医院所有制与效率：以德国为关注重点的研究回顾

德国医院市场在过去20年里进行了一揽子医疗改革,特别是在2004年引进了疾病诊断相关分组——以期提高医院效率。本文旨在回顾近期就比较德国公立医院、私立非营利医院和私立营利医院效率所开展的研究。尽管研究结果错综复杂,但结合其他国家,特别是美国的研究证据,德国方面的研究结果表明:与公立医院相比,私立医院(私立非营利和私立营利医院)的运营效率并不一定就高。由于私立营利医院通常都会被认为是最有效率的所有制形式,因此本研究结果对很多决策者来说也许有些意外。     

Measuring and comparing the (in)efficiency of German and Swiss hospitals

A nonparametric data envelopment analysis (DEA) is performed on hospitals in the federal state of Saxony (Germany) and in Switzerland. This study is of interest from three points of view. First, contrary to most existing work, patient days are not treated as an output but as an input. Second, the usual DEA assumption of a homogeneous sample is tested and rejected for a large part of the observations. The proposed solution is to restrict DEA to comparable observations in the two countries. The finding continues to be that hospitals of Saxony have higher efficiency scores than their Swiss counterparts. The finding proves robust with regard to modifications of DEA that are motivated by differences in hospital planning in Germany and Switzerland.     

绩效管理推动医院高质量发展:以广东省人民医院为例

国家三级公立医院绩效考核是对医院综合质量的检阅,对公立医院发展具有指挥棒作用。广东省人民医院通过建立绩效考核三级管理机制,对标公立医院绩效考核评分细则,实施精细化管控,促进医院绩效考核相关指标改进。在医疗质量、运行效率、可持续发展和满意度评价4个维度中均实现了提升。为促进医院高质量发展,建议强化绩效考核意识,完善绩效考核管理机制;制定“大规划、大战略”,持续优化考核效果。     

基于数据包络分析的17所科研单位投入产出分析

在经济社会发展的转型期,国家越来越重视人民生活和生命健康水平.国家不断加大对科研项目的投入,提高医疗科研水平,改善人民社会生活.然而,国家大量的资金投入是否得到应有的产出是人们普遍关注的问题.利用数据包络分析法,对17所科研单位申请的国家自然科学基金医学科学部一处、二处、三处的2009结题项目进行投入产出相对绩效分析.结果有11所科研单位投入产出DEA有效,即能够较好的利用投入得出相应的产出;有6所单位相对无效,产出没有达到相对较优的状态,造成了投入的浪费.表明通过合理调整科研结构、制定科研绩效目标来不断完善科研管理工作,仍有提升科研整体水平的空间.     

数据包络分析与随机前沿分析的比较研究--基于 Monte Carlo 模拟研究

目的：比较研究数据包络分析（ DEA）和随机前沿分析（ SFA）方法。方法通过蒙特卡罗模拟方法,比较两种方法效率值估计的准确性和效率值排名的一致性（ Spearman相关系数）以及评价指标选择对两者的影响。结果DEA与SFA结果一致性较高;删减必要指标对两种方法评估的准确性和一致性的影响较大,而增加无关指标对两者的影响较少,增加无关指标前后效率值一致性较高,Spearman相关系数大部分在0．9以上。结论选择指标时要慎重,对效率评估结果影响较大的指标应保留。     

我国公立医院的技术效率分析：数据包络分析的应用

本研究通过应用DEA的方法，对2006年我国公立医院的技术效率进行经验分析，利用分层随机抽样法在三类医院中分别随机抽取100家医院。无论是医院的筹资体系、支付体系和管理体系，我国公立医院与西方国家公立医院都有明显不同。本文旨在补充我国DEA研究的文献资料，研究选择基于医院产出水平的DEA方法以验证假设。研究结果显示，与三级医院和一级医院相比，二级医院的平均技术效率值最低。另外，产出不足和/或投入过剩的分析结果显示，在不影响技术效率的情况下，医生/护士比率和高技术医疗设备可能需要进一步调整。研究结果可以作为评价我国公立医院技术效率的参考依据之一。     

Hospital adverse events and control charts: the need for a new paradigm

Control charts are being increasingly used to summarise sequential rates of hospital adverse events (AEs). They are designed to detect departures from stable, predictable processes and are therefore appropriate when information about the mean value and variability of the relevant time-series data is available, from when the process is or has been in a stable, predictable state. This is often the case with binary data AEs such as surgical site infections and surgical mortality. However, it may not always be possible to determine the stable predictable rate at which events such as patient falls, pressure ulcers, medication errors or new isolates of a multiresistant organism (MRO) occur. Furthermore, such a rate may sometimes not exist, as is frequently the case with antibiotic usage and MRO prevalence data. It may then be better to employ time-series methods to analyse and present the data. A convenient approach is to employ spline-regression or a generalised additive model.     

