| Objective: With the introduction of the national policies, actively guiding social capital to do the medicine, rational allocating medical resources, and planning the development of private hospitals, attracts the attention of some experts and hospital administrators. Thus, hospitals administrators will meet new challenges, how to make full use of medical resources, improve the internal management of hospitals, optimize the service process and improve service quality and efficiency. The purpose of this paper was to measure the efficiency of public and private hospitals in China and identify the effect of ownership on hospital technical efficiency based on the data of 1092 hospitals from 2010 to 2012 in Henan, a province in China.Methods: The paper sorted out the input and output indicators of hospital efficiency measurement and evaluation at home and abroad based on literature research method. Input and output indicators of hospital efficiency, and control variables were discussed and determined by Expert Panel Discussion. The team conducted the on-site research in the Information Center of Henan Health and Family Planning Commission, some typical public and private hospitals. And basic information and annual statistical report data, including the public and private hospitals with beds between 20 and 500 in Henan, would be collected. To analysis the allocation status of medical resources for different hospitals, descriptive analysis was used in the paper. More, the bootstrap-dea(bootstrap data envelopment analysis) and bootstrap truncated regression method were used in this research. Firstly, the bootstrap-DEA method was applied to evaluate the hospital total efficiency, pure technical efficiency and scale efficiency of 1092 hospitals in 2010, 2011, and 2012. We explored, in the second stage, the effect of ownership and other exogenous variables on hospitals' technical efficiency using bootstrap-truncated regression analysis.Results:(1) The literature research status of hospital efficiency for different ownership and correlation at home and abroad There are two main findings based on related literature research at home and abroad. Firstly, few researches about the impact of ownership on efficiency, have been found at home. In addition, the bootstrap-DEA, a more prevalent method, haven't been adopted to measure and evaluate the hospital efficiency in domestic health field.(2) The status analysis of allocation and utilization of medical resources for different forms of ownership hospitals in Henan Province On the one hand, it found that the number of public hospitals showed the decrease, while private hospitals in the increase by 2010-2012. And staff and beds for public and private hospitals have been increased, and the utilization for two has been improved. On the other hand, the development gap between the two ownership showed significant—the severely unbalanced distribution of medical resources. It was noted that private hospitals accounted for only a small part of medical resources.(3) Evaluation of hospital efficiency for public and private hospitals On the overall efficiency, sample private hospitals was higher than public in 2010, while there was on difference for two ownership in 2011 and 2012. In terms of pure technical efficiency, private hospitals were still higher than public in these three years. However, scale efficiency in public hospitals was much larger than private hospitals by 2010-2012. As can be seen from changes: the overall efficiency and pure technical efficiency of public hospitals has a small increase, while the scale efficiency decrease. For private hospitals, it showed that the overall efficiency and scale efficiency were not changed, while the pure technical efficiency have been decreased.(4) The impact of ownership on hospital efficiency Regression analysis estimated that ownership assumed a significant sign with technical efficiency and private hospitals showed higher overall and pure technical efficiency than public. In addition, a significant positive association was assumed between overall hospitals efficiency and ratio of elderly patients with at least 65 old, ratio of patients receiving surgeries, average length of stay and bed occupation rates, while HHI(Herfindahl-Hirschman Index), average length of stay and bed occupation rates exerted a significant impact with pure technical efficiency of hospitals.Conclusions and suggestions: Conclusions: In the paper, our result investigated that private ownership was associated with higher technical efficiency significantly than public peers, which implied the effect of ownership on hospital technical efficiency in Henan, China. Suggestions:(1) Rationally allocation of medical resources and increasing investment in private hospitals;(2) Encouraging the development of private hospitals, which improve the efficiency of health services system. It is suggested to increase the size of a private hospital and shorten the average length of stay.(3) Optimzing the management and development model of public hospitals, such as delicacy Management exerted on inefficient hospitals. And the development model, inefficient and extensive, is proposed to change by introducing highly medical technology.(4) Adopting the bootstrap-dea method to measure the hospital efficiency to ensure the accuracy of results.Innovation and shortage of research: There are two main innovations in this paper. Firstly, this is the first initiative to explore the association between hospital ownership and technical efficiency in China by the quantitative method. Secondly, Bootstrap-DEA and bootstrap truncated regression method were applied to estimate relative hospital efficiency, which will be very helpful to draw reliable and robust conclusions. There is also a main limitation in this study. Case-mix adjustments of output variables of DEA were not conducted in the first analysis without implement of DRGs in China. Even though there are some limitations, the research can be regarded as a useful preliminary study towards exploring the effect of ownership on technical efficiency in China. |
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