城市综合医院床位利用效率的评价指标筛选初步探讨

指标的筛选是进行评价模型选取与构建的重要前提,在阅读大量文献与专家咨询的基础上,利用北京地区17家综合医院2010年的完整病历首页信息与基本情况,采用统计学方法为主的筛选方法,运用因子分析、聚类分析和相关分析等方法,筛选出评价城市综合医院床位利用的4个投入指标与4个产出指标.     

数据包络分析法对某医院临床科室相对效率的评价

目的 以西部某大型综合性三甲医院2004～2008年5年内14个临床科室作为研究对象,对其进行相对效率研究.方法 通过应用聚类分析法确定投入产出指标、进行数据调查,采用数据包络分析(Data Envelopment Analysis,DEA)方法中CCR和BCC模型对各科室相对效率进行评价和分析.结果 分析了DEA方法在临床科室相对效率评价中的应用价值,总结了应用中在指标选择、数据处理和结果判读方面需注意的问题,并提出了DEA应用于临床科室相对效率评价的发展方向.结论 利用DEA对相对效率进行分析,对医院管理具有重要意义.     

基于DEA不同指标组合的31个省市医院相对效率研究

选取我国31个省市的医院作为决策单元,应用数据包络分析(DEA)的CCR模型,选出7组不同指标组合对医院效率进行全面分析,发现10个省份总体效率较高,年出院人次指标对DEA结果影响较大,B组指标组合对医院效率分析效果最好。DEA可以科学有效地评价医院的相对效率,不同指标组合对DEA评价结果存在差异,应合理选取指标组合。各级政府还需依照科学管理方法,提高医疗资源使用效率。     

应用数据包络分析方法评价某医科大学教研室相对运行效率

目的 探索在DEA方法中指标体系的筛选和构建以及DEA方法在医学院校教研室相对效率评价方法中的应用,为提高教研室运行效率提供依据.方法 应用文献法建立三级指标体系,通过相关性分析和专家法确定适合医学院校的DEA评价指标;运用DEA方法对某医学院校教研室的相对效率进行评价.结果 16个教研室为整体相对有效(25％);48个教研室为相对无效(75％).结论 DEA方法能够定量地描述医学院校教研室之间存在的差异,为管理者提供决策信息,使医学院校教研室更加有效运行.     

DEA在评价哈尔滨市二级医院相对效率中的应用

目的 尝试运用数据包络分析（DEA分析）对哈尔滨市48所二级医院进行相对效率综合评价。方法 共收集48所二级医院投入产出资料，采用描述性分析、聚类分析及数据包络分析进行分析研究。结果 DEA分析结果显示：①近1／2的被评价医院处于低效率运行状态；②最无效率的医院（D24）通过各指标的改善值可达到相对有效。结论 建议在增加三级医院投入的同时，也要结合二级医院的特点增加投入，建立一个良好的投资机制、经营机制。     

DRG支付背景下山东省55家三级综合医院住院医疗服务评价研究

目的 按疾病诊断相关分组（DRG）支付背景下，聚焦住院医疗服务，侧重绩效，注重结果导向，对山东省55家三级综合医院的住院医疗服务进行综合评价。方法 利用AHP层次分析法构建“三级综合医院住院医疗服务评价指标体系”，评价体系包括3个一级指标、7个二级指标，一致性检验结果有统计学意义（P<0.05）；借助RSR秩和比法对其进行综合评价。结果 55家医院共划分为好、较好、中等、较差、差5个档次，各档次分别有2家、14家、24家、14家、1家医院。结论 评价结果能够科学评估医院医疗服务与管理情况，为医疗服务管理提供决策参考。     

效益评价中指标筛选及其假设检验

西文介绍了综合效益评价中指标的逐步筛选及其假设检验方法，用该法选出的指标具有独立性强、代表性好的优点。同是分析处理了全国３４家县级医院的投入指标，从中筛选出５个指标参与评价。     

