| [Objective] Study the present status of health resource utilization of traditional medicine hospitals in rural area of Henan province. Explore the optimal bed size of county hospitals of traditional Chinese medicine by estimating the technical and scale efficiency of 81 sample hospitals during the period from 2010-2012 through a bootstrap data envelopment analysis(DEA) approach combined with case mix index. In the meantime, a bootstrap truncated regression was used to examine the impacts of hospital characteristics on hospitals' efficiency. Finally, strategy was made to improve the efficiency of health resource utilization.[Methods] Data sources:(1) Literatures, including related materials in international and domestic databases, Google Scholar and official websites.(2) Health statistic data provided by hospitals and health faculties in Henan province. The following methods:(1) Literature analysis was used to summarize the domestic and foreign related researches on hospital efficiency, economics of scale and factors affecting the efficiency, so as to find out to draw lessons from the experience and method of this study and provide the reference of the design of the evaluation indicators.(2) Statistical analysis:(1) Descriptive analysis was used to study the current situations of county hospital of traditional Chinese medicine, including hospital's general status, personnel structure, bed size, medical services provision and hospital operation.(2) A bootstrap truncated regression was applied to examine the impacts of hospital variables on hospital efficiency. Technical efficiency and scale efficiency were dependents, and hospitals' internal and external factors were independent variables.(3) Operational approach:(1) A bootstrap-DEA was adopted to measure the technical efficiency, pure technical efficiency and scale efficiency and their confidence interval. We explore the optimal bed size by study the relation between scale efficiency and beds. The selection of inputs and outputs is the key of hospital efficiency evaluation. Variable coefficient was used to eliminate the low sensibility variables. Correlation analysis was used to estimate the correlation between the variables. Entropy method was used to measure the variable's weight and determine the inputs and outputs.(2) A bootstrap Malmquist was applied to analyze the change and the trends of the total factor productivity, which was decomposed into technical efficiency change and technological change.(4) Qualitative research:(1) Expert consultation was used to select and revise the indicators of efficiency evaluation by consulting the experts of hospitals management, managers of traditional Chinese medicine hospitals and so on in the form of meeting and experts interview.(2) Focus group discussion was used to know the optimal bed size of county hospital of traditional Chinese medicine and how hospital's internal and external factors affect the health resource utilization. A total of 12 experts were invited, including hospital management, administrative department of traditional Chinese medicine and so on.[Results](1) The theoretical study of efficiency evaluation and economics of scale shows that two stage efficiency evaluation method combined with the Bootstrap-DEA method and the Bootstrap Truncated regression model was popular used in the international health area, and it might be applied in the domestic research. The inflection point judgement method is commonly used in the optimal size of hospitals.(2) Health resource utilization of county hospital of traditional Chinese medicine shows that the proportion of traditional Chinese medicine practitioners accounted for medical practitioners was about 43%. Hospitals' bed size was expanding with the 15% growth during three years. The average bed size of sample hospitals was 198, and the proportion of hospitals with less than 200, 200-400 and more than 400 beds was 55.1%, 35.4% and 9.5%, respectively. The average occupancy rates was 82%.(3) During 2010 to 2012, technical efficiency of county hospitals of traditional Chinese medicine were 0.516, 0.564 and 0.602, respectively. Traditional DEA efficiency overestimated the resource utilization efficiency. From the efficiency change, the total factor productivity were increasing 13.6% and 10.9%, respectively during 2010-2011 and 2011-2012. Technological change was the main reason of efficiency increase. More than 70% of the sample hospitals were still at the increasing returns of scale, but the numbers of decreasing returns of scale is increasing by years. The appropriate scope of bed size was 180-320.(4) The results of factors affecting hospitals efficiency shows that catchment population and average GDP were negatively associated with hospital's technical efficiency. High level of market competition improves scale efficiency. Government subsidy was positive, but no statistically significant. From the aspect of internal characteristics, bed occupancy rate was positive and statistically significant. Hospital operating time was positive associated with technical and scale efficiency.[Conclusions](1) Reasons of low technical efficiency of sample hospitals might contained serious westernization of county hospitals of traditional Chinese medicine, unsound management mechanism and the lack of traditional Chinese medicine personnel. Pursuing high advanced equipment and technique could improve efficiency in the short term, but effective use of technique and the optimal management of medical resources will be helpful for the long term development.(2) Bed size control policy should distinguish between traditional Chinese medicine hospitals and general hospitals. Most of county hospitals of traditional Chinese medicine were in the increasing return of scale, and it means that hospital's bed size could expand appropriately. But the numbers of over expanding hospitals is increasing by years. Therefore, the bed size of hospitals should be adapted to the local healthcare demand, economic development level and the change rule of disease spectrum.(3) The development of traditional Chinese medicine was more limited in the economic developed areas. Promoting service ability construction of traditional Chinese medicine, implementing the development policy of paying equal attention to both traditional and modern medicine, accelerating the reform of medical insurance payment and preventing market monopoly of general hospital would be helpful of the efficiency improvement.(4) The hospital's management level are the important factors affecting hospital's efficiency. Instead of expanding bed size, improving the bed occupancy rate is more helpful for the efficiency development. |
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