不同管理系统下的医院运营效率比较

目的：评价并比较北京地区国家卫生和计划生育委员会直属（委属）与北京市医院管理局直属（市属）综合公立医院的运营效率，为提升公立医院整体效率、完善公立医院改革的相关政策提供依据。方法：从2011-2014年北京市卫生统计直报数据中，获取得到8家委属和8家市属大型综合医院的投入与产出数据。以数据包络分析作为医院运营效率的测量工具；采用CCR和BCC模型计算16家医院在2011年度和2014年度的综合技术效率、纯技术效率、规模效率及规模报酬情况；采用Malmquist指数模型对16家医院进行跨期分析，求解2011-2014年间两类医院全要素生产率变化、技术变动、综合技术效率变化、纯技术效率变化及规模效率变化情况。结果：2011年委属医院的综合技术效率、规模效率和纯技术效率均高于市属医院，其中委属医院综合技术效率均值为0.918，市属医院为0.873；到了2014年，委属医院的各效率指标则均低于市属医院，其中委属医院综合技术效率均值为0.906，市属医院为0.951。Malmquist指数模型结果显示，市属医院全要素生产率变化大于委属医院，前者平均每年增长5.9%，后者平均每年增长2.8%；技术变动方面，委属、市属医院均为技术进步状态，委属医院平均每年增长3.2%，市属医院为2.9%；委属医院纯技术效率的增长幅度远低于市属医院；委属医院规模效率的下降幅度大于市属医院。结论：不同管理体系下两类医院的运营效率及变化有很大差异，其中技术进步和管理水平是影响医院效率的最重要因素；结合规模报酬情况及北京地区宏观卫生政策，委属和市属医院仍需进一步推进优质资源向市中心区以外转移，同时应注重医院技术水平和管理水平的提升。

Assessment and comparison of hospital operating efficiency under different management systems

Objective: To assess and analyze the operation efficiency of 8 commission general public hospitals managed directly by National Health and Family Planning Commission and 8 municipal general hospitals managed directly by Beijing Municipal Administration of Hospitals in Beijing and to provide suggestions on improving service capacity and designing relevant health policy.Methods: Input and output data of 8 commission hospitals and 8 municipal hospitals were obtained from Beijing Direct-Reported Health Statistics data from 2011 to 2014.Data envelopment analysis was used as the hospital operation efficiency measurement tool.The CCR and BCC models were built to calculate technical efficiency (TE), pure technical efficiency (PTE), scale efficiency (SE) and the status of scale efficiency of 16 hospitals in 2011 and 2014;the Malmquist index model was built to analyze the total factor productivity change (TFPC), technological change (TC), technical efficiency change, pure technical efficiency change and scale efficiency change of the 16 hospitals from 2011 to 2014.Results: In 2011, the TE, PTE and SE of the commission hospitals were higher than those of the municipal hospitals, and the TEs of the commission hospitals and the municipal hospitals were 0.918 and 0.873 respectively.In 2014, the TE, PTE and SE of commission hospitals were lower than those of the municipal hospitals, and the TE of the commission hospitals and the municipal hospitals were 0.906 and 0.951, respectively, which was contrary to the results in 2011.According to the Malmquist index model, the average of TFPC of the municipal hospitals was larger than that of the commission hospitals, the former increased 5.9% and the latter increased 2.8% per year;the average of TC was greater than the one in both the municipal hospitals and the commission hospitals, with a growth of 3.2% and 2.9% per year, respectively;the average growth of PTE in the commission hospitals was lower than that of the municipal hospitals, and the average descent of SE in the commission hospitals was larger than that in the municipal hospitals.Conclusion: There are significant differences in the operation efficiency between different management systems and the main factors associated with operation efficiency are the technological and management level.Given scale efficiency status and macroeconomic medical policies, the commission hospitals and the municipal hospitals require further adjusting the distribution of medical resources, and it is of great significance for all the commission hospitals and the municipal hospitals to improve the management level and resource integration capability.