县区级妇幼保健机构综合评价体系及评价模型研究

目的构建县区级妇幼保健机构综合评价指标体系及评价模型。方法运用Delphi法、变异系数法等方法从初选的若干个指标中筛选出反映县区级妇幼保健机构综合能力评价指标,建立综合评价体系和评价模型。采用该评价体系和评价模型,对安徽省3个市的全部县区级妇幼保健机构2010年的机构运行情况调查结果进行综合评价并排序,运用Spearman等级相关法,与3个市的卫生行政部门2010年对其辖区县区级妇幼保健机构的考核排序结果进行比较,论证结果一致性。结果根据Delphi法、变异系数法筛选出7个一级评价指标和41个二级评价指标,构成评价指标体系和评价模型。用该指标体系和评价模型对安徽省A、B、c3个市县区级妇幼保健机构进行评价,将评价结果顺位与其卫生行政部门的实际考核结果比较,结果均呈正相关性[rA=0．929（P〈0．05）、ru=0．933（P〈0．05）、rc=0．786（P〈0．05）]。结论本研究建立的妇幼保健机构综合评价体系能够较好反映县区级妇幼保健机构的综合能力,筛选后建立的指标体系具有一定的代表性,能够较全面的对县区级妇幼保健机构综合能力进行评价,具有一定的实际应用价值。     

县级疾控机构综合效益评价指标的筛选及其应用研究

目的构建反映"预防为主"功能的县级疾控机构综合效益评价的指标体系。方法运用Delphi法、变异系数法和聚类分析法等3种方法从初选的43个指标中筛选出反映县级疾控机构综合效益的评价指标,采用筛选后的指标,运用加权TOPSIS法对杭州地区13家县级疾控机构2004年各自的综合效益进行模拟评价,并与杭州市疾控中心对上述单位进行评价的实际结果相比较,论证其一致性。结果根据Delphi法、变异系数法和聚类分析法筛选出17个评价指标,用其对13家县级疾控机构进行模拟评价的结果与杭州市疾控中心自身评价的实际结果之间存在正相关性(rs=0.825,P<0.05)。结论本研究建立的整套评价指标能够较好地体现"预防为主"的功能,具有良好的政策导向作用,筛选后的17个指标有一定的代表性,能够比较全面地对县级疾控机构的综合效益进行评价,且容易操作,具有一定的实际应用价值。     

数据包络分析在国外医院效率评价中的应用

数据包络分析方法（DEA）是80年代发展起来的测量医院技术效率的一种系统分析方法，在国外医院效率评价中已得到广泛的应用。本文通过DEA方法在国外医院效率评价中的应用，阐述了DEA应用的注意事项，并就应用的效果和其它方法做了比较。     

综合分析方法在妇幼保健机构效率和绩效评估中的应用

目的:应用综合分析方法对广东省地级市妇幼保健机构的运营效率和综合绩效进行评估,对综合分析方法的适用性和绩效评价体系进行验证。方法:采用数据包络分析方法对21所地级市妇幼保健院的投入、产出指标进行分析,评价其效率。采用TOPSIS法与RSR法相结合对21所地级市妇幼保健院进行综合绩效评价和分档。结果:数据包络法分析显示,14所的效率值为1,DEA有效;7所的效率值小于1,DEA无效。TOPSIS法结合RSR法分档,6所机构被评为上档,9所被评为中档,6所被评为下档。结论:数据包络分析方法特别适合多输入、多输出的评价系统,适用于保健机构投入、产出效率的分析。采用TOPSIS法评价结果与实际情况较为符合,评价指标体系较为合理。     

卫生部57家成本监测医院的DEA效率分析

目的:对57家医院进行数据包络分析,量化相对非有效医院投入的不足,为医院改革提供一定的参考依据。方法:分地域、分级别对医院效率进行分析和比较。结果:在57家医院中,数据包络分析有效的医院为21家,占全部医院的37%;非数据包络分析有效得分的单元为36家,占全部医院为63%;西部医院的总体效率最高,特别是四川省和云南省,东南沿海地区医院的总体效率偏高于中部地区的医院。结论:通过对不同地域、不同级别医院的分析与比较,在全国范围内,市级医院的总体效率都需要提高,各级卫生部门需要重点加大对市级医院的投入和管理。     

