Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Public Health. 2022 Jun 10;10:918571. doi: 10.3389/fpubh.2022.918571. eCollection 2022.
The efficient operation of county-level medical institutions is a significant guarantee in constructing Chinese rural tertiary care service networks. However, it is still unclear how to increase the efficiency of county hospitals under the interaction of multiple factors. In this study, 35 county general hospitals in China were selected to explore the configuration paths of county hospitals' high and poor efficiency status under the Environment-Structure-Behavior (ESB) framework and provide evidence-based recommendations for measures to enhance its efficiency.
Data envelopment analysis with the bootstrapping procedure was used to estimate the technical efficiency value of case hospitals. A fuzzy-set qualitative comparative analysis approach was carried out to explore the configuration of conditions to the efficiency status.
Antecedent configurations affecting the efficiency status of county hospitals were identified based on the ESB analytical framework. Three high-efficiency configuration paths can be summarized as structural optimization, capacity enhancement, and government support. Another three types of paths, namely insufficient capacity, aggressive expansion, and poor decision-making, will lead to inefficient configurations.
Qualitative comparative analysis is necessary when exploring complex causality. The efficiency situation of county hospitals results from a combination of influencing factors instead of the effect of a single one. There is no solitary configuration for high efficiency that applies to all healthcare units. Any measures aimed at efficiency promotion should be discussed within the framework of a case-specific analysis.
县级医疗机构的高效运作是构建中国农村三级医疗服务网络的重要保障。然而，在多种因素的相互作用下，如何提高县级医院的效率仍不清楚。本研究选取中国 35 家县级综合医院，运用环境-结构-行为（ESB）框架探讨县级医院高、低效率状态的配置路径，为提高县级医院效率的措施提供循证建议。
采用数据包络分析（DEA）和 bootstrap 程序估算病例医院的技术效率值。采用模糊集定性比较分析（fsQCA）方法探讨影响县级医院效率状态的条件配置。
根据 ESB 分析框架，确定了影响县级医院效率状态的前置配置。可以总结出三种高效率配置路径，即结构优化、能力提升和政府支持。另外三种低效配置路径为能力不足、盲目扩张和决策失误。
在探索复杂因果关系时，定性比较分析是必要的。县级医院的效率状况是多种影响因素共同作用的结果，而不是单一因素的影响。不存在适用于所有医疗机构的单一高效配置。任何旨在提高效率的措施都应在具体案例分析的框架内进行讨论。
