山东省县级公立中医院效率及其影响因素分析

目的 对山东省不同经济地区县级公立中医院2006—2012年医疗服务效率进行比较, 分析县级医院效率的影响因素。方法 使用数据包络法评价县级中医院医疗服务效率现状, 构建面板Tobit回归模型分析效率影响因素。结果 2006—2012年, 山东省县级公立中医院的投入产出均有所增长, 医院的技术效率(0.773 vs 0.864)和纯技术效率(0.813 vs 0.910)也有所提升;且发达地区医院的效率在2009年之后的表现要优于其他地区;规模效率变动不明显, 但发达地区中医院的规模效率有所提升, 特别是在2009年以后, 与其他地区医院的规模效率差距在缩小;医院床位规模、出院者人均住院日、人均住院费用、医院资产负债率及药占比等与医院效率负相关。结论 中医院技术效率水平提高主要在于纯技术效率水平的改进, 且发达地区中医院表现更优;规模效率提升空间有限;控制医院规模、缩短平均住院日、降低住院医疗费用及资产负债率有利于提高医院效率。

Medical service efficiency of public county traditional Chinese medicine hospitals and its influencing factors in Shandong province

Objective To explore medical service efficiency of public county traditional Chinese medicine(TCM)hospitals and its influencing factors in Shandong province and to provide references for improving the efficiency of the hospitals.Methods Data envelopment analysis was used to evaluate efficiency level and Tobit regression model was used to analyze influencing factors of the efficiency.Results The technical efficiency(TE)and pure technical efficiency(PTE)value for the public county TCM hospitals increased from 0.772 and 0.773 to 0.813 and 0.910, respectively, from 2006 to 2012 and the hospitals located at developed regions presented higher TE and PTE than the hospitals at undeveloped regions, especially after 2009. No obvious improvement in scale efficiency(SE)of the hospitals was observed, however the gap in the SE among the hospitals located at regions with different economic development level narrowed.The medical service efficiency of a public county TCM hospital was inversely correlated with the number of beds, average hospitalization days, average medical expense per inpatient, asset-liability ratio, and the ratio of drug income versus total income of the hospital.Conclusion The TE of public TCM hospitals at county level showed an increasing trend between 2006 and 2012 mainly due to the increase of PTE and the trend was much more obvious for the hospitals in developed regions;controlling the scale of a TCM hospital, shortening average duration of hospitalization, and reducing hospitalization expense and asset-liability ratio could improve medical service efficiency of county public TCM hospitals.