School of Management, Nanchang University, Nanchang, China.
Anhui University of Finance and Economics, Bengbu, China.
PLoS One. 2020 Dec 11;15(12):e0243460. doi: 10.1371/journal.pone.0243460. eCollection 2020.
Since the last medical reform in 2009, China's public hospitals have been facing the changes in the institutional environment. However, the effects of reforms have not been received enough attention to deliver evidence-based implications. In this paper, we first assess the efficiency of regional public hospitals from 2011 to 2018, employing a proposed method based on an additive indicator and an aggregate directional distance function (DDF). The method applied allows for decomposing total factor productivity (TFP) indicator into three components, including technical efficiency change (TEC), total productivity (TP) and scale efficiency change (SEC). Second, following the efficiency assessment, we carry post-efficiency analysis to identify the determinants of efficiency of the public hospitals. The results show that annual average TFP growth rate is 1.38%, which is driven mainly by TEC. Regional disparities of public hospitals' performance are expanding. Almost 75% of the regions considered show a positive TFP growth. The regression results show that the significant determinants of efficiency of regional public hospitals include the price of and demand for health services.
自 2009 年最后一次医疗改革以来，中国公立医院一直面临制度环境的变化。然而，改革的效果并没有得到足够的重视，无法提供基于证据的启示。在本文中，我们首先采用基于加法指标和综合方向距离函数（DDF）的方法，评估了 2011 年至 2018 年地区公立医院的效率。该方法可以将全要素生产率（TFP）指标分解为三个组成部分，包括技术效率变化（TEC）、总生产率（TP）和规模效率变化（SEC）。其次，在进行效率评估后，我们进行了效率分析后，以确定公立医院效率的决定因素。结果表明，公立医院的年平均 TFP 增长率为 1.38%，主要由 TEC 驱动。公立医院绩效的地区差距正在扩大。考虑到的近 75%的地区显示出正的 TFP 增长。回归结果表明，地区公立医院效率的显著决定因素包括卫生服务的价格和需求。
