基于网络DEA的我国卫生资源配置效率研究

目的：分析各省卫生资源配置效率,为我国区域卫生规划和资源优化配置提供参考。方法：采用网络DEA模型,分析2015—2019年各省卫生资源配置效率,对2019年卫生资源配置非有效省份进行改进值分析。结果：2015—2019年各省卫生资源配置效率总体上升,但省域间差异明显;2019年非有效省份多达23个,应调整卫生人力物力资源总量,同时近一半省份需减少卫生支出。结论：政府对卫生资源配置和医疗服务产出效率应进行双重管理,对卫生资源配置非有效省份要因地制宜制定改进策略,完善相关政策。     

基于DEA的陕西省卫生资源配置效率评价

目的:对陕西省卫生资源配置效率进行研究,探索优化资源配置的措施和途径,为新一轮卫生资源配置研究提供政策建议。方法:采用数据包络分析(DEA)理论及方法,对陕西省卫生资源配置的横向及纵向效率进行相对有效性评价及分析。结果:DEA横向评估中,卫生资源配置效率存在地区差异,5个市卫生资源配置效率呈相对无效状态;DEA纵向评估中,2000-2009年卫生资源配置综合效率不断提高,规模效率递增,2007-2009三年规模效率不变。结论:加大政府投入,加强区域卫生规划实施力度;以存量调整、结构优化、管理水平改进为主要手段,促进资源优化配置。     

我国卫生资源配置效率的省际差异分析

目的：分析我国卫生资源的配置情况及效率,提出提高卫生资源配置效率的相关建议,为政府制定卫生经济政策提供相应的决策参考。方法从卫生资源投入与产出的角度,运用因子分析与聚类分析法测算2010年我国31个省市卫生资源配置效率。结果全国31个省市中,20个省市卫生资源配置总量低于全国平均水平,19个省市卫生资源配置效率低于全国平均水平,只有不到30％的省市综合得分优于全国平均水平。结论我国各省市卫生资源的配置总量与各地区经济发展情况基本一致,卫生资源配置效率整体情况堪忧,部分经济发展好、卫生资源配置较好的地区,其卫生资源配置效率反而越差。建议从顶层设计上完善区域卫生规划,对经济欠发达地区给予相应的政策倾斜,在政府调控的基础上适当加强市场调节。     

基于DEA的西藏地区卫生资源配置效率纵向分析

[目的]分析西藏地区卫生资源配置效率的纵向发展变化情况,为优化西藏卫生资源配置提供依据.[方法]利用数据包络分析(DEA)对2010-2018年西藏卫生资源配置效率进行分析,评价其综合效率、技术效率及规模效率.[结果]2010-2018年西藏卫生资源配置综合效率均值为0.988、纯技术效率均值为0.998、规模效率均值...     

基于超效率DEA中国妇幼保健院效率分析与评价

目的分析评价我国妇幼保健院2006-2015年效率变化情况,以期发现我国妇幼保健院资源配置效率存在的问题,并寻找有效的资源配置措施和途径,为进一步优化卫生资源配置提供科学依据,从而推动卫生资源优化配置。方法采用超效率数据包络分析方法 (DEA)对2006-2015年我国妇幼保健院卫生资源技术效率、规模效率及纯技术效率进行分析评价。结果我国卫生资源配置技术效率值呈上升趋势,2006-2013年为DEA无效年份,规模报酬均递增,纯技术效率值高于规模效率值,规模效率均<1,DEA无效主要由规模无效造成,我国卫生资源投入未到达最优规模。2014、2015年为DEA有效年份,盲目增加投入导致规模报酬递减,资源浪费。结论我国妇幼保健院卫生资源配置效率正逐渐提高,应当继续优化配置卫生资源的规模与结构,做好政策规划,促进我国妇幼保健院资源配置效率的稳步提高。     

成都市某区卫生资源配置公平性及效率评价

公平与效率是医疗卫生服务领域永恒的话题〔1〕。一个地区医疗资源配置的公平性是提高该地区卫生服务体系绩效的重要结构性因素,也是规划该地区未来医疗资源配置的重要依据〔2〕。研究一个地区医疗资源配置的效率,对于最大限度地满足居民的医疗服务需要,提高医疗资源的使用效率具有重要的意义。本研究对四川省成都市某区2009年卫生资源配置的公平性及其2000-2009年效率情况进行分析,为相关部门有针对性地制定卫生资源配置计划,合理分配卫生资源,提高卫生资源配置的公平性与效率提供参考依据〔3〕。现将结果报告如下。     