Financial performance monitoring of the technical efficiency of critical access hospitals: a data envelopment analysis and logistic regression modeling approach

From 1980 to 1999, rural designated hospitals closed at a disproportionally high rate. In response to this emergent threat to healthcare access in rural settings, the Balanced Budget Act of 1997 made provisions for the creation of a new rural hospital--the critical access hospital (CAH). The conversion to CAH and the associated cost-based reimbursement scheme significantly slowed the closure rate of rural hospitals. This work investigates which methods can ensure the long-term viability of small hospitals. This article uses a two-step design to focus on a hypothesized relationship between technical efficiency of CAHs and a recently developed set of financial monitors for these entities. The goal is to identify the financial performance measures associated with efficiency. The first step uses data envelopment analysis (DEA) to differentiate efficient from inefficient facilities within a data set of 183 CAHs. Determining DEA efficiency is an a priori categorization of hospitals in the data set as efficient or inefficient. In the second step, DEA efficiency is the categorical dependent variable (efficient = 0, inefficient = 1) in the subsequent binary logistic regression (LR) model. A set of six financial monitors selected from the array of 20 measures were the LR independent variables. We use a binary LR to test the null hypothesis that recently developed CAH financial indicators had no predictive value for categorizing a CAH as efficient or inefficient, (i.e., there is no relationship between DEA efficiency and fiscal performance).     

利用DEA方法评价我国34家医院的技术效率

ＤＥＡ是８０年代发展起来的测量医院技术效率的一种系统分析方法,在甸外医院评价中已得到广泛应用,它可以客观准确地衡量医院的总体效率,还能够找出低效率运行的原因所在。本文利用ＤＥＡ方法测量了全国３４家样本医院的效率,做了进一步的分析,并对应用ＤＥＡ的注意事项、优点和缺点进行了分析和探讨。     

Efficiency and productivity change in the English National Health Service: can data envelopment analysis provide a robust and useful measure?

OBJECTIVE: Several tools are available to health care organisations in England to measure efficiency, but these are widely reported to be unpopular and unusable. Moreover, they do not have a sound conceptual basis. This paper describes the development and evaluation of a user-friendly tool that organisations can use to measure their efficiency, based on the technique of data envelopment analysis (DEA), which has a firm basis in economic theory. METHODS: Routine data from 57 providers and 14 purchasing organisations in one region of the English National Health Service (NHS) for 1994-1996 were used to create information on efficiency based on DEA. This was presented to them using guides that explained the information and how it was to be used. They were surveyed to elicit their views on current measures of efficiency and on the potential use of the DEA-based information. RESULTS: The DEA measure demonstrated considerable scope for improvements in health service efficiency. There was a very small improvement over time with larger changes in some hospitals than others. Overall, 80% of those surveyed gave high scores for the potential usefulness of the DEA-based measures compared with 9-45% for existing methods. The quality of presentation of the information was also consistently high. CONCLUSIONS: There is dissatisfaction with efficiency information currently available to the NHS. DEA produces potentially useful information, which is easy to use and can be easily explained to and understood by potential users. The next step would be the implementation, on a developmental basis, of a routine DEA-based information system.     

数据包络分析在哈尔滨市三级医院效率评价中的应用

目的应用数据包络分析(DEA)方法评价哈尔滨市三级医院的效率,为医院管理提供依据。方法应用DEA的C2R、C2GS2模型,并结合比率分析法进行分析。结果总体有效的医院有13个,占全部单元的65.5%,表明哈尔滨市三级医院的效率较好。结论非总体有效医院其人员工作效率、设备利用率偏低,收费偏高;并提示三级医院的功能发生了变化。     

Relative efficiency in rural primary health care: an application of data envelopment analysis.

