Study On Operational Efficiency Evaluation And Influencing Factors Of County-Level Public Hospitals Based On The DEA-Tobit Model

Background County-level public hospitals play an important role in China's medical tertiary health care network and medical health network.Since the new round of medical reform in2009,county-level public hospitals have been continuously exploring and reforming.Knowing the changes in the operational efficiency of county-level public hospitals,the scale of hospital development,resource input and output,etc.,We can provide suggestions for the future development of county-level public hospitals.This study is based on 36 sample hospitals to understand the current status of county-level public hospitals and related influencing factors.Methods Fujian,Anhui and Qinghai provinces were selected as sample provinces according to the eastern,central and western regions.Each province randomly selected 12 counties according to regional differences and economic development levels.According to the self-designed hospital operation questionnaire,the basic information of the hospital,hospital personnel information,hospital service capacity,and hospital operation ability were investigated.After collecting the data,based on cluster analysis and correlation analysis,the key indicators are selected.After determining the indicators,the technical efficiency,pure technical efficiency and scale efficiency of the sample hospital are calculated based on DEA;the productivity change during the five years is calculatedbased on the Malmquist index;based on the Tobit model Analysis the influencing factors.Results(1)Based on cluster analysis and correlation analysis,four DEA input indicators were selected: actual doctors,actual nurses,total expenditures,fixed assets;three output indicators were selected: number of emergency and outpatients patients,medical income,actual occupation of the total number of bed days.(2)In 2011-2015,the TE values of the county-level public hospital were 0.881,0.914,0.881,0.851,and 0.890,respectively.The average growth rate of TE values was0.254%,and the PTE values were 0.923,0.939,0.910,0.891,and 0.925,respectively.the SE values were 0.955,0.971,0.969,0.954,0.961,respectively.(3)In 2011-2015,the change range of TE and PTE is obvious.The trend of SE is relatively flat compared with the former.The change of TE is greatly affected by SE,and the PTE value is lower than SE.The SE have a greater impact on hospital operation efficiency;(4)The number of hospitals with TE=1 is 13(36.11%),20(55.56%),16(44.44%),11(30.56%)and 14(38.89%),respectively.The total number of effective hospitals in the eastern region is 7(53.85%),9(45.00%),9(56.25%),5(45.45%),and 6(42.86%)respectively;(5)In 2011-2015,the TFPC of 36 sample hospitals was 1.007,an average increase of0.7 percentage points,the TC increased by an average of 1.1%,and the TEC decreased by an average of 0.4%.The increase of TFPC was mainly due to TC.(6)The efficiency values of TE,PTE and SE in 8 hospitals did not reach 1.Under the input-oriented,the inputs of these 8 hospitals have different levels of surplus;(7)By Tobit regression analysis,it can be concluded that the number of per capita emergency doctors is positively correlated with TE,and the per capita fixed assets and fiscal revenue ratio are negatively correlated with TE.Conclusions In 2011-2015,the average values of TE,PTE and SE in county-level public hospitals were 0.883,0.918 and 0.962,respectively,and the average scale efficiency was higher.The average values of the Malmquist index averaged 1.007,an increase of 0.7percentage points,which was caused by TC.However,it was significantly lower in2012-2015 than in 2012-2013,and we considered this may be due to the “saturation point” after the policy was implemented.In the past 5 years,the change of TE was mainly the influence of SE rather than PTE.The TE value of the sample hospital was affected by the per doctors emergency and outpatients of doctors,fiscal revenue ratio,and the per capita fixed assets.The hospital should pay attention to the impact of scale.While maintaining the same output,pay attention to streamlining the input of personnel and the number of beds,strengthen the connotation construction of hospitals,improve the level of diagnosis and treatment,standardize the behavior of medical staff,and improve the business ability of hospital management administrators.Moderately arrange doctors' work tasks to improve hospital efficiency.There are differences in efficiency values among the three regions.The overall performance of the eastern region is the best.The importance of regional differences and economic development differences on hospital operational efficiency is emphasized.Regional resource planning should be tailored to local conditions.At the same time,hospitals themselves must focus on improving their own management and development.To unify efficiency and efficiency,we must not rely solely on the input of higher-level finance to achieve the normal operation of the hospital,but should be its own medical income.