| Objectives:Through the analysis of current situation of maternal and child health care resources allocation in China in this study,we can master the level of maternal and child health care services in our country.Through the combination of qualitative and quantitative analysis of maternal and child health care resources in China,a comprehensive understanding of the shortage of resources allocation can be knew.Through the construction of data envelopment analysis of the super-efficiency model,we can evaluate the efficiency of maternal and child health resources allocation in 31 provinces and cities in China,then dig factors which lead to low efficiency of input and output of maternal and child health care resources,then we can optimize the input-output structure of maternal and child health resources in order to provide scientific basis and policy recommendations to improve China's maternal and child health service capacity.Contents:This study uses a combination of qualitative and quantitative research methods to analyze the current situation and development of institutional resource allocation,allocation of bed resources,human resources of maternal and child health care services in obstetrics and gynecology hospitals and maternal and child heath centers in China from 2006 to 2015 systematically.With the use of data envelopment analysis of the super-efficiency model,the technical efficiency of the maternal and child health centers in 31 provinces and cities in China was analyzed from the two dimensions of time series and cross section,which provided reference messages for the health administrative departments to formulate the policy suggestions on the resource allocation of maternal and child health centers.Methods:?Descriptive analysis.Based on the time series data from 2006 to 2015 and the cross-sectional data of 31 provinces and cities,the descriptive statistical analysis of maternal and child health resource allocation and maternal and child health level in China was carried out to compare the differences between different years and different regions.?Super-efficiency models and Data envelopment analysis(DEA).With the use of super-efficiency models in data envelopment analysis,in this study,taking the number of institutions,the number of health technicians and the number of beds of the maternal and child health centers in China as the input indicators,the number of clinics and the number of people discharged as the output indicators to analyze technical efficiency of maternal and child health hospitals of 31 provinces and cities in China from the dimensions of time series and cross section.Results:From 2006 to 2015,China's obstetrics and Gynecology increased to 527,the average growth rate was 14.85%,proportion increased from 5.82%to 11.67%;the specialist hospitals of children increased by 47,with an average growth rate of 5.46%,proportion decreased from 2.22%to 1.89%.the number of licensed(Assistant)doctors in maternity and gynecological hospitals in China has increased 13274 persons,proportion increased from 8.08%to 11.29%,and the number of registered nurses has increased 23,004 persons,showing an upward trend in fluctuation;The number of practitioners(assistants)in specialist hospitals of children increased by 8321,proportion increased from 8.36%to 8.70%;The number of registered nurses increased by 16482,accounting for a fluctuating trend,reaching a maximum of 9.64%in 2010.From 2006 to 2015,156439 beds in the maternity hospital were added,proportion decreased from8.04%to 10.23%;The number of beds in children's hospital increased by 124753,proportion decreased from 6.38%to 5.52%;Maternity hospital clinic visits increased by 24,164,716 people,with an average growth rate of 13.2%,proportion increased from 11.40%to 12.27%;Number of discharged patients increased by 1,005,865 people,with an average growth rate of 12.24%,proportion decreased from 11.83%to 10.73%;Visits in Pediatric hospital increased 31542569 persons,with an average growth rate of 8.84%,proportion decreased from 27.49%to 19.93%;Number of discharged patients increased by 999666 persons,with an average growth rate of 9.39%,reaching a maximum of 20.43%in 2008 and decreased to 12.33%in 2015.Between 2006 and 2015,the number of institutions of maternal and child health care in China is on the rise,reached to a total increase of 75,with an average growth rate of 0.25%.The total number of health technicians has increased by 134344 persons,with an average growth rate of 6.34%;Practicing(Assistant)physicians grew by 30902 persons,with an average growth rate of 3.50%,proportion decreased from 47.72%to 36.32%;The number of registered nurses increased by 77400 persons,with an average growth rate of 10.22%,proportion increased from 29.94%to 42.70%?Meanwhile,beds of institutions of maternal and child health care in China has increased from 9.93 thousand to 19.54 thousand,with a cumulative increase of 9.61 million and an average growth rate of 7.0%?Visits in china's maternal and child health care clinics increased by 130.68 million