a downward trend, the proportion of drug income decline gradually from 49% in 2008 to 42% in 2013.3、Among six years,the bed occupancy rate and bed turnover times of the province’s medical institutions showed an overall growth trend. In 2013, the bed utilization rate was 76.92%, compared with 2008 increased by 7.84 percent, the number of bed turnover increase by 1.39 percentage points. The number of diagnosis increased from 141 million to 215 million during six years, with an average annual growth rate of 8.78%;outpatient and emergency visits from 127 million to 127 million, the average annual growth rate was11.03%; the average annual growth rate was 10.69%; the number of discharged patients changed from 673.81 million to 1106.23 million. In the aspect of health service technical efficiency, the upward trend are showed. The average outpatient and emergency visits per worker increased from 2033.83 to 2610.45 trips; By the same time, the average hospital bed days per worker has increased from 712.08 to 888.67 days; average revenue per worker increased from $ 484867.39 dollars in 2008 to $ 801,502.30 dollars in 2013.4、2008-2013, the average TFP score of medical institutions in Shandong Province was 1.008.The score of average efficiency value and average value of changes in technical change were 0.995 and1014. In the four types of medical institutions, the efficiency optimization is the township hospital, total factor productivity is 1.033, technological change value achieved an average annual growth of 3.3%generally. City Hospital FTP lowest was 0.998, less than 1, the total factor productivity of decline trend. With panel data to analyze overall medical and health institutions in Shandong province, the score of TFP is greater than 1 only in the year of 2010, while in other years showed a downward trend. In 2010, the province’s medical institutions increased efficiency is due to substantial increase in technical level, reaching an average annual increase of 3.0%.This corresponds with the scale efficiency is still showed a decreasing trend. Except 2012, regardless of efficiency change and technical change is decreased, the efficiency of variation is caused by the decline of scale efficiency decreased.Discussions and suggestionsFirstly, primary health care institutions is the first line of defense to protect the health of residents, the province should further improve the government-based multi-channel compensation mechanism, continue to control the growth of medical costs, the government should not only strengthen and implement financial compensation policy but also need to track the use of financial resources, multi-faceted the benefits of primary health care institutions. Different subsidies were given to medical institutions according to the different levels and functions. Besides, government needs to step up publicity and implementation efforts to promote the community health service center implement the essential drug system to further reduce the cost of medicines. Secondly, city hospitals need more strict control of hospital scale, achieving the first treatment in the community and two-way referral system, to form a reasonable medical treatment pattern. The great cause of low efficiency of medical and health institutions is low personnel quality, our province medical institutions need to strengthen the training of health personnel, a variety of ways to promote the construction of talent team, improve the quality of health workers. Finally, with the deepening of the medical system reform, the improvement of people’s consumption level, the traditional mode of providing medical services can’t meet the modern residents’ diverse health service demands. Health care institutions need to change management philosophy, and adapt to changes in demand for health services actively; continue to enhance service awareness, adjust and improve the service model to improve service efficiency in order to meet the diverse needs of people. |
PDF Full Text Request