| PurposeThe purpose of this study is to design a scientific and comprehensive index system of efficiency evaluation for township hospitals in the perspective of hierarchical medical system,and use both parametric and non-parametric methods to analyze the efficiency and influencing factors of township hospitals in Guangzhou,so as to provide a policy basis to improve township hospitals’ efficiency from the perspective of health economics.MethodsThe data from this study was obtained from Health System Table 2-1 of township hospitals in Guangzhou from 2012 to 2019,and the research subjects were 30 township hospitals.First,through literature research,Delphi method and principal component analysis,determine the input-output index system of township hospitals under the hierarchical medical system,then use the BCC and Malmquist exponential of DEA,and production function of SFA to measure the static and dynamic efficiency value,and valuate the change of efficiency of Guangzhou township hospitals and the reasons scientifically.Results1.Between 2012-2019,the number of township hospitals in Guangzhou remained stable,the investment of health resources was generally increasing,and the average growth rate per annum of room area,health technicians,total assets and total revenue were 2.39%,5.77%,32.24% and26.63% respectively.Business indicators representing resource utilization were also growing generally,the average growth rate per annum of the total number of patients,discharges,referrals to superiors and discharge transfers to hospitals were 8.31%,0.20%,123.64% and 6.72% respectively;On behalf of the grassroots medical treatment tendency index showed a downward trend,the average growth rate per annum of the average daily number of doctors and the average daily number of doctors were 1.51% and-4.42% respectively.2.Between 2012-2019,the average growth rate per annum of staff,room area,and equipment in the sample township hospitals in Guangzhou were 5.03%,5.06%,and 13.37% respectively.The average growth rate per annum of outpatient and emergency services,family health services,middle medical treatment,referral to superiors,and discharge to hospital were 7.44%,4812.06%,762.86%,163.71%,and 6.88% respectively;the average growth rate per annum of public health practitioners(assistant)doctors,general practitioners and permanent residents in the area of public health services were 9.33%,35.26% and 6.95% respectively.The number of child immunization programs,infectious diseases and public health emergencies,standardized electronic files,health management of 0-6,early pregnancy registration,diabetes health management and patients with severe mental and disorders under standardized management were 11.56%,12.95%,15.83%,12.23%,1.60%,5.10%,and 5.60%.3.According to DEA-BCC,the average efficiency of medical service TE in the sample townshi p hospitals from 2012-2019 were 0.796,0.801,0.816,0.792,0.838,0.831,0.870 and 0.898,and the ove rall efficiency level was moderate showing a trend of growth year by year.Overall the PTE showed a trend of decline first and then rise(0.905,0.893,0.909,0.888,0.864,0.854,0.903,0.927 per year),the overall growth of scale efficiency(0.880,0.896,0.899,0.895,0.967,0.968,0.964,0.969);The average T E of public health services from 2015 to 2019 were 0.900,0.889,0.920,0.931,0.932,high overall ef ficiency level excepting for a slight decline in 2016,the overall growth trend was showing,and PTE showed an overall growing trend(0.916,0.906,0.935,0.947,0.945 each year),the SE showed an incre asing trend(0.982,0.981,0.983,0.984 and 0.985 each year).It can be seen from the underutilization o f inputs and insufficient output in 2019 mainly including the output of 2,3 and 4 of medical services and the main components of public health services 2.4.The TFP of sample hospitals in 2012-2019 calculated by DEA-Malmquist was generally decreased(-7.0%,1.0%,-4.2%,7.5%,-0.6%,-12.1% and-2.8%),among which TC was the main reason.The TFP of basic public health services in 2015 to 2019 was generally decreased(-1.2%,10.3%,-2.4% and-1.2%),and relatively decreased(1.1% from 2015 to 2019),among which technological progress was also the main reason.5.The average efficiency value of medical services in 30 sample town hospitals from 2012 to2019 calculated by SFA was 0.65,which was at the medium level;the average efficiency value of public health services in 30 sample town hospitals from 2015 to 2019 was 0.67,also at the medium level.In 2015-2019,these two efficiency values were different with P =0.028.The variance ratio for medical and public health services were 0.35 and 0.57,and the difference was significant statistically;in the production function of SFA the coefficient of independent variable health technicians,number of beds,equipment over 10,000 yuan,room area,public health practitioners doctors,general practitioners,and permanent resident population in the area were: 0.29,-0.06,0.18,0.06,0.18,0.27,0.54,among them the independent variables corresponding to the medical efficiency were statistically significant in the number of health technicians and equipment sets of more than 10,000 yuan,among the independent variables corresponding to the efficiency of public health services,the number of public health practitioners doctors,the number of general practitioners and the number of permanent residents in the area all had a positive impact on the output capacity of hospitals.Conclusions1.In 2012-2019 Guangzhou township hospitals’ resources presented a growing trend,under the hierarchical medical system township hospitals kept a stable developing trend in addition to inpatient services,there was a problem of utilizing resources insufficiently.2.Before 2015 the SE of sample hospitals restricted the medical services’ TE,after 2015 the PTE restricted the efficiency of medical and public health services.From the dynamic view,the TFP of medical service and public health service in the sample township hospitals had declined,and the overall efficiency change of medical services varied in different economic zones.3.From excess input and output proportion,sample township medical and public health services had different degrees of underutilization of inputs and insufficient output,such as family health services,the Chinese medicine services,and chronic disease management mainly.4.In terms of service type,the average efficiency of medical service was lower than that of public health service,and health centers with high efficiency of basic medical services also had higher efficiency of basic public health services.Public health service efficiency varied across economic zones and institutional categories.5.On how to promote the efficiency of township hospitals,this paper proposes the following policy suggestions from the government,township hospitals and person: government departments need to continue to optimize resource allocation,implementing relevant policies reasonably to guide the hierarchical medical system;township hospitals should strengthen connotation construction and optimize characteristic service;people should enhance health awareness and correct reasonable medical consciousness,and actively participate in the feedback of the service effect of primary medical and health institutions. |
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