persons,with average growth rate of 8.44%;Number of discharge patients increased by 4.49 million persons,with an average growth rate of 8.05%.The number of live births in China has increased by 2 million 775 thousand cases,and the proportion of pregnant women has risen from 13%to 22.6%,with a cumulative increase of 9.6%.The new law rate of delivery in 2013-2015 has reached to 99.9%for three consecutive years.Perinatal mortality rate dropped from 9.68 ‰ to 4.99 ‰,with the cumulative decline of 4.69 ‰.The proportion of severe malnutrition among children under 5 years decreased from 2.10%to 1.49%,with a cumulative decline of 0.61%.The proportion of babies with birth weight<2500 grams is on the rise continuously.Analyze from time series data,between 2006 and 2013,China's maternal and child health care center was DEA ineffective,the pure technical efficiency value was higher than the scale efficiency value,and the scale efficiency was<1.2014,2015 were effective for DEA.In 2015 at the same time reached to scale efficiency and technology effectively,the decreasing return to scale,at this point,diminishing returned to scale.Between 2006 and 2015,the number of medical institutions and the number of health technical personnel in China's maternity and child care centers are redundant,and some years should be reduced to achieve the frontier of production.Between 2006 and 2013,there was insufficient investment in bed resources.Between 2014 and 2015,there was redundant investment in it.Between 2006 and 2015,the overall output of maternity and child care centers in China is insufficient.Analyze from cross-sectional data,in 2015,there were 204 institutions of maternal and child health care in Hebei province,which was the largest number in China,and Beijing was the least,which has 19.Guangdong province had the largest number of health technical personnel,with 32821 people,Tibet had the least number,with 447 people.Maternal and Child Health Hospital in Guangdong Province had the largest bed,which reached to 19993 while Tianjin had the smallest,130.The diagnosis and treatment of people up to 37 million 140 thousand people in Guangdong Province,discharge up to 1 million 670 thousand persons,which were in the leading position in the 31 provinces and cities.The number of visits and discharged persons were the lowest in Tibet,which were 530 thousand people and more than 5 thousand people respectively.In 2015,the average allocation efficiency of health resources in maternal and child health care centers of 31 provinces and cities in China was 0.91,the average of pure technical efficiency was 1.07,and the average scale efficiency was 0.88.The pure technical efficiency of Maternal and child health hospital health resources allocation was different greatly in 31 provinces and cities,only 7(22.6%)provinces and cities' pure technical efficiency reached>1,which technology was relatively effective,but the scale efficiency was<1,did not reach the optimal scale,pure technical efficiency of 24 provinces was still<1.There were 17(54.8%)provinces and cities in the state of diminishing returns to scale,that was,the investment was too large;there were 14(45.2%)provinces and cities in the state of increasing returns to scale,that was,investment was not fully utilized.In 2015,the number of medical institutions and health technical staff in 31 provinces and cities of China was somewhat redundant,and some provinces and cities needed to reduce their input to achieve the frontier of production.The number of beds in Anhui,Jiangsu,Liaoning,Qinghai,Shanghai and Tianjin had been under invested.Conclusions:We should further strengthen the development of obstetrics and gynecology and strengthen the construction of children's specialized hospitals.Increase the manpower investment in obstetrics,gynecology and pediatrics and coordinate the proportion of specialized human resources.Attention should be paid to the total allocation of bed resources and to increase the proportion of bed resources in obstetrics,gynecology and pediatrics.Meet the needs of Obstetrics,gynecology and pediatric health services and rationally allocate health resources.We should strengthen the construction of primary and secondary maternal and child health care centers,and pay attention to primary prevention of maternal and child health care.Advocate practicing physicians to take multi-point practice and optimize the structure of doctors and nurses in maternity and child care centers.Improve the utilization rate of beds in maternal and child health care centers and enhance the rational allocation of bed resources.Improve the critical care ability of pregnant women and newborns,and promote maternal and child health and quality services.Grasp the scale and efficiency of maternal and child health care resources,and improve the utilization rate of allocation of resources.Optimize the input and output methods of maternal and child health care resources,and reduce the provincial allocation efficiency differences. |
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