Martinussen Pål E, Midttun Linda
SINTEF Unimed Health Services Research, N-7465 Trondheim, Norway.
Health Policy. 2004 May;68(2):183-96. doi: 10.1016/j.healthpol.2003.09.003.
Day surgery has gained increasing significance in Norwegian health care during the 1990s, and now constitutes more than 50% of all elective surgery. Although the underlying general assumption is that this mode of delivering surgery will increase the efficiency of hospitals, most former studies have focused only on the cost-efficiency for specific types of surgical operations. The present study therefore uses data from Norwegian hospitals to test whether the proposition that day surgery spells efficiency also holds true at the hospital level. Hospital efficiency is measured as the technical efficiency of hospitals. This indicator captures how efficient hospitals are in utilising their total resources, and builds on a variety of hospital inputs (inpatient care, outpatient care) and hospital outputs (physician full-time equivalents (FTEs), other labour equivalents, medical expenses). Our empirical analysis is based on a simple decision model where the hospitals maximise utility functions of income, patients and effort under the constraint of the budget and various structural characteristics. The empirical model thus controls for several other important determinants of efficiency, such as hospital budget, the outpatient revenue share, irregularly long length of stay, hospital type and the share of emergency admissions. After accounting for these variables, our results document significant effects of day surgery on technical efficiency. The results furthermore show that the positive effect of day surgery is contingent upon hospital budget, as hospitals with large budgets experience stronger efficiency effects of day surgery.
日间手术在20世纪90年代的挪威医疗保健中变得越来越重要，现在占所有择期手术的50%以上。尽管基本的普遍假设是这种手术方式将提高医院的效率，但以前的大多数研究只关注特定类型手术操作的成本效益。因此，本研究使用挪威医院的数据来检验日间手术意味着效率这一命题在医院层面是否也成立。医院效率以医院的技术效率来衡量。该指标反映了医院在利用其全部资源方面的效率，并基于各种医院投入（住院护理、门诊护理）和医院产出（医生全职等效人员（FTE）、其他劳动力等效人员、医疗费用）。我们的实证分析基于一个简单的决策模型，在该模型中，医院在预算和各种结构特征的约束下最大化收入、患者和努力的效用函数。因此，实证模型控制了效率的其他几个重要决定因素，如医院预算、门诊收入份额、异常长的住院时间、医院类型和急诊入院份额。在考虑这些变量后，我们的结果证明了日间手术对技术效率有显著影响。结果还表明，日间手术的积极效果取决于医院预算，因为预算大的医院日间手术的效率影响更强。
