| Background: With the continuously deepen of the national essential medicines system and related reforms,Establishing the public hospital performance evaluation system which could highlight the function orientation and social benefits at the county level has gradually become one of the important strategic task of reform of public hospitals.However,not much empirical research assessed the public hospital comprehensive reform at the county level has been done.Therefore,it is necessary to combine the social public benefits,the health administrative department of public hospital regulation and the demand of diverse stakeholders to establish a set of performance evaluation index and carry out an empirical study on performance evaluation of public county hospitals in Anhui Province.This study was conducted to monitor the operation status and performance changes before and after the reform of public hospitals at the county level,to found the advantages and weaknesses in development,to discuss the reasons for the changes of performance results and the difference between each other and to put forward corresponding countermeasures and suggestions,and to offer reference and basis for further development of performance evaluation and scientific decision-making of the health administrative department.Methods: The series of questionnaire and interview outline was designed by the methods of literature review and expert consultation.In a retrospective study,according to the geographical distribution,each random sample of 4 public county hospitals in south,central and north of Anhui form the 21 first public county hospital comprehensive reform pilot pioneer were investigated by self-designed questionnaires.The data and the related indexes of the operation status in 2011 and 2015 were collected.The quantitative data was double entered into Epidata3.1 or Excel to construct database and was analyzed with statistic software of SPSS16.0.The constituent ratio and growth rate were used to describe the overall index change before and after the hospital reform and each hospital operation status in 2015.The weighted TOPSIS method was used to evaluate the six dimensions of performance and comprehensive performance.Results:(1)Human resources:The total number of employees in the 12 hospitals was 8637 in 2015,which increased 27.94% compared to 2011(the average annual growth rate of 6.35%);among them,health professionals,college degree or above,master degree or above,senior professional titles accounted for 82.19%,74.59%,1.54%,3.70%,comparedto 2011 increasedrespectively 0.93,10.66,0.99 and 0.07 percentage points,the number of registered nurses and accounted for a larger increase,the number of college degree or aboveincreased significantly,high-quality personnel accounted for less.The ratio of doctors and nurses,the bed to nurse ratio wererespectively 1:1.54 and 1:0.51,which increased and decreased slightly compared to 2011.(2)The capacity of medical services: The actual opening of the beds in the 12 hospitals was 7041 in 2015,which increased44.28% in 2011(an average annual growth rate of about 9.60%).The total amount of medical services,outpatient and emergency visit were4156,4000,3848,7000,317,3000,which increased respectively 69.64%,72.22%,47.24% compared with 2011,with an average annual growth rate of 14.13%,14.56%,10.16%,and outpatient growth rapidly.(3)The economic situation: The ratio of financial subsidy income,medical income,and drug income to total income in the 12 hospitals was respectively 7.17%,54.28%,and 35.81% in 2015,an increase of 0.59 compared to 2011 5.80 and-7.55 percentage points.After the reform,financial subsidy income,medical income accounted for the proportion of total income increased compared to before the reform,and the drug proportion of income reduction.In 2015,the medical service cost,management expenses,financial expenditure total expenditure ratio were respectively 84.48%,12.32%,2.76%,compared to 2011 decreased by 1.26,2.02 and 0.39 percentage points,the proportion of drug costs decreased from 41.88% to 36.71%,5.17 percentage points lower,the proportion of drug costs changed greatly after the reform.In 2015,compared to 2011,the total balance of payments increased,an increase of 22.18%;the balance of business decreased significantly compared to 2011,a decline of 86.87%;the balance of financial compensation increased significantly compared to 2011,the growth rate is 132.20%.(4)The dimension of take the patients as the center: The 12 hospitals all established a doctor-patient communication system,medical service process system in 2015.The satisfaction rate of inpatients was 96.12%,which decreased 1.72 percentage points compared to 2011.The preoperative average bed day is 2.29,0.11 bed days increase compared to 2011;10 minutes of urgent consultation response compliance rate remained above 99%,accessibility of medical services in general.(5)The dimensions of public welfare oriented: The average outpatient expenses is?206.89,representing a growth rate of 3.52%,the average outpatient drug costs accounted for 42.78% in 2015,which decreased 2.54 percentage points compared to 2011;the average hospitalization cost is?4943.49,that growth rate is 7.32%,and the average hospital drug costs accounted for 38.21%,which decreased 9.91 percentage points compared to 2011.The urban workers hospitalized patients compensation ratio is 78.63% in 2015,which 0.56 percentage points lower than 2011,the scale of changes is small.The urban and rural residents inpatient compensation ratio are 61.46%,which there are an increase of 5.30 percentage points compared to 2011,and increased considerably.The national essential drugs rate is 50.13% in 2015,which there are an increase of 7.43 percentage points over the previous year,the national essential drug purchase amount in 19.73%;after the policy of the amount of purchase,the implementation of the policy to fully compensate for the loss,the vast majority of drugs can also be timely supply.