基于数据包络分析的河南省卫生资源配置效率评价

目的 对河南省卫生资源配置效率进行分析,为制定河南省卫生规划提供依据。 方法 采用数据包络分析法（DEA）,并应用DEAP2.1软件,对河南省卫生资源配置的横向和纵向效率进行分析。 结果 河南省卫生资源配置效率横向比较中,各地区配置效率存在差异,其中5个市卫生资源配置相对有效;在纵向比较中,2005-2013年综合规模效率不断提高,2013年规模收益呈递减趋势。 结论 提高规划力度,调整卫生资源内部结构,促进资源优化配置。     

基于数据包络分析的重庆市卫生资源配置效率研究

目的 分析2015—2020年重庆市各区县卫生资源配置效率,为重庆市提升资源配置效率提供参考。方法 采用数据包络分析的BCC模型和Malmquist指数对2015—2020年重庆市各区县卫生资源配置效率进行分析。结果 在2020年,重庆市卫生资源配置的综合效率不高,38个区县中有7个区县处于DEA有效状态,8个区县处于DEA弱有效状态;2015—2020年,重庆市全要素生产率指数均值为0.945,3个区县的全要素生产率指数大于1。结论 重庆市各区县卫生资源配置效率有待提高,重点在于提升技术进步水平;重庆市四大区域内部和四大区域之间卫生资源配置效率差异较大,需整合医疗卫生资源,重视医学科技创新和成果转化,达到提升卫生资源配置效率的目标。     

我国三大重大战略区域的卫生资源配置效率分析

目的 对比分析国家三大重大战略区域京津冀、长三角及粤港澳大湾区的卫生资源配置效率,为进一步优化三大区域卫生资源配置,实现卫生健康事业高质量发展提供参考依据。方法 采用数据包络分析法的BCC模型和Malmquist指数评价三大区域卫生资源配置效率。结果 2016—2020年长三角和粤港澳大湾区卫生资源配置的综合效率均为1,DEA有效; 京津冀在2017—2019年综合效率及规模效率分别为0.972、0.968、0.957,纯技术效率为1,DEA弱有效; 2016—2020年京津冀、长三角、粤港澳大湾区全要素生产率及技术进步均数分别为0.899、0.893、0.929,技术效率、纯技术效率及规模效率均数均为1。结论 京津冀卫生资源配置效率相对较低,长三角和粤港澳大湾区卫生资源配置结构存在不合理,进步不足阻碍三大区域卫生资源效率。     

基于数据包络分析的北京市精神卫生资源配置效率研究

目的 评价十三五期间北京市精神卫生资源配置效率变化,为优化北京市精神卫生资源配置提供依据。方法 采用DEA方法中的BCC模型和Malmquist指数模型对北京市精神卫生资源分别进行静态和动态分析。结果 2019年北京市仅有5个行政区实现DEA有效,综合效率均值为0.673,纯技术效率为0.882,规模效率为0.760;生态涵养区综合效率最高,平原山区新城次之、中心城区与城市副中心功能区最低;2015—2019年间北京市精神卫生资源配置全要素生产率均值为1.080,技术进步率是卫生资源配置的效率提升主要动力。结论 总体上看,十三五期间北京市精神卫生资源配置效率有所提高,整体水平仍有待提升,资源配置综合效率地区空间分布差异明显,资源冗余与资源匮乏共存,各功能区资源配置全要素生产率存在差异,平原山区新城效率最低。建议加大财政投入与支付转移,缩小区间差异,合理调配资源,避免盲目投入,据各功能区定位,全面提高精神卫生资源配置效率。     

关于我国公立医院经济效率的探讨

目的分析我国公立医院的经济效率。方法以总服务人次数为产出指标,以卫生技术人员数和政府投入金额为投入指标,分别使用柯布道格拉斯生产函数中的指数及相关系数代表技术效率与配置效率。结果全国的整体技术效率为1.206,配置效率为1.659,东、中、西部分别为1.168、1.685,0.986、0.866,1.001、1.867。结论整体技术效率高于各地区的技术效率,东、中、西部对比分析发现效率差异与经济发达程度关系不大。     

