| Objective:To analyze the growth of medical and health resources in Suqian City,evaluate the efficiency of health resource allocation in Suqian City horizontally and vertically,and explore the problems in the development of private hospitals in Suqian City through the analysis of the operational efficiency of thirty-four secondary and higher hospitals in Suqian City in 2016 and 2017.And finally,we would propose policy recommendations for the private hospitals in Suqian City to get out of the predicament by discussing the causes of these problems.Methods:Using the fixed base ratio and ring ratio analysis method,the number of hospitals,bed configuration,health human resources,assets,liabilities and financial subsidies in Suqian City from 2011 to 2016 were statistically described and compared with the surrounding areas.Then,the data envelopment analysis(DEA)input and output indicators were determined respectively through the literature meta-method,expert consultation and argumentation method,and the DEA method was used to analyze the health resource allocation efficiency of thirteen cities in Jiangsu Province in 2016 and the efficiency of Suqian City from 2009 to 2016.Finally,the operational efficiency of thirty-four secondary and higher hospitals in Suqian City was evaluated in 2016 and 2017.The Malmqusit index model was used to analyze the changes of total factor productivity and the influencing factors.Combined with the content of in-depth interviews,the problems in the development of private hospitals in Suqian City were analyzed.Results:(1)From 2011 to 2016,the total growth rate of Suqian hospitals was 6.94%;the number of beds increased by 6%ring ratio or more per year,and the ratio of 2013 to 2012 was 16.73%,and the total increase in 6 years was 66.22%;The total number of health staff increased by about 10%per year,with a total increase of 70.64%;total health assets of 2011 was 6.25 billion China Yuan(CNY),and 2016 was 14.08 billion Yuan,with a total increase of 125.2%.At the same time of rapid asset growth,along with the surge in the debt of health institutions in Suqian,the increase was as high as 185.43%,with high operating costs and high capital pressure.(2)Compared with the surrounding areas,Suqian City is in the middle and upper ranks in the total number of beds,number of health technicians,number of beds per 1,000 people,and number of health technicians per thousand.In terms of asset growth,Suqian has the fastest growth rate,with a fixed base ratio of 125.39%.In terms of resource efficiency,the average cost of emergency department and hospitalization was at a medium level,and the utilization efficiency of health technicians is relatively high,which was in a leading position but with a downward trend.In terms of business income,fixed asset output efficiency and bed utilization efficiency,it has been in a backward position and needs to be improved.Meanwhile,it is worrying that the financial subsidy income level of Suqian City has been chronically at a backward level.The debt situation of Suqian City Health Organization is characteristic,and the growth rate is significantly higher than that of the other three regions,and the debt surges.(3)In 2016,the results of horizontal comparison of health resources indicated that Suqian City was at relatively non-DEA effective level in thirteen cities of Jiangsu Province,with a comprehensive efficiency of 0.963,which was higher than the other seven cities which were also non-DEA,and higher than the provincial average of 0.938.(4)It showed that the allocation of health resources in Suqian City was effective in 2010,2013 and 2014,but the rest five years were invalid through the longitudinal analysis of the allocation of health resources in Suqian City from 2009 to 2016.The main influencing factors were related to scale efficiency,suggesting that some problems occurred in redundancy and over-development of investment and scale in Suqian.(5)In 2016 and 2017,the overall efficiency of thirty-four secondary and higher hospitals was relatively low,only seven and six of them had an overall efficiency of one,respectively.The rest twenty-seven and twenty-eight had less than one of comprehensive efficiency,and non-DEA effective units accounted for a relatively high proportion.From the hospital category(level),the tertiary general hospital has the highest efficiency,the second-level specialized hospital has the second highest efficiency,and the second-level general hospital has the lowest overall efficiency,Only two of second-level general hospitals were effective,accounting for only 11.11%.In terms of regional distribution,there were three and two hospitals,the values of which annual comprehensive efficiency were one among thirteen secondary and higher hospitals in two districts of Suqian City,with average comprehensive efficiency of 0.70 and 0.686,respectively;there were two effective hospitals in both years of 2016 and 2017 in twelve secondary and higher hospitals of Shuyang County,and the average efficiency is 0.724 and 0.763,respectively.The two of four secondary and higher hospitals with comprehensive efficiency equaled to one in Siyang County,and the average efficiency is 0.836 and 0.828,respectively.There are no effective units of DEA found in the five secondary and higher hospitals of Sihong County in year 2016 and 2017,and the average efficiency is 0.609 and 0.721,respectively.Regarding the perspective of slackness,redundant inputs were found in twenty-five hospitals in these two years,and the number of beds,employees and fixed assets in 2016 increase from 1822,2,367,and 2.76 billion yuan to 4,288,2,756,and 4.42 billion yuan in 2017.The redundancy of the investment continued to increase,especially in the secondary general hospitals.(6)The results of Malmqusit analysis indicated that the total factor productivity change of thirty-four secondary and higher hospitals in Suqian City was 1.013 in 2016 and 2017,and the efficiency change was 1.050,0.964 of the technological progress change,and 1.053 of the pure technical efficiency change,and the scale efficiency change was 0.997.The main factor of progress is related to the improvement of technology and management level,but the reduction of scale efficiency is the main factor affecting development.Conclusion:The marketization mechanism has enabled the rapid growth of health resources in Suqian City;the utilization efficiency of health resources has remained at a relatively high level,but with a downward trend;the utilization level of beds and fixed assets has been low and needs to be improved;rapid development has also led to a sharp increase in liabilities,high operating costs,seriously affecting the sustainable development of medical institutions;financial subsidy level of Suqian City has been at a lower level than the surrounding areas in a long-term period;in terms of configuration and operational efficiency of hospitals,the low efficiency and poor operational efficiency are still manifested by redundant input of health resources,insufficient output levels,and unreasonable hospital scale.The tertiary general hospitals tend to mature in terms of resource allocation and utilization,scale compensation,etc.,and the internal management level of hospitals is relatively high;while the overall efficiency of secondary general hospitals is at low level,the waste of resources is heavier,and the scale is overdeveloped.The problems of the secondary specialized hospitals are mainly because of underdevelopment and the small scale,so the output level has room for further exploration.In combination with in-depth interviews,private hospitals in Suqian City face policy issues such as"unclear ownership of property rights","unclear return on investment","non-transfer" barriers,"taxation and land",which affect the sustainable development of private hospitals in Suqian;The competent department lacks scientific regional health planning,and the unhealthy input and supervision mechanisms,resulting in the lack of public welfare.The "one plus two" policy payment method of the medical insurance department is unreasonable and even unfair,which seriously affects the sustainable development of the hospitals;lack of professional management,low-interest funding sources,limited financing,and low efficiency of asset usage have caused risks in their capital management.It is suggested that the relevant authorities of Suqian City could propose specific measures and rules on the policy implementation level to encourage and support the socially-friendly medical policies to break through the historical problems;moreover,it needs to strengthen regional planning,guide mergers and acquisitions,revitalize assets,improve investment mechanisms and strengthen supervision,Increased scale efficiency;regarding medical insurance policy,it could raise the bed daily payment standards,expand the coverage of single disease,and establish a relatively reasonable payment model in line with regional characteristics.Private hospitals need to strengthen the introduction and cultivation of talents,establish a rational governance structure,achieve scientific and refined management,improve technology development and promote pure technology efficiency.Besides,we could use policies and regulations to connect multi-level social capital,explore new forms of financing and financing channels,and ease financial pressures.Consequently,it would promote the sustainable and healthy development of private hospitals in Suqian City and improve the construction of a medical and health system with Suqian characteristics. |
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