Analysis On Market Structure And Operating Efficiency Of Henan Secondary General Hospitals

ObjectiveTo analyze regional distribution, market structure, service capabilities, scale and efficiency of Henan secondary general hospitals. To evaluate market structure and operating efficiency systematically, to explore possible reform ideas and reference for Henan public secondary hospital reform. MethodsData is from “10 target” annual statement of secondary and tertiary hospitals in Henan Province in 2014. Select number of employees, beds, total assets, outpatients, hospitalizations, surgical volume, total revenue and total expenditure of 218 secondary general hospitals. Data was analyzed descriptively by Microsoft Excel 2007 and SPSS21.0. CRn index and HHI index are used to estimate market structure. Based on input orientated DEA-VRS model, the efficiency value was calculated by DEAP2.1 software. Results1 There is 108 county-level hospitals, 82 urban secondary hospitals, and 28 secondary general hospitals in county in Henan. Scale analysis shows that the province secondary general hospitals have 131,882 employees, 113,104 beds, 36,692,336,200 RMB assets. In 2014, number of outpatient visits are 52,655,907, number of hospital visits, 4,449,090, number of surgery, 869,314. In size and service capabilities, county-level hospitals accounted for 70%, urban secondary hospitals, about 20%, secondary hospitals in county, about 10%.2 Regional distributions: the province’s 18 prefecture-level areas, respectively, have secondary general hospitals ranged from 3-29. There are 1 or 2 secondary hospitals in counties and county-level cities. In prefecture-level areas, the correlation coefficient about number of districts and number of secondary hospitals: r=0.558, P= 0.016, county number and hospital number:r=0.736, P=0.000, the region’s total population and outpatient visits: r=0.808, P=0.000, the resident population and outpatient visits, r=0.889, P=0.000.3 Scale and Service: about 70% of the province’s secondary general hospitals have employees between 200 and 1000, beds between 100 and 900, assets between 50 million RMB to 300 million RMB. 90% of those have hospital outpatient visits at 500 thousand or less, number of hospitalizations at 50, 000 or less, and surgery, in 10,000 or less.4 Market Structure: CR4 index about employees, beds and total assets of 218 hospitals are between 5% ~ 10%, CR8, between 9%~ 15%. CR4 index about outpatient, hospitalization and surgery are between 5%~7%, CR8, about 10%. HHI value is uneven in regional distribution, the overall HHI values are significantly less than 500.5 Operating Efficiency: the average overall efficiency of 218 hospitals is 0.863, the average pure technical efficiency, 0.890, the average scale efficiency, 0.970. 60% of hospitals are in the state of decreasing return to scale, 21.11% are in the state of increasing returns to scale, 18.81% are in the state of constant returns to scale. Among them, 76.85% of county-level hospitals are in the state of decreasing returns to scale. Conclusion1 More than 200 secondary general hospitals in Henan Province have developed rapidly, showing advantages in quantity and region. Among them, county-level hospitals showing obvious advantages, the regional distribution is relatively reasonable, showing consistency with the administrative area and the population distribution.2 The market structures of the province are relatively reasonable, a few regions showing oligopolistic markets.,most of them showing moderate competitive market. It is a lower concentration of competitive market within the province. In the whole the secondary hospitals has a more balanced development, showing for compatible service capabilities and technical level according to its self-positioning and function.3 A part of the secondary hospitals, especially county-level hospitals, showing development of an expansion, but revenue is relatively unreasonable, the proportion of drug income is high, the overall operational efficiency is not high, and there happening constant returns to scale or decreasing returns to scale. The secondary hospitals, especially county–level hospitals should be made clear functional orientation, maintain a reasonable economy of scale range, form a good development model about scale and efficiency.