Study On The Efficiency Of Hospital Operation Before And After Comprehensive Reform Of County-Level Public Hospitals

Objective: Based on the main input and output indexes of county-level piblic hospital in Ningxia,the operation efficiency of them was analyzed by using the three-stage DEA model.We were to understand the change of hospital operation efficiency after the comprehensive reform of county-level public hospitals,to study the influencing factors of hospital operation efficiency,and to provide scientific basis for the decision of comprehensive reform of county-level public hospitals.Methods: Collected and summarized the related literature material in recent five years,the key indexes which are used most frequently in hospital efficiency and productivity evaluation based on DEA at home and abroad are selected.Then the appropriate input and output indexes were selected by cluster analysis method,and the hospital efficiency evaluation index system was constructed.The three-stage DEA method was used to calculate the operational efficiency.Its main feature is by using of SFA regression analysis to strip out the environmental factors and statistical noise which had influence on hospital efficiency.By comparing the operating efficiency of pilot and non-pilot hospitals in different time periods,this paper put forward some suggestions on the future development of county public general hospital in Ningxia.Results: From 2007 to 2016,the investment scale of county-level public hospitals in Ningxia continued to grow.The average annual growth rate of the working staff is 5.38%,the fixed assets is 11.67%,the actual beds is 7.79%,the total spending is 20.43%,the number of outpatient and emergency patients is 9.14%,the number of discharged patients is 10.07%.Before and after the new reform,the average annual growth rate of fixed assets of pilot hospitals and non-pilot hospitals decreased from 10.38% and 24.05% to-7.38% and 2.35% respectively,the average annual growth rate of beds decreased from 8.98% and 9.38% to 1.02% and 9.29% respectively,the average annual growth rate of number of outpatient and emergency patients decreased from 13.43% and 9.33 to 2.03% and 3.05% respectively,the average annual growth rate of discharged patients decreased from 13.56% and 13.81% to-1.4% and 5.83% respectively.The average annual growth rate of the number of employees in the pilot hospitals decreased from 7.85% to-1.88%,total expenditure fell from 20.35% to 5.3%.The average annual growth rate of non-pilot hospitals increased from 3.98% to 10.5%,the annual growth rate of total expenditure increased from 24.56% to 27.22%.The results of the three-stage DEA model analysis show that after separating the influence of environmental variables and statistical noise on hospital efficiency,the comprehensive technical efficiency of county-level public general hospital in Ningxia fluctuated around 0.900 from 2007 to 2016.The annual comprehensive technical efficiency of the pilot hospital is higher than that of non-pilot hospitals.The gap between the efficiency values of the pilot hospitals and non-pilot hospitals was relatively stable before the comprehensive reform of county-level public hospital(2007-2013),but it has gradually widened since the comprehensive reform of county-level public general hospital(2014-2016).The inefficiency of comprehensive technical efficiency(the efficiency value is less than 1)is mainly due to the inefficiency of its scale efficiency.It is suggested that the scale of the current hospital is not suitable for the development of the hospital.The adjustment of hospital scale is very necessary.The results of malmquist model show that total factor productivity of Ningxia county-level public hospital in Ningxia grew at an average annual rate of 2.8% between 2007 and 2016.The technical progress change index contributes more to the improvement of total factor productivity than the technical efficiency index.The change of the index of technical efficiency and the change of the technical progress of the hospital show the relationship of the reverse change.It may be that the technical level of the hospitals has a delayed effect on technical efficiency.It was found that the total factor productivity of the pilot hospitals before the comprehensive reform of county-level public hospitals was similar to the non-pilot hospitals when the comprehensive reform of countylevel public hospitals was taken as the time node,and there was no significant difference in the level of ? = 0.05 in t-test.The total factor productivity of the pilot hospitals after the comprehensive reform of county-level public hospitals is higher than that of non-pilot hospitals,t test was statistically significant.The operation efficiency of the pilot hospital is increased,and the operation efficiency of the non-pilot hospital is reduced.Conclusion: Implement the policy of public hospital reform and promoting public hospital reform in an all-round way.Control the scale of county-level public hospitals and improve the overall operation efficiency.Improve the technical innovation ability of hospital and improve the overall quality of professional.Promote the three stage DEA efficiency evaluation method and establish a long-term management mechanism.