Cueva Ares Juan, Cacho Uzal Mateo, Lopez-Juiz Fe, Reyes-Santías Francisco
Universidad Carlos III. Facultad de Economía. Departamento de Economía. Madrid. España .
Universidad Carlos III. Facultad de Economía. Departamento de Economía. Madrid. España.
An Sist Sanit Navar. 2024 Dec 21;47(3):e1100. doi: 10.23938/ASSN.1100.
This study aims to assess the impact of transitioning a hospital/foundation from indirect management to direct management on the efficiency of hospital resource management.
Until 2010, the Virxe da Xunqueira hospital/foundation, located in the Galicia-North Portugal Euroregion, operated under indirect management. In 2010, it transitioned to direct management as a health centre within the Galician Health Service (Spain). Public management of hospital resources was compared using data development analysis for two periods: indirect management (2005-2009) and direct management (2011-2015). Inputs included labour (number of workers) and capital (number of beds), while outputs were measured by the number of consultations, emergencies, interventions, admissions (inpatients), hospital stays, patients on waiting the list, average length of stay, waiting times, and hospital occupancy rate. The synthetic index used was the basic care units.
Virxe da Xunqueira demonstrated greater efficiency as a hospital/foundation in terms of the number of consultations, emergencies, admissions, inpatients, and indicators related to patient stay (including number and average length of stay). After transitioning to direct management, the hospital showed improved efficiency in average waiting times, the number of patients on the waiting list, and the number of surgical interventions. The production factors exhibited decreasing returns to scale in both types of governance.
Both type of management show greater efficiency in certain inputs. However, there is insufficient evidence to conclude that the previous management model (indirect management) is more efficient than direct management.
本研究旨在评估医院/基金会从间接管理转变为直接管理对医院资源管理效率的影响。
位于葡萄牙北部加利西亚欧洲地区的维尔塞·达·克塞拉医院/基金会在2010年之前采用间接管理模式运营。2010年，它转变为西班牙加利西亚卫生服务体系内的一个健康中心，实行直接管理。利用数据包络分析对两个时期的医院资源公共管理情况进行比较：间接管理时期（2005 - 2009年）和直接管理时期（2011 - 2015年）。投入包括劳动力（工作人员数量）和资本（床位数量），而产出通过会诊次数、急诊次数、干预次数、住院人数（住院患者）、住院天数、候诊名单上的患者人数、平均住院时间、等待时间和医院占用率来衡量。所使用的综合指标是基层医疗单位。
在会诊次数、急诊次数、住院人数、住院患者数量以及与患者住院相关的指标（包括住院天数和平均住院时间）方面，维尔塞·达·克塞拉医院/基金会作为医院/基金会表现出更高的效率。转变为直接管理后，该医院在平均等待时间、候诊名单上的患者人数和外科手术干预次数方面效率有所提高。在两种管理模式下，生产要素均呈现规模报酬递减。
两种管理模式在某些投入方面都表现出更高的效率。然而，没有足够的证据得出先前的管理模式（间接管理）比直接管理更高效的结论。