The Decomposition of Cost Efficiency: An Empirical Application of the Shadow Cost Function Model to Dutch General Hospitals

This paper investigates the performance of the Dutch general hospital industry by a parametric method. In general, the parametric approaches find more difficulties in distinguishing between technical and allocative efficiencies than DEA. Only recently a class of models is developed based on shadow prices which have possibilities to distinguish between technical and allocative efficiency. However, these models cause some serious computational problems. This paper recommends an approach to overcome these problems by using an iterative two-stage estimation procedure. The estimation is conducted on a panel data set of Dutch general hospitals. Estimation shows that this method is effective. The parameter estimates are plausible, reliable and satisfy all theoretical requirements. In particular we find some reliable estimates for the individual hospitals' shadow prices. According to these shadow prices hospitals should reallocate their resources in favor of material supplies at the cost of other personnel and nursing personnel. The mean technical efficiency is about 86%, whereas the allocative efficiency is about 92%. The outcomes also show that technical progress is very small. Economies of scale are present only for small hospitals.     

Has the Swap Influenced Aid Flows in the Health Sector?

The sector wide approach (SWAp) emerged during the 1990s as a mechanism for managing aid from the multiplicity of development partners that operate in the recipient country's health, education or agricultural sectors. Health SWAps aim to give increased control to recipient governments, allowing greater domestic influence over how health aid is allocated and facilitating allocative efficiency gains. This paper assesses whether health SWAps have increased recipient control of health aid via increased general sector‐support and have facilitated (re)allocations of health aid across disease areas. Using a uniquely compiled panel data set of countries receiving development assistance for health over the period 1990–2010, we employ fixed effects and dynamic panel models to assess the impact of introducing a health SWAp on levels of general sector‐support for health and allocations of health‐sector aid across key funding silos (including HIV, ‘maternal and child health’ and ‘sector‐support’). Our results suggest that health SWAps have influenced health‐sector aid flows in a manner consistent with increased recipient control and improvements in allocative efficiency. Copyright © 2015 John Wiley & Sons, Ltd.     

Determinants of expenditure variation in health care and care of the elderly among finnish municipalities

In Finland, municipal health care expenditure varies from FIM 3 800 per capita to FIM 7 800 per capita. The objective of this study was to estimate the impact of different economic, structural and demographic factors on the per capita costs of health services and care of the elderly. Using regression analysis we attempted to explain observed differences in expenditure by determining separately the effects of allocative and productive inefficiency and the effects of factors influencing the demand for services. We found income level of local population, generosity of central government matching grant, allocative efficiency (the mix of care between institutional and non-institutional care), productive efficiency of service providers, and factors associated with the need of services (age structure, morbidity) to be the most important determinants of health care expenditure. Our results reveal that municipalities have the means at their disposal (by shifting resources to outpatient care and increasing productivity) to significantly reduce expenditure on health services and care of the elderly.     

Implications of basing health-care resource allocations on cost-utility analysis in the presence of externalities

Cost-utility analysis is increasingly being advocated as a tool for helping to establish funding priorities among programs and services in the health-care sector. As currently conducted, however, cost-utility analysis is problematic as a basis for achieving allocative efficiency because it excludes externalities. The exclusion of externalities may bias program ranking in unpredictable ways, leading to a non-optimal allocation of resources. Consideration of externalities also raises a number of distributional issues for the evaluation of health services and highlights the important of developing economic evaluation methods that are consistent with the conceptual basis for allocating resources.     

Measuring efficiency of long-term care units in Finland

Data Envelopment Analysis (DEA) was used to measure the nursing care efficiency of 64 long-term care units in Finland. New approaches introduced for evaluating efficiency were unit/ward level analysis, and the case-mix classification Resource Utilization Groups (RUG-III). Efficiency determinations were based on four DEA measures: cost, technical, allocative, and scale efficiency. The results indicated considerable variation in efficiency between units, suggesting that efficiency could be improved through better management and allocation of resources. Larger units seemingly operated more efficiently than smaller units. Allocative inefficiency resulted from using too many registered nurses and aides, and too few licensed practical nurses.     