中国医院效率DEA研究分类与投入产出指标分析

目的:了解中国目前医院效率数据包络分析(DEA)研究现状,为进一步提升中国医院效率DEA研究水平提供参考.方法:对1984—2014年应用数据包络分析中国医院效率的85篇密切文献进行系统分类和综述,总结归纳文献的基本特点,对其投入产出指标进行归类统计,并与国际同类文献比较,评价中国此类研究的规范性.结果:应用DEA分析中国医院效率的研究存在医院配置效率研究文献缺乏、医院技术效率模型单一、投入产出指标筛选不严谨、误将经济类指标作为产出指标等突出问题.结论与建议:中国医院效率DEA研究方法使用的合理性、规范性有待进一步提高,研究与国际研究仍存在较大差距.建议相关研究者在医院效率DEA研究方面应追踪国际最新研究,科学筛选投入产出指标,深入分析使用方法和应用条件,提升中国医院效率DEA研究的规范性和科学性.     

基于DEA模型构建医院临床科室绩效评价体系的研究

目的:研究医院卫生资源配置与优化,对临床科室绩效进行评价。方法:运用数据包络分析(DEA)法,以北京某三甲医院为例,构建临床科室绩效评价的DEA模型。结果:根据模型运行的结果,得出目标科室的技术效率和规模效率值、非有效决策单元的投入冗余率及产出不足率。结论:通过DEA的评价结果,找出目标科室的投入冗余及产出不足,从医院资源配置优化的角度,提出改善医院运行绩效的对策,对不断提高医院的综合竞争力有重要的指导意义。     

数据包络分析法在综合性医院科室效率评价中的应用

目的：以某大型综合性三甲医院17个临床科室作为研究对象,对其相对效率进行评价,为医院管理者进行科学决策提供一种可操作性的思路。方法运用专家咨询法确定投入产出指标,投入指标包括：医护人均数、床位数、设备投入,产出指标包括：门诊量、出院人次、业务总收入,运用数据包络分析法（ data envelopment analysis, DEA）进行相对效率评价和分析。结果得出各临床科室的综合效率、纯技术效率、规模效率、规模收益情况,以及非有效科室的产出不足比例。17个临床科室的平均综合效率值是0.849,总体有效的科室共有5个,总体无效的科室共有12个。这12个科室没有同时达到技术有效和规模有效,说明其还存在投入过剩或产出不足的问题,或是现有规模偏大或是偏小等问题。17个临床科室的平均技术效率值是0.945,技术有效的科室共有11个,技术无效的科室共有6个。这6个科室需要改善运营管理,通过改进病床管理手段提高床位的周转效率,对设备进行结构或功能的优化调整,提高医生的诊疗水平和服务态度等手段,以达到最大产出。结论 DEA方法应用于医院临床科室的效率评价,既能对各科室进行效率高低的比较,又能较为准确的指出产出不足的地方,能够为医院科学化决策提供依据。     

卫生体系效率评价的概念框架与测量方法——兼论应用数据包络分析的方法学问题

提高效率与促进公平是医药卫生体制改革的目的,卫生体系效率评价是医药卫生体制改革评价的重要方面。本文构建了可操作性更强的卫生体系效率测量的概念框架及其测量指标,在此基础上讨论了应用数据包络分析测量卫生体系效率时需要注意的一些方法学问题,包括模型导向和规模报酬的选择、样本大小与默认有效、外部不可控因素、效率值的可比性、率或比值数据的处理和负向指标的处理等方法学问题。     

Productivity and efficiency changes in primary care: a Malmquist index approach

The reforms of the National Health System in the UK introduced in 1990 led to substantial changes in the organisation of primary health care. In this paper we analyse the efficiency of primary care provision in the English Family Health Service Authorities (FHSAs) over the period 1990/91–1994/95. We use Data Envelopment Analysis to measure Malmquist indices of productivity changes, which are then decomposed into indices of pure technical efficiency change, scale efficiency change and technological change. The analysis indicates a small improvement in the productivity over the period considered. The increase is attributed to pure technical efficiency improvement and positive change in scale efficiency, while the technology does not show significant change. The analysis suggests that there is very limited scope for productivity gains in this sector.     

我国公共卫生资源配置的公平与效率分析——基于HRAD和DEA的研究

目的:分析评价我国31个省市公共卫生资源配置的公平性及利用效率情况,为公共卫生资源规划提供参考和依据。方法:采用集聚度分析评价公共卫生资源配置情况,并利用数据包络分析探究公共卫生资源配置效率。结果:我国人口密集的经济发达省市公共卫生资源的集聚度大于或接近于1,与人口集聚度的差值大都小于0;人口较少的经济落后省市资源的集聚度小于1,与人口集聚度的差值大都大于0。公共卫生资源配置的综合技术效率均值为0.44,纯技术效率和规模效率的均值分别为0.74和0.64。结论:我国经济发达省市的公共卫生资源集聚度较高,但按人口分布其均衡性较差;对于经济落后的省市,其公共卫生资源的地理可及性较差。此外,我国公共卫生资源的配置效率相对较低,主要是由于资源配置的结构和比例不合理导致。     

