Comparative Study On Operational Efficiency Of County General Hospitals In Shandong Province

Objective: County public hospitals play an increasingly important role in the field of medical services with the support of the national medical reform policy.The county general hospital is the main force of county public hospitals.By comparing the operating efficiency of county general hospitals,we can effectively grasp the effectiveness of the comprehensive reform of county public hospitals.In order to realize the improvement of hospital efficiency,optimization of resource allocation and economics of returns to scale,the article collects the operational data of 68 county general public hospitals in Shandong Province from 2016 to 2017,compares the differences in operating efficiency of county public hospitals from the perspective of per capita GDP and bed size,and explores the impact of economy and scale on hospital operation efficiency.Methods: Taking 68 county general hospitals in Shandong Province as research objects,seven evaluation indicators were determined through literature research and expert consultation.These indicators included the actual number of open beds,the number of doctors,the number of nurses,the total expenditure,the total number of visits,the number of discharged and the total income.The CCR model of Data envelopment analysis was used to calculate the technical efficiency scores of 68 county general hospitals and the BCC model was used to calculate the hospital's pure technical efficiency and scale efficiency scores.In addition,the article analyzes the slacked values of non-DEA effective hospitals and evaluates the operation efficiency of county general hospitals in2016 and 2017.At the same time,from the two dimensions of per capita GDP and bed size,the Kruskal-Wallis H rank sum test was used to compare the differences in hospital technical efficiency,pure technical efficiency,and scale efficiency,and the chi-square(c2)test was used to compare the differences in hospital returns to scale.The study estimates the size of beds suitable for the development of county general hospitals in Shandong Province.Results: Of the 68 county general hospitals in Shandong Province,only 15(22.06%)were efficient in 2016,while only 20(29.41%)were efficient in 2017.In 2016 and 2017,the average technical efficiency scores of 68 county general hospitals were 0.905 and 0.940,pure technical efficiency was 0.924 and 0.951 respectively,and scale efficiency scores were 0.980 and 0.988 respectively.There were 21 hospitals with increasing returns to scale,20 hospitals with constant returns to scale and 27 hospitals with decreasing returns to scale in 2016.There were 27 hospitals with increasing returns to scale,23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale in2017.In the comparison of economic differences and scale effects of hospital operating efficiency.The difference in technical efficiency of county-level general hospitals with different per capita GDP in 2016 was statistically significant(P<0.05),and the difference in pure technical efficiency of county general hospitals with different bed sizes was statistically significant(P<0.05).The differences in scale efficiency and returns to scale of county general hospitals with different bed sizes in 2017 were statistically significant(P<0.05).When the bed size was 885 beds,hospitals with decreasing returns to scale began to appear;when the bed size exceeded 1100 beds,there will no longer be hospitals with increasing returns to scale.Conclusion: In 2017,the operational efficiency of county general hospitals in Shandong Province was significantly improved compared with 2016.However,the number of efficient hospitals needed to be further increased,and there was still room for further improvement in operational efficiency.The hospital should choose a suitable development model according to the actual situation.Most county general hospitals in Shandong Province had problems of redundant inputs or insufficient outputs.The hospital should improve the technical efficiency,make full use of health resources and improve staff efficiency.The different bed sizes will affect the scale efficiency and the returns to scale of hospitals.The size of the bed exceeds a certain amount,which will lead to the decline of the scale efficiency of hospitals and the decreasing returns to scale.Hospitals with decreasing returns to scale should reasonably control the size of hospital beds.