卫生研发活动经费流向调查指标与监测体系

在提高卫生研发活动资源配置效率日益成为全球卫生科技发展热点的情况下,掌握研发活动经费流向情况是改善资源配置效率的重要前提。以往关于卫生研发经费流向情况的信息十分缺乏,系统地追踪全球卫生研发经费流向情况是一个长期的目标。本就卫生研发活动经费调查在世界范围内所进行的情况,以及实施调查涉及的概念、分类指标进行概述。同时,就我国卫生研发经费调查的现状进行分析,并对建立我国卫生研发活动监测体系给予政策建议。     

从配置优化角度来提高卫生资源利用效率

有效提高卫生资源的利用效率一直是卫生服务研究所追求的目标.政府在医疗、公共卫生和医保三方面对医疗卫生事业进行投入,实行对医疗市场需方和供方同时补贴的政策,既分散了政府的卫生资源,也不利于医疗机构建立自我约束、自我发展的机制.通过盘活存量资产,优化卫生资源配置结构,可提高卫生资源的利用效率,改善医疗卫生行业的整体社会效果.     

Application of cost-effectiveness analysis of health care interventions in developing countries. A case study in Mauritius

OBJECTIVE: Cost-effectiveness analysis is a tool to help inform the decision maker of efficient allocation of scarce health care resources and its application has increased in developing countries during the past decade. There are, however, a variety of different approaches used to calculate cost-effectiveness ratios, given the range and the controversies surrounding the use of some components of total cost, depending on the constraints faced by various decision-making bodies. This study is an investigation of cost-effectiveness of both currently delivered and prospective health interventions in Mauritius to set priorities and assess allocative efficiency by taking into account such constraints. METHODS: Resource use and unit cost data were collected from the representative health facilities and the Ministry of Health to estimate costs of each health intervention per person. Effectiveness of each intervention was estimated from the results of the national burden of disease study and the efficacy database compiled for this exercise. Several types of cost-effectiveness were calculated for each intervention according to its characteristics and the constraints imposed by the existing infrastructures and other health interventions. RESULTS: Cost-effectiveness ratios with and without the decision maker's constraints differed significantly. Infrastructure-constrained average cost-effectiveness of thirteen currently delivered and twenty one prospective interventions ranged from $127 to $92,949 and from $77 to $66,302 per DALY averted, respectively. Incremental cost-effectiveness of the prospective interventions was from $83 to $70,553. Among the currently delivered interventions, those for perinatal disorders, mental illness, and ischemic heart disease were particularly less cost-effective than the prospective interventions. Sensitivity analysis of both effectiveness and discount rates did not change the cost-effectiveness ranking significantly. CONCLUSION: The present study showed that cost-effectiveness ratios differ significantly depending on the decision maker's constraints and that an interpretation of each cost-effectiveness study should be made with great caution when implementing its results in practice. Both average cost-effectiveness of the currently delivered interventions and incremental cost-effectiveness of the prospective interventions suggest that there is an allocative inefficiency among the currently delivered health interventions in Mauritius and a possibility of enhancing allocative efficiency through introducing alternative interventions.     

Evaluation of resource utilization efficiency in obstetrics and gynecology units in China: A three-stage data envelopment analysis of the Shanxi province

In China, health care resources for expectant mothers and children are still not utilized to full efficiency, with health requirements still not being met. The purpose of this study is to critically examine the efficiency of gynecology and obstetrics hospital (OB/GYN) units in Shanxi province of China, with the overarching objective of exploring methods for improving their efficiency. We employ the three-stage data envelopment analysis (DEA) model to measure the efficiency of 134 OB/GYN units in Shanxi. The results show that the technical efficiency and scale efficiency scores of the sample units were low (0.48 and 0.54, respectively). The efficiency of the OB/GYN units varies by region, city, and county and by type of unit. We conclude that the main reason for the low efficiency of OB/GYN units in Shanxi province lies in the unreasonable scale. The government should, therefore, allocate health resources more reasonably, improving the efficiency of different regions, cities, and counties, as well as different types of OB/GYN units.