Study on operational efficiency and status of economy of scale in public secondary general hospitals_West China Medical Journal

Authors：

YANG Tingting , LI Meng , GUO Shuyan , YANG Wei ,  DONG Siping

National Institute of Hospital Administration, Beijing 100044, P. R. China;

Corresponding author：

DONG Siping, Email: sipingd@163.com

Keywords：

Technical efficiency; Pure technical efficiency; Scale efficiency; Economy of scale; Public hospital; Secondary general hospital; Bootstrap-data envelopment analysis

DOI：

10.7507/1002-0179.201911205

Video：

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Objective To measure the operational efficiency and explore the phenomenon of the economy of scale in secondary public general hospitals of China for improving the health service efficiency.Methods From February to August 2019, the data set of two input indicators (the number of employees and actual open beds) and two output indicators (the numbers of outpatients and discharges) in 511 secondary general hospitals of Shandong, Anhui, Shanxi, Hubei and Hainan provinces in 2018 were collected for data envelopment analysis. The analysis processes were three folds: First, the technical efficiency, pure technical efficiency, scale efficiency and scale compensation status of the sample hospitals were calculated respectively. Second, the comparative analysis of efficiency value and scale compensation status was carried out in 5 groups according to the bed scale. Finally, the input and output projection analysis was carried out on the ineffective decision making units.Results The medians of technical efficiencies, pure technical efficiencies, and scale efficiencies of the 511 secondary general hospitals were 0.472, 0.531, and 0.909, respectively. In the 511 hospitals, 493 hospitals (96.5%) were in ineffective state, of which 321 hospitals (62.8%) were in the state of decreasing return to scale. The staff redundancy of the group with beds >100 and ≤300 was 23.86%, and its service quantity could be increased by 39.37%.Conclusions The overall operating efficiencies are inefficiency in secondary general hospitals of China and the optimal scale of actual open beds is between 300 and 500 beds from the perspective of scale efficiency.

Citation： YANG Tingting, LI Meng, GUO Shuyan, YANG Wei, DONG Siping. Study on operational efficiency and status of economy of scale in public secondary general hospitals. West China Medical Journal, 2019, 34(12): 1362-1367. doi: 10.7507/1002-0179.201911205 Copy

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1. 中华人民共和国国务院. 关于印发推进县级公立医院综合改革意见的通知. (2015-05-08)[2019-08-15]. http://www.gov.cn/zhengce/content/2015-05/08/content_9710.htm.
2. 霍海英, 吴维民. 基于DEA的广西26家县级医院相对效率评价. 中国卫生事业管理, 2012, 29(11): 834-836.
3. 彭永波, 马龙, 古丽巴哈尔·卡德尔, 等. 北疆地区28家县级医院服务效率的数据包络分析. 中国卫生资源, 2012, 15(2): 169-170.
4. 李丹娜, 马燕, 李斌, 等. DEA在评价哈尔滨市二级医院相对效率中的应用. 中国医院统计, 2007(1): 14-16.
5. 张桂林, 潘习龙. 基于数据包络分析方法的北京市农村基本公共卫生服务项目效率评价. 北京大学学报(医学版), 2013, 45(2): 264-268.
6. Efron B. Bootstrap methods: another look at the jackknife. Ann Stat, 1979, 7(1): 1-26.
7. 董四平, 左玉玲, 陶红兵, 等. 中国医院效率DEA研究分类与投入产出指标分析. 中国卫生政策研究, 2014, 7(10): 40-45.
8. Wilson PW. FEAR: a software package for frontier efficiency analysis with R. Socio-Econ Plan Sci, 2008, 42(4): 247-254.
9. 王吉善, 张振伟, 董四平. 基于DEA的京、沪两地三级医院运营效率比较研究. 中国卫生质量管理, 2011, 18(4): 48-50, 55.
10. 魏东晓. 河南省二级综合医院市场结构与运营效率评价. 郑州: 郑州大学, 2016.
11. 李慧娟, 徐凌中. 2003年全国县级医院生产率分析. 中国卫生经济, 2007, 26(5): 80-82.
12. 李杰, 姜潮, 刘宗航, 等. 在DEA模型中应用病例组合指数评价医院服务效率. 中国卫生统计, 2003, 20(5): 11-13.
13. 王存慧, 王珩, 李念念, 等. 基于DEA-Tobit模型的县级公立医院运行效率及影响因素. 南京医科大学学报(社会科学版), 2019, 19(1): 45-49.
14. 陈聚祥, 曾培培, 陈亚运, 等. 基于DEA的全国中医类医疗卫生资源配置效率评价. 中国卫生统计, 2016, 33(2): 271-273, 277.
15. 龚倩怡, 杨土保, 游茂, 等. 湖南省17家改革试点县级公立医院运行效率DEA的评价. 实用预防医学, 2016, 23(7): 885-888.
16. 沈鹏悦, 耿蕊, 寿文静, 等. 我国中医类医院医疗卫生资源区域配置分析. 中国卫生统计, 2018, 35(3): 445-448.
17. 吴明, 李曼春, 侯建林, 等. 随机前沿成本函数方法在医院经济效率评价中的应用. 中华医院管理杂志, 2000, 16(8): 58-60.
18. 董四平, 肖婧婧, 梁铭会. 基于数据包络分析的县级综合医院规模经济效率研究. 中国卫生经济, 2011, 30(1): 67-70.

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