(6)The dimension of medical quality and safety: Diagnosis,treatment,nursing,hospital infection,safety management,most indicators are controlled in a better level,and in accordance with the hospital management standard,but part of the core control index is still not ideal.The rate of cesarean section decreased from 55.11% in 2011 to 49.64% in 2015,nursing documents writing qualified rate increased from 95.68% to 97.17%,the number of the establishment of key drug monitoring system in hospital from 4 to 9;The usage rate of antibiotics in inpatients decreased from 71.93% to 62.04%;The rate of prophylactic use of antimicrobial agents in patients with type I incision surgery was reduced to 76.22%(decreased7.43 percentage points),and the compliance rate of hand hygiene was increased from 42.88% to 57.09%,these indicators have not yet reached the relevant management standards.(7)The dimensions the of efficiency and effectiveness: The personnel expenditure total expenditure ratio was 30.54% in 2015,which increased 6.22 percentage points compared to 2011;the average revenue per worker year was?282,100,which increased ?88.200 than 2011.The management of expenditure ratio decreased from 14.35% to 12.32%;the business balance rate was decreased to 0.28% in 2015,which decreased 3.68 percentage points compared to 2011;Return on assets,return on net assets declined respectively from 5.24% to 3.39%,8.45% to 12.43%,After the reform,asset profitability decreased slightly.Doctors' per capita daily burden of hospital beds to 2.70 beds,which increase 0.18 bed days compared to 2011;the burden of treatment in the number of physician per day increased from 4.90 passengers to 6.55,there shows that the work efficiency is improved,but the workload increase.In 2015,4 hospital beds in the state of efficient operation,and the 8 of them in a state of low efficiency.(8)The employee dimension: The employee education(training)investment accounted for the proportion of business income is 0.14% in 2015,which down by 0.07 percentage points compared with 2011,the staff education(training)investment is insufficient.The proportion of health care professionals is 3.52%,which increased 0.75 percentage points compared to 2011,and insufficient number of trainees.In 2015 the staff satisfaction 92.68%,compared with 2011 increased 0.30 percentage points.(9)The development of hospital dimensions:In 2015,new rural cooperative medical patients account for the total number of patients was 35.07%,which was an increase of 5.17 percentage points compared with that in 2011,after the reform of county medical service capacity has improved;Municipal and key disciplines,specialty number 13,an increase of more than 10 in 2011,after the reform of key disciplines,specialty construction to strengthen.In 2015 the government investment accounted for total expenditure in hospital was 7.53%,which was an increase of 0.41 percentage points compared to 2011,government investment increment is insufficient;Net assets growth rate of 13.77%,lower than in 2011 by 6.21 percentage points,net assets after the reform has been reduced;Asset liability ratio was 44.60%,compared with 2011 increased by 4.05 percentage points(2012 was 51.86%),after the reform,the asset liability ratio is higher than before the reform,but showed a downward trend;Business revenue growth was 10.06%,compared with 2011,down by 7.07 percentage points,after the reform of business revenue growth slowed.the construction and utilization of information in 2015 was 69.05%,which increased 54.76 percentage points compared with 2011,and the ability of information service was enhanced.(10)Comprehensive performance evaluation: 2015 comprehensive performance value was significantly higher than in 2011,the county public hospital reform results can be reflected.Public welfare oriented,quality and safety,efficiency and effectiveness,the development of the 4 dimensions of performance values are higher than before the reform,however the dimensions of take the patient as the center,the staff performance value is lower than before the reform.In 2015,the comprehensive performance of D hospital was the highest,followed by G hospital,J hospital was the lowest,except for the top 2,and the performance difference between other hospitals was small.Conclusion:(1)The medical service ability is improved,but the service quantity in county area is still insufficient.(2)The amount of human resources for health is increase,but thigh-quality health resources are relatively scarcity and structure is not reasonable.(3)The economic operation status is overall steady and the balance of payments structure changes,but the government investment is still insufficient(4)The unreasonable increase of medical care expenditure is under control,but the overall cost benefit are not obvious.(5)The drug purchase facility is preliminarily established,but its details still need further refinement.(6)The overall medical quality and security is good,but management mechanism remains to be further optimized.(7)The sickbed work efficiency leaves much to be desired.(8)The employee treatment conditions are improving,but the restricting factors of work enthusiasm ascension still exist.(9)The performance evaluation index system and evaluation method has a strong maneuverability,but the problems need to be further investigated.Suggestions:(1)Strengthen the county medical and health service system planning,and promote the healthy development of the county hospital.(2)Improve the mechanism of government spending and ensure the implementation of the government responsibility.(3)Adjust unreasonably low prices of medical service and realize the value of technical work performed by medical personnel.(4)Innovate the mode of medical insurance payment and perform the function of medical insurance lever.(5)Strengthen the self-management and enhance self-support ability to run.(6)Improve the personnel and the salary distribution system and mobilize medical staff's work enthusiasm.(7)Improve patient feeling and promote patient satisfaction.(8)Strengthen the management of medical quality and ensure the safety of medical treatment.(9)Strengthen the construction of information systems and improve the efficiency of hospital management.(10)Improve the performance evaluation mechanism and increase the efficiency of the performance evaluation. |
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