Research On Operational Efficiency Evaluation And Influencing Factors Of Provincial Public Hospitals In Shandong Province

BackgroundThe operation efficiency of public hospitals reflects the fine,specialized and scientific management level of hospitals.With the deepening of medical reform,improving the service quality and operation efficiency of public hospitals has become an important task to establish a modern hospital management system and deepen the reform of public hospitals.The improvement of operation efficiency is also of great significance to public hospitals in the fierce market competition.Through strengthening the internal management of public hospitals,controlling operating costs,standardizing medical service behaviors and other measures,we can promote the level of management of public hospitals,take social responsibility and promote their own development.However,there are many problems of operation in public hospitals,such as heavy work load,high potential financial risk,high Asset-liability Ratio,unreasonable structure of income and expenditure,rapid growth of medical expenses,etc.Therefore,under the guidance of Guidelines on Establishing a Modern Hospital Management System and Suggestions on Strengthening the Performance Appraisal of Tertiary Public Hospitals of the State Council,it is necessary to provide further instructions for provincial public hospitals to implement the functional positioning,to improve the operation efficiency and scientific management level of public hospitals,and to realize the sustainable development of provincial public hospitals.ObjectiveUnder the background of Deepening the Reform of Medical Health System and Establishing Modern Hospital Management System policy,the purpose of this study is to evaluate and study the operation efficiency of provincial public hospitals in Shandong province,to explore the key factors that influencing the provincial public hospital operating efficiency,and to look for contributing mechanism of improving the operation efficiency.This study may provide scientific basis for the administrative department of health and provincial public hospitals to issue corresponding policies,establish and improve internal management.Data and MethodsThe data were obtained from the Project of Reform and Development Strategy Research on Provincial Public Hospitals in Shandong Province.Comprehensive survey was conducted on all 22 provincial public hospitals that were included in the system management of Shandong provincial government and provincial finance.Data were collected by both quantitative and qualitative methods,questionnaires of medical institutions were designed by ourselves.Contents of the survey mainly includes:basic situation and operation status from 2015 to 2017,medical service capacity,cost accounting,as well as the government's financial input,operation management,medical service price,medical cost control and other aspects.We also implement Focus Group Interviews with relevant personnel of every hospital,give an insight into hospital medical services,operation and development of the actual situation.Data analysis was mainly conducted by EXCEL and SPSS21.0.Data analysis methods mainly included Descriptive Analysis,Entropy Weight Method,Weighted TOPSIS and Rank Sum Test Results1.The overall workload of doctors in provincial public hospitals decreased during 2015?2017,but the workload of doctors in General Hospitals had a little growth.The number of pharmacists has been greatly reduced,and the structure of income and expenditure has been continuously optimized.However,the Asset-liability Ratio has been increased,and the Asset-liability Ratio of some hospitals is relatively high,there may be debt service risks of some hospitals.The total medical income of provincial public hospitals is increasing year by year,the medical expenses are higher than the both of national and provincial Tertiary public hospitals,and the patients' medical burden is heavy and increasing.Some provincial public hospitals need to strengthen management of cost,establish and to promote the System of Chief Accountant urgently2.Compared with 2016,operation efficiency of 5 provincial public hospitals was improved in 2017,including 2 general hospitals and 3 specialized hospitals.6 hospitals,including 2 general hospitals and 4 specialized hospitals,had reduced their operational efficiency ranking.There was no change in the ranking of operation efficiency of 11 provincial public hospitals3.The number of pharmacists per 100 beds,the proportion of outpatient income in medical income,the proportion of inpatient income in medical income,the proportion of personnel expenditure in health spending,and the implementation of the chief accountant system are main internal factors that affecting the operation efficiency Through the analysis of qualitative data,it is found that the cancellation of Drug Addition Policy,the unsound Medical Security System and the lack of flexibility of policies are external factors that affect operation efficiency.Conclusions and SuggestionsBalance of payments structure is gradually optimized,but the number of pharmacists is reduced and the level of medical expenses is relatively high.Whether to establish the system of chief accountant and implementation of the policy of eliminating drug markups has impact on the operation of each hospital.We should reduce the workload of physicians,explore more reasonable pricing mechanism of medical services,appropriately increase the proportion of personnel expenditures,control the growth of medical expenses,and establish the System of Chief Accountant.