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。     

The impact of the internal market on hospital efficiency, productivity and service quality

In this paper we use nonparametric mathematical programming models to compute and decompose Malmquist indices of productivity and quality change, which are used to evaluate the reforms in the UK National Health Service in the early nineties. We focus on acute hospitals and we study them over the first five years of the reforms. The findings of the study indicate that there was a productivity slowdown in the first year after the reforms but productivity progress in the subsequent years and thus, overall there was a net gain in productivity over the entire period considered. Productivity trends were dominated by technical change rather than hospital relative efficiency changes, as hospitals were already largely relatively efficient at the time of the introduction of the reforms. In fact, over the last four years in the period studied there was small relative efficiency regress and this does not bear out the argument that the reforms would increase hospital efficiency. The productivity changes are similar when service quality is incorporated in the analysis but the magnitude of these changes diminishes. Quality of service followed different trends to productivity change and this may have been the price for the productivity gains achieved.     

基于数据包络分析的全国医疗资源配置效率评价

目的:分析我国医疗资源配置效率,为进一步合理配置医疗卫生资源提供科学依据.方法:采用2000—2020年《中国统计年鉴》和《中国卫生健康统计年鉴》数据,运用数据包络分析法对我国医疗资源配置效率进行评价,同时采用Malmquist模型进行动态分析.结果:1999—2019年,我国医疗资源配置效率不断提高,但受多因素综合影...     

Congestion analysis to evaluate the efficiency and appropriateness of hospitals in Sicily

Over the past twenty years, important changes in the Italian National Health System have been made in order to obtain significant improvements in the efficiency, appropriateness and quality of health care delivery, while reducing health expenditure. In this paper we proposed a multidimensional approach to assess the impact of organization inappropriateness on the efficiency evaluation of hospitals in Sicily for the year 2009. This study was based on cross-sectional data for 116 (out of 129) short-term, acute-care hospitals. The analysis considered beds, physicians, nurses and other personnel as inputs, ordinary discharges and day-hospital admissions as desirable outputs and inappropriate discharges and day-hospitals as undesirable outputs of the health care process. We refer to output-congestion to measure the loss of desirable outcome, which is related to the simultaneous occurrence of inappropriateness. The main findings of our analysis indicate that most of the measured overall inefficiency of Sicilian hospitals could be attributed to congestion and pure technical inefficiency and that congestion was statistically different among hospital trusts, local public hospitals and for-profit hospitals and along the provinces. In Sicily, significant shares of inputs are still employed to supply inappropriate care, with the effect of producing less desirable health care outcomes than expected.     

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。     

基于数据包络分析的医院绩效管理优化策略探讨

目的探究数据包络分析方法在医院临床科室效率评价中的应用,提出绩效管理优化策略。方法以北京市某三级综合医院39个临床科室为样本,用DRGs对住院服务产出进行风险调整,用径向模型对科室2018年-2019年技术效率进行静态测度,用全局参比Malmquist指数模型对科室两年中各月的全要素生产率及其分解构成变化进行动态测度。结果2018年-2019年仅有3个科室总体有效,全要素生产率总体呈上升趋势,主要由技术进步效应推动,结构效应贡献有限。结论数据包络分析在临床科室年度和月度效率评价中显示出技术优势和实用价值。据此提出绩效管理优化策略:基于DRGs进行风险调整;提高绩效管理的灵活性与适应性;提供客观、公正的效率评估视角;效率驱动绩效改进;正确运用测量方法。     

Analyzing the ambiguous relationship between efficiency,quality and patient satisfaction in healthcare services: The case of public hospitals in Turkey

Objective

This paper empirically analyzes the effects of efficiency and structural quality on patient satisfaction in Turkish public hospitals. It also investigates the controversial relationship between hospital efficiency and structural quality for small, medium and large size hospitals in a comparative perspective.

Methods

Data envelopment analysis (DEA) is used to analyze the efficiencies of hospitals. Data concerning 523 public hospitals is obtained from Turkish Ministry of Health. Due to the missing data of some hospitals, the sample of this study is composed of the remaining 348 observations. Multiple regression analysis is used to evaluate the relationship between patient satisfaction as a dependent variable and structural quality, hospital efficiency and institutional factors as independent variables. Furthermore, stepwise process multiple regression analysis is used to analyze the moderator effects of hospital efficiency on the form of the relationship between quality and satisfaction.

Findings

The findings indicate that hospital efficiency changes the form of the relationship between structural quality and patient satisfaction as a moderator variable. The trade-off between quality and efficiency is found to vary depending on the hospital size. Negative correlation is found between quality and efficiency for small-size hospitals. However, positive correlation between efficiency and quality is found significant as indicated by Total Quality Management (TQM) approach for large-size hospitals. This study also provides the empirical evidence on the negative relationship between patient satisfaction and hospital size.

Conclusions

The effect of hospital efficiency on patient satisfaction might be improved for inefficient small and medium size hospitals by taking successful large hospitals as role models.