Wang Xuan, Luo Hongye, Qin Xianjin, Feng Jun, Gao Hongda, Feng Qiming
School of Information and Management, Guangxi Medical University, 22 Shuang Yong Road, Qing Xiu District, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
Int J Equity Health. 2016 Aug 23;15(1):131. doi: 10.1186/s12939-016-0420-y.
As the core of the county-level Maternal and Child Health Hospitals (MCHH) in rural areas of China, the service efficiency affects the fairness and availability of healthcare services. This study aims to identify the determinants of hospital efficiency and explore how to improve the performance of MCHH in terms of productivity and efficiency.
Data was collected from a sample of 32 county-level MCHHs of Guangxi in 2014. Firstly, we specified and measured the indicators of the inputs and outputs which represent hospital resources expended and its profiles respectively. Then we estimated the efficiency scores using Data Envelopment Analysis (DEA) for each hospital. Efficiency scores were decomposed into technical, scale and congestion components, and the potential output increases and/or input reductions were also estimated in this model, which would make relatively inefficient hospitals more efficient. In the second stage, the estimated efficiency scores are regressed against hospital external and internal environment factors using a Tobit model. We used DEAP (V2.1) and R for data analysis.
The average scores of technical efficiency, net technical efficiency (managerial efficiency) and scale efficiency of the hospitals were 0.875, 0.922 and 0.945, respectively. Half of the hospitals were efficient, and 9.4 % and 40.6 % were weakly efficient and inefficient, respectively. Among the low-productiveness hospitals, 61.1 % came from poor counties (Poor counties in this article are in the list of key poverty-stricken counties at the national level, published by The State Council Leading Group Office of Poverty Alleviation and Development, 2012). The total input indicated that redundant medical resources in poverty areas were significantly higher than those in non-poverty areas. The Tobit regression model showed that the technical efficiency was proportional to the total annual incomes, the number of discharge patients, and the number of outpatient and emergency visits, while it was inversely proportional to total expenditure and the actual number of open beds. Technical efficiency was not associated with number of health care workers.
The overall operational efficiency of the county-level MCHHs in Guangxi was low and needs to be improved. Regional economic differences affect the performances of hospitals. Health administrations should adjust and optimize the resource investments for the different areas. For the hospitals in poverty areas, policy-makers should not only consider the hardware facilities investment, but also the introduction of advanced techniques and high-level medical personnel to improve their technical efficiency.
作为中国农村地区县级妇幼保健院（MCHH）的核心，其服务效率影响着医疗服务的公平性和可及性。本研究旨在确定医院效率的决定因素，并探索如何在生产率和效率方面提高妇幼保健院的绩效。
数据收集自2014年广西32家县级妇幼保健院的样本。首先，我们明确并测量了分别代表医院资源消耗及其概况的投入和产出指标。然后，我们使用数据包络分析（DEA）估算每家医院的效率得分。效率得分被分解为技术、规模和拥挤成分，并且在该模型中还估算了潜在产出增加和/或投入减少的情况，这将使相对低效的医院变得更高效。在第二阶段，使用Tobit模型将估算出的效率得分与医院外部和内部环境因素进行回归分析。我们使用DEAP（V2.1）和R进行数据分析。
医院的技术效率、纯技术效率（管理效率）和规模效率的平均得分分别为0.875、0.922和0.945。一半的医院是有效的，9.4%和40.6%分别为弱有效和无效。在低生产率医院中，61.1%来自贫困县（本文中的贫困县是指国务院扶贫开发领导小组办公室2012年公布的国家级重点贫困县名单中的县）。总投入表明贫困地区的冗余医疗资源明显高于非贫困地区。Tobit回归模型显示，技术效率与年度总收入、出院患者数量以及门诊和急诊就诊次数成正比，而与总支出和实际开放床位数成反比。技术效率与医护人员数量无关。
广西县级妇幼保健院的整体运营效率较低，需要加以提高。地区经济差异影响医院的绩效。卫生行政部门应针对不同地区调整和优化资源投入。对于贫困地区的医院，政策制定者不仅应考虑硬件设施投资，还应引进先进技术和高水平医务人员以提高其技术效率。