This study applied data envelopment analysis (DEA) to the evaluation of rural primary health care programs, which are known to be very heterogeneous. DEA is a mathematical programming technique that optimizes the relative efficiency ratio of current inputs over current outputs for each decision-making unit (DMU). It produces a summary scalar efficiency ratio for each DMU and identifies the amount of inefficiency. The data came from the National Evaluation of Rural Primary Health Care Programs. Despite the demands of the software used for homogeneous units and nonzero values, the efficiency analysis was useful to the evaluation. It assessed multiple inputs and multiple outputs simultaneously, and identified directly those units that are performing efficiently or inefficiently when compared to specific peer programs. This then allowed us to compare this efficient-inefficient classification with other data, first, to verify the classification and, second, to assist with the evaluation. DEA can contribute to the evaluation of heterogeneous health programs, especially when used in conjunction with other methods of analysis.     

Alternative Methods to Examine Hospital Efficiency: Data Envelopment Analysis and Stochastic Frontier Analysis

There has been increasing interest in the ability of different methods to rank efficient hospitals over their inefficient counterparts. The UK Department of Health has used three cost indices to benchmark NHS hospitals (Trusts). This study uses the same dataset and compares the efficiency rankings from the cost indices with those obtained using Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA). The paper concludes that the methods each have particular strengths and weaknesses and potentially measure different aspects of efficiency. Several specifications should be used to develop ranges of inefficiency to act as signalling devices rather than point estimates. It is argued that differences in efficiency scores across different methods may be due to random noise and reflect data deficiencies. The conclusions concur with previous findings that there are not truly large efficiency differences between Trusts and savings from bringing up poorer performers would in fact be quite modest.     

Decomposition of potential efficiency gains from hospital mergers in Greece

This paper evaluates the technical efficiency of 71 Greek public hospitals and examines potential efficiency gains from 13 candidate mergers among them. Efficiency assessments are performed using bootstrapped Data Envelopment Analysis (DEA) whilst merger analysis is conducted by applying the Bogetoft and Wang methodology which allows the overall potential merger gains to be decomposed into three main components of inefficiency, namely technical (or learning), scope (or harmony) and scale (or size) effects. Thus, the analysis provides important insights not only on the magnitude of the potential total efficiency gains but also on their sources. The overall analysis is conducted in the context of a complete methodological framework where methods for outlier detection, returns to scale identification, and bias corrections for DEA estimations are also applied. Mergers are analyzed under the assumptions of constant, variable and non-decreasing returns to scale in an input oriented DEA model with three inputs and three outputs. The main finding of the study indicates that almost all mergers show substantial potential room for efficiency improvement, which is mainly attributed to the pre-merger technical inefficiencies of the individual hospitals and therefore it might be possible to be achieved without the need of implementing full-scale mergers. The same -though, at a lower extent- applies to the harmony effect whilst the size effect shows marginal or even negative gains.     

福建省县级综合性公立医院运行效率变化分析

目的:研究福建省40家县级综合性公立医院的综合效率、技术效率和规模效率变化情况,以及全要素生产率随着时间变化的情况,为提高县级综合性公立医院运营效率提供决策依据和参考。方法:收集2009—2014年福建省40家县级综合性公立医院运营相关数据,运用数据包络分析法(DEA)的CCR、BCC和Malmquist模型进行分析。结果:40家县级综合性公立医院中绝大多数处于规模递减状态,2009—2014年的全要素生产率为1.019,21家(52.5%)医院生产率有所提高,其中3家医院生产率提高是由于技术进步,3家是由于效率提高,15家是由于技术进步和效率提高共同作用。结论:福建省县级综合性公立医院效率总体不足,且不同地区医院运行效率有差异,山区医院效率有所提高,沿海地区医院效率出现下降。因此,政府在加大对县级综合性公立医院投入时,应采取差别化政策,注意合理控制医院规模,同时应加强内涵建设,重视医疗技术的提升。