Measurement Of The Economies Of Scale In Public Hospitals Based On Public Welfare

BackgroundPublic hospitals in China are public welfare health institutions run by the government.As an important carrier of basic medical and health services,county-level public hospitals serves as the link between the head of the the county medical and health service center and rural tertiary medical and health service network and urban and rural medical and health service system,which plays an irreplaceable role in improving the health of urban and rural residents,perfecting the medical and health service system and lightening the economic burden of medical treatment.With the rising demand for medical treatment,the medical market is increasingly competitive.In order to seeking market share in the medical service market,county-level public hospitals have begun large-scale expansion of basic facilities and large medical equipment to expand hospital scale to meet business needs.To face the current situation that "scale expansion" of public hospitals in China and residents is "difficult and expensive to see a doctor" exist at the same time,the state further promotes and deepens the reform of public hospitals,several key words such as "moderate scale","appropriate scale" and "strict control of the size of public hospital beds" were clearly put forward.Theoretically,the expansion of hospital scale has certain positive significance to solve the shortage of health resources and insufficient supply of health services.But from a practical point of view,many hospitals have overextended hospitals,which leads to the increase of hospital liabilities,low utilization efficiency of health resources and rapid growth of medical expenses.Secondly,literature review finds that the resaearchers from different departments and health fields all have different understandings of the problems of the public welfare.So,there are great controversies about the definition and realization of the public welfare,which has not reached consensus.And the current research results are only defined as the connotation denotation of public welfare,which has no substantive and operable way to return public hospitals to public welfare.By the literature review of the public welfare,the requirements of public hospitals' public welfare is to provide equal and accessible,adaptable contain both quality and efficiency health services.Among them,equality and accessibility is reflected in the provision of basic services at affordable prices for residents.Efficiency is reflected in the public hospital's health resources input can be effectively utilized.In order to secure the public welfare in public hospitals,we have to define the orientation and targets of the public hospitals.This paper aims at realizing the public welfare of county-level public hospitals.Through the function orientation of county-level public hospitals,the public welfare of county-level public hospitals can be realized by searching for the provision of affordable,low-cost and efficient basic medical service packages and then make the realization of public welfare operable.Then the appropriate scale of basic medical service package which can realize the public welfare in county-level public hospitals can be measured to provide empirical evidence for humanity,finance,materials and other resources of health.ObjectiveThis paper aims to return to the public welfare of public hospitals.Firstly,this paper evaluates the equity and efficiency of county-level public hospitals.Secondly,it defines the function orientation and public welfare of county-level public hospitals,determine the basic medical service package that can achieve public welfare and the appropriate scale that it needs.Finally,this paper compare the scale of county-level public hospitals with the appropriate scale of basic medical service packages,obtain the input situation of investment of the most suitable person and property of county-level public hospitals,provide the management basis for hospital management,provide theoretical reference for government departments to regulate the scale of public hospitals.MethodsThis paper is a sample of eleven county-level comprehensive public hospitals in every counties of the Ningxia Hui Autonomous Region.Descriptive statistical methods are used to analyze the health resource allocation,medical service capacity and financial operation from 2009 to 2016.Gini coefficient and DEA are used to determine its scale status.Quantitative analysis is used to calculate the comprehensive impact of the disease which can define the range of diseases of basic medical services.Scale model is designed to measure the appropriate scale of basic medical service package.Finally,Contrastive analysis the status quo of scale of county public hospitals and appropriate size of basic medical service packages.Results1.Basic situation analysis of county-level public hospitals.Through analysis,the number of working staff increased by 37.85% in 2016 compared with 2009.The number of actual beds increased by 51.14% in 2016 compared with 2009.The area of housing construction increased by 51.63% in 2016 compared with 2009.The total value of equipment over 10,000 yuan increased by 263.59% in 2016 compared with 2009.Average income rose 211.62 percent in 2016 compared with 2009.Average spending increased by 217.31 percent in 2016 compared with 2009.The average number of patient visits increased by 52.06 percent in 2016 compared with 2009.Among them,the total value of the equipment over 10000 increases the most.2.Equity of health resources allocation in county-level public hospitals.From 2009 to 2016,the health human resources and material resources of the county public general hospital are relatively fair from these two dimensions: population and geography.But from financial resources,especially financial aid to the county-level public hospitals,are relatively unfair in terms of both population and geography.3.Efficiency evaluation of operation of county-level public hospitals.According to the average operation efficiency evaluation of county-level public hospitals,the overall operation efficiency of county hospitals in 2009,2012,2015 and 2016 were in the fixed stage of scale compensation.In 2010 and 2011,the county-level public were in the operational efficiency of the scale of the increase phase.In 2013 and 2014,county-level public hospitals were in the stage of decreasing scale of medical operation efficiency.4.Screening results of basic medical service packages.Quantitative analysis is used to calculate the comprehensive impact of the disease which can define the range of diseases of basic medical services,and identify a total of 130 diseases,among these,the comprehensive worth of the top ten diseases is: O80,J18,I10,I25,I63,K29,J06,K80,K35,J44.5.The appropriate scale measurement results of basic medical service package from 2009 to 2016.In 2009,the average number of hospitalizations for basic medical services package in hospitals was 7568,which the optimum median bedspace was 155 and the average number of staff was 211-227.In 2016,the average number of hospitalizations for basic medical services package in hospitals was 11814,which the optimum median bedspace was 235 and the average number of staff was 305-328.6.The appropriate scale prediction results of basic medical service package from 2017 to 2021.In 2017,the average number of hospitalizations for basic medical services package in hospitals was 12678,which the optimum median bedspace was 253 and the average number of staff was 329-354.In 2021,the average number of hospitalizations for basic medical services package in hospitals will be 15169,which the optimum median bedspace was 303 and the average number of staff was 394-425.7.According to literature review and expert consultation,the scale measurement indexes did not mention the financial aid,this paper fails to provide the evidence that the amount of financial aid that the government should put into the appropriate scale.Recommendation1.To control the size of public hospital bedspace in county-level public hospitals.Control the monomer scale of county-level public hospitals,and the size of bed is on speaking terms with the number of patients.To fix the number of services quantity and the times of service relatively in each county.To control the ratio of the number of service to the size of bedspace strictly which is of great significance to control the blind expansion of county-level public hospitals.2.To improve the efficiency of public hospitals.For the county-level public hospitals with relatively low operating efficiency and the situation that the number of the hospitals which scale efficiency is increasing are decreasing year by year.One of the ways to improve efficiency is to reduce the number of input redundancies such as the number of beds and the number of people.3.Try to promote the basic medical service package in the pilot county area.It is an important way to realize the public welfare of the basic medical service package composed of diagnosis and treatment of the frequently-occurring disease and common disease as the function orientation of county-level public hospitals.The basic medical service package should be promoted at county-level public hospitals,so that the control scale of county-level public hospitals,lower cost and medical expenses are better realized.4.Free diagnosis and treatment of diseases within basic medical service package.The realization of public welfare is to provide residents with low-cost,even free medical services and free diagnosis and treatment of diseases within basic medical service package,which is an important way to promote the public welfare of county-level public hospitals to return.5.The establishment of appropriate scale measurement model for county-level public hospitals.The service population of county-level public hospitals is relatively fixed,and demand for medical services is also relatively constant.The size of the medical demand calculated according to the population which have certain reference value in the county-level hospitals.It has certain reference significance to establish the scale of county-level hospital according to the actual demand,and has some reference to the scale calculation of county-level public hospitals in other provinces and cities...