北京市三级公立医院效率及其影响因素

目的：评价北京市2006-2015年间三级公立医院的综合技术效率，探讨其影响因素，并提出相应的政策建议。方法：使用数据包络分析测算北京市三级公立医院的综合技术效率、单纯技术效率和规模效率，利用Malmquist指数模型分析其动态效率情况，最后运用随机效应面板Tobit模型分析综合技术效率影响因素。结果：北京市三级公立医院的平均综合技术效率和单纯技术效率水平较高，分别由2006年的0.44和0.51升至2015年的0.62和0.68，两种效率值在0.5～0.8之间所占比例最高；规模效率值绝大部分分布于0.8～1.0之间，大部分医院处于规模报酬递减状态；医院全要素生产率平均每年以5.78%的速度进步，得益于技术效率和生产技术分别以年3.77%和1.94%的速度在进步，进一步分解技术效率进步，单纯技术效率在以年3.21%的平均速度进步，规模效率仅有0.53%的年平均进步速度。综合技术效率与床位周转率、医师年均担负诊疗人次、医护比呈正相关，与床位数、门诊住院人次比、卫生技术人员占比和药占比呈负相关。结论：严格控制三级公立医院规模，注重医院生产技术的创新和应用，转变医院内部管理水平和管理模式，推进精细化管理，以实现可持续发展。

Study on the efficiency of tertiary public hospitals and its influencing factors in Beijing

Objective： To evaluate the comprehensive technical efficiency of the tertiary public hospitals in Beijing between 2006 and 2015 and explore its influencing factors, so as to propose corresponding policy suggestions. Methods: The data envelopment analysis was employed to evaluate the comprehensive technical efficiency, pure technical efficiency and scale efficiency of the tertiary public hospitals in Beijing. Malmquist index model was used to analyze the changes of the above three dynamic efficiencies. Finally, random-effect panel tobit model was utilized to analyze the influencing factors of the comprehensive technical efficiency. Results: The average comprehensive technical efficiency and pure technical efficiency of the tertiary public hospitals in Beijing were relatively high, and they had respectively increased from 0.44 and 0.51 in 2006 to 0.62 and 0.68 in 2015, and the highest proportion of two kinds of efficiency values was between 0.5 and 0.8. Most of the scale efficiency values distributed between 0.8 and 1.0, and the majority of hospitals were in a state of decreasing returns to scale. The total factor productivity of hospitals had been increasing at an average rate of 5.78% per year due to the double progress of technical efficiency and technology at annual rates of 3.77% and 1.94% respectively, further decomposing technological efficiency change, and the pure technical efficiency change increased at the speed of 3.21% per year, and the annual average rate of progress in scale efficiency was only 0.53%. The comprehensive technical efficiency was positively correlated with the turnover rate of beds, annual visits per doctor, the ratio of doctors to nurses, and negatively correlated with the number of beds, the ratio of outpatients to inpatients, the proportion of medical technical personnel, and the proportion of drugs. Conclusion: Future health policies should strictly control the scale of tertiary public hospitals, pay attention to the innovation and application of hospital technology, change the hospital internal management le-vel and management model, promote refined management, and achieve sustainable development.