Accounting and Finance, University of Zaragoza, Gran Via, 2, 50005 Zaragoza, Spain.
Soc Sci Med. 2010 Sep;71(6):1131-40. doi: 10.1016/j.socscimed.2010.05.043. Epub 2010 Jun 19.
In some western countries, market-driven reforms to improve efficiency and quality have harmed the performance of some hospitals, occasionally leading to their closure, mostly in rural areas. This paper seeks to explore whether these reforms affect urban and rural hospitals differently in a European health service. Rural and urban hospital performance is compared taking into account their efficiency and perceived quality. The study is focused on the Andalusian Health Service (SAS) in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. Data Envelopment Analysis, the Mann-Whitney U test and Multidimensional Scaling techniques are conducted for two years, 2003 and 2006. The results show that rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better than urban hospitals in the patient satisfaction dimension. When the two dimensions are considered jointly, some rural hospitals are found to be the best performers. As such, market-driven reforms do not necessary result in a difference in the performance of rural and urban hospitals.
在一些西方国家，以提高效率和质量为目标的市场驱动型改革损害了一些医院的绩效，偶尔导致医院关闭，主要是在农村地区。本文旨在探讨这些改革是否会对欧洲医疗服务中的城乡医院产生不同的影响。本研究考虑了农村和城市医院的效率和感知质量，比较了它们的绩效。该研究集中在西班牙的安达卢西亚卫生服务局（SAS），该机构实施了医院选择自由政策和基于医院绩效的报销制度。本研究使用数据包络分析、Mann-Whitney U 检验和多维尺度技术对 2003 年和 2006 年两年的数据进行了分析。结果表明，农村和城市医院在效率维度上的表现相似，而农村医院在患者满意度维度上的表现明显优于城市医院。当同时考虑这两个维度时，一些农村医院被发现是表现最好的医院。因此，市场驱动型改革不一定会导致城乡医院绩效的差异。
