Study On The Change Of Operational Benefits Of County-level Public Hospitals After The Reform Of Compensation Mechanism

Objective: To analyze the changes in indicators such as fiscal revenue,medical income,medical services volume,hospital expenditure,medical expenses,and operational efficiency before and after the full appropriation policy of the People's Hospital of YQ County,Guizhou Province,evaluate the impact of the policy on hospital operation and development,and provide corresponding reference for improving the compensation mechanism of county-level public hospitals.Methods: According to the relevant data before the reform of the compensation mechanism of the YQ County People's Hospital(2009-2011)and after the reform(2012-2017).Analysis of hospital operating benefits from two aspects: economic benefits(resource allocation,medical service volume,hospital expenditure,work efficiency,development capability,operational efficiency)and social benefits(medical cost control,medical staff and patient satisfaction evaluation).Descriptive statistical analysis was used to analyze quantitative data,and data envelopment analysis was used to analyze changes in hospital operating efficiency.Through questionnaires to understand the satisfaction of patients and medical staff on the current medical environment,an independent sample t test was used to analyze the data,and interviews were used to understand the views of hospital administrators on hospital reform and development.Results: The income structure of the YQ County People's Hospital changed before and after the reform of the compensation mechanism.After the reform,the financial subsidy income increased year by year,in 2017,the fiscal revenue accounted for 22.73%,and the drug share decreased from 36.19% in 2009 to 22.56% in 2017.In terms of economic benefits,compared with 2009,the number of employees in the hospital increased by 421in 2017,and the number of beds in the hospital increased by 300.The average growth rate of hospitals after the reform was 22.51%,which was greater than-5.4% before the reform;the average hospitalization period was shortened,the bed turnover rate has decreased.Through data envelopment analysis,it was found that the operating efficiency of YQ County People's Hospital did not change significantly before and after the reform.In 2011 and 2012,the hospital was in the DEA invalid state,and the rest of the years were in the DEA valid state.Compared with the average operating efficiency of county-level hospitals in Guizhou Province,the total factor productivity of YQ County People's Hospital was higher than the provincial average in 2013 and 2014,and was lower than the provincial average for the next three years.In terms of social benefits,the average growth rate of outpatient medical expenses of outpatients in YQ County People's Hospital after reform was 8.84% lower than 28.66% before the reform,and the average growth rate of inpatients' average medical expenses after reform was 3.64% slightly higher than 2.40% before the reform;The satisfaction of patients and medical staff in YQ County People's Hospital was higher than that of the county people's hospital that did not implement the full appropriation policy.Conclusion: First,the financial subsidy investment has increased year by year,and the government's duties have become increasingly prominent;Second,The medical income structure has gradually become more reasonable,but it still needs improvement;Third,the hospital's economic benefits has improved;Fourth,the hospital's operational efficiency is insufficient,the new policy may be in an inefficient period;Fifth,The average rate of medical expenses is slow,and patients and medical staff are more satisfied.In summary,the reform of the compensation mechanism for full appropriation greatly promote the development of county-level public hospitals,especially the social benefits of hospitals,but the disadvantage is that the efficiency is low.Regarding the issue above,First,pay attention to the transformation of financial subsidies and prevent blind investment.Second,adjust the price of medical services and continue to optimize the income structure.Third,strengthen the introduction of health talents,pay attention tothe training and development of employees;Fourth,strengthen the refined management of hospitals and improve the efficiency of hospital operations.