Hollingsworth B, Parkin D
Department of Epidemiology and Public Health, School of Health Sciences, University of Newcastle, Newcastle upon Tyne.
J Public Health Med. 2001 Mar;23(1):47-50. doi: 10.1093/pubmed/23.1.47.
A recent paper in Journal of Public Health Medicine (O'Neill et al., 2000; 22(1): 108-115) used regression modelling to determine the average costs of neonatal care services for a sample of 49 units in the United Kingdom in 1990-1991, and concluded that economies of scale were present in the sample as a whole. Although this form of modelling is useful, analysis of the efficiency of production for individual units is also important.
Data envelopment analysis (DEA) was used to analyse the data set published by O'Neil et al., to determine technical efficiency of neonatal units, measuring efficiency compared with a benchmark efficient frontier, and estimating economies of scale for each unit. Potential cost savings if units were to operate efficiently are estimated.
There is evidence of substantial levels of technical inefficiency. Economies of scale varied between units, with increasing returns in the 36 inefficient units, and mainly constant returns in the 13 efficient units. This suggests that the presence of technical inefficiency was as important as scale inefficiencies. Total cost savings, if all units were operating efficiently, are estimated at ł10.4 million, equivalent to 10 extra units producing 57,000 additional days of care.
DEA is a technique of great potential value in analysing the efficiency of health care production. As well as inefficiencies in the production of neonatal care in the United Kingdom due to differences in the scale of production, there appears to have been considerable technical inefficiency, which was not due to differences in case mix. The potential cost savings from efficiency gains are large.
《公共卫生医学杂志》最近发表的一篇论文（奥尼尔等人，2000年；22(1):108 - 115）运用回归模型确定了1990 - 1991年英国49个新生儿护理单位样本的平均成本，并得出结论，整个样本中存在规模经济。尽管这种建模形式很有用，但对各个单位的生产效率进行分析也很重要。
数据包络分析（DEA）被用于分析奥尼尔等人发表的数据集，以确定新生儿护理单位的技术效率，将效率与基准有效前沿进行比较来衡量，并估算每个单位的规模经济。估算了各单位若有效运营可能节省的成本。
有证据表明存在大量技术无效率情况。各单位的规模经济情况各不相同，36个无效率单位呈现规模报酬递增，13个有效率单位主要呈现规模报酬不变。这表明技术无效率的存在与规模无效率同样重要。如果所有单位都有效运营，估计总成本可节省1040万英镑，相当于增设10个单位可多提供57000天的护理服务。
数据包络分析是一种在分析医疗保健生产效率方面具有巨大潜在价值的技术。除了由于生产规模差异导致英国新生儿护理生产存在无效率情况外，似乎还存在相当严重的技术无效率，且这并非由病例组合差异所致。提高效率带来的潜在成本节省巨大。
