Construction And Application Of Public Welfare Stratification Dynamic Evaluation Index System In Public Hospitals

Background Since the new medical reform,the government has always stressed that public hospitals should return to the public welfare,but there is still lack of a reasonable and universal evaluation index system on how to evaluate the public welfare of public hospitals at different levels.Therefore,it is urgent for China to establish an evaluation index system,which is suitable for evaluating the public welfare of different levels of hospitals,so as to provide reference for improving the public welfare of hospitals,so as to promote the public hospitals in our country to provide efficient,convenient,high quality,low price and fair medical services for the masses.Objective This research is based on the literature reading and related theoretical knowledge learning,defining the public welfare concept of public hospitals reasonably and distinguishing the function positioning of different levels of hospitals.Screening the public welfare evaluation indicators through expert consultation method,and determining the weights of each index,establishing the public welfare evaluation index system of large and grassroots(county and below)public hospitals respectively.Finally,a representative hospital was selected for empirical research to prove the practical significance of the evaluation index system.Method Bibliometric analysis method,determining the basic framework of public hospital evaluation index system of public hospitals and selecting the public welfare evaluation alternative indicators preliminary.Delphi method,carrying out two rounds of expert consultation and combine mathematical statistics analysis method to calculate the scores of each indicator,determining the final indicator.Analytic hierarchy process,determining the index weight value.TOPSIS method,conducting an empirical study onthe sample hospitals,calculating the public welfare scores and rank them,and comparing the public welfare levels of the hospitals in different years.Result(1)The consulting experts in this study included 16 persons(72.72%)with professional titles of vice high or above.The number of people in the research field in public health policy and hospital management is 6(27.27%)and 10(45.45%),respectively.19(86.36%)have been engaged in this profession for more than 10 years.Therefore,the expert has the better work practice experience.The authoritative coefficient of experts is above 0.7.The expert coordination coefficient of the second,third and overall indicators is significantly less than 0.05,the operability of the indicators and The P value of the consistency score of the dynamic score coordination coefficient is less than 0.05.(2)The framework of the public welfare evaluation index system is preliminarily determined through bibliometric analysis.After the first round of expert consultation,the importance,operability and dynamics of each index accounted for 0.446,0.343 and 0.211,respectively.Delete and modify some indicators in combination with expert opinions,and finally a public hospital evaluation index system was constructed including 3 first-level,8 second-level and 48 third-level indicators(41 primary hospitals).(3)In the structural matrix of the index system of large and primary hospitals,there is a small number of three-level indicator matrix consistency test ratio greater than 0.01,others are less than 0.01.Large and primary hospitals have significant differences in the weights of the first-level indicators.Respectively,medical service effects(0.4984/0.4058),fairness accessibility(0.2824/0.3212)and social benefits(0.2192/0.2730),and there are also some differences in the weights of the secondary and tertiary indicators.(4)In the public welfare evaluation of large hospitals,the scores of medical services in 2015 were lower,the scores on medical service quality and social responsibility in 2016 were lower,and the overall score was higher in 2017.Primary hospitals: In 2015,the scores on medical services were low.In 2016,the scores on medical services were the lowest,and the overall score in 2017 was higher.Conclusion(1)The index system designed by the institute follows the principles of systemic,scientific,dynamic,concise,and operability,and has certain representativeness.(2)In the large-scale and grass-roots hospital public welfare evaluation index system constructed,the same point is that the first-level indicators of the two are the same.The difference is that the large-scale hospitals on the secondary indicators include the completion of the government's mandatory plan and the level of teaching and research,and the primary hospitals do not have,and the weights of indicators at all levels have significant differences.(3)The overall public welfare of large hospitals and grassroots hospitals has increased year by year in 2015-2017,and the reform of the new medical and health system has achieved remarkable results.