Wang Man-Li, Fang Hai-Qing, Tao Hong-Bing, Cheng Zhao-Hui, Lin Xiao-Jun, Cai Miao, Xu Chang, Jiang Shuai
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Administration Office, Shenzhen People's Hospital, 2nd Clinical Medical College of Jinan University, Shenzhen, 518020, China.
J Huazhong Univ Sci Technolog Med Sci. 2017 Oct;37(5):681-692. doi: 10.1007/s11596-017-1789-6. Epub 2017 Oct 20.
China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis (DEA) to evaluate the technical efficiency (TE) and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals (39, 45, and 43 in Eastern, Central, and Western China, respectively) were collected during 2012-2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal-Wallis H test and Mann-Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency (PTE), and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012-2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012-2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.
中国于2012年实施了公立医院改革。本研究采用自抽样数据包络分析（DEA）来评估2012年公立医院改革后中国东部、中部和西部县级公立医院的技术效率（TE）和生产率。收集了2012 - 2015年期间127家县级公立医院的数据（东部、中部和西部分别为39家、45家和43家）。通过自抽样DEA和自抽样Malmquist估计TE和生产率随时间的变化。采用Kruskal - Wallis H检验和Mann - Whitney U检验比较中国三个地区公立医院在TE和生产率方面的差异。在四年期间，中国东部、中部、西部以及全国的平均偏差校正TE值分别为0.6442、0.5785、0.6099和0.6094，发现平均非技术效率、低纯技术效率（PTE）和高规模效率。2012 - 2015年期间，中国及其三个地区的生产率分别提高了8.12%、0.25%、12.11%和11.58%，生产率的提高分别源于技术进步变化16.42%、6.32%、21.08%和21.42%。中国三个地区县级医院的TE和PTE存在显著差异。中国东部和西部的TE和PTE显著高于中部。中国及其三个地区超过60%的县级公立医院处于规模报酬递减状态。中国及其三个地区的县级医院在TE改善方面有相当大的空间。2012 - 2015年期间，医院生产率有所提高；然而，PTE出现了不利变化。此外，中部地区的效率得分持续显著低于东部和西部地区。中国的决策者和管理者应找出观察到的效率低下的原因，并采取适当措施提高中国三个地区，特别是中部地区县级公立医院的效率。
