基于DEA-Tobit模型的上海市53家医联体效率影响因素分析

目的以上海市53家医联体为研究对象,结合投入产出指标和效率评价结果,分析医联体效率影响因素,为实现医联体的建设目标、优化卫生资源配置提供理论和实践依据。方法以效率值为被解释变量,影响因素为解释变量,以stata作为统计软件,运用随机效应面板Tobit回归模型进行分析。结果采用逐步回归策略筛选出包含4个影响因素的模型,该模型的F值为20.70,P<0.001,拒绝回归方程显著性检验的原假设,其中二级-副高及以上职称所占人员比例与医联体效率呈正相关关系,其偏相关系数为1.060(P=0.014),牵头-出院者平均住院日、二级-出院者平均住院日、二级-门急诊人次均费用(元)与医联体效率呈负相关关系,其偏相关系数分别为-0.036、-0.014、-0.001(P<0.001,P<0.001,P=0.007),且均具有显著性差异。结论规范双向转诊流程可缩短平均住院日,从而来改善医联体效率水平;在医疗联合体内部实行相关医疗保险制度可降低门急诊次均费用,从而提高医联体运行效率;创造条件鼓励基层人才优化,提升二级医院副高及以上职称所占人员比例,有利于医联体内部运行效率的提升。

Analysis of factors influencing efficiency of 53 medical consortia in Shanghai based on DEA-Tobit model

Objective To take 53 medical consortia in Shanghai as the research subjects, to analyze the factors affecting efficiency of the medical consortia based on input-output index and efficiency evaluation results, and to provide a theoretical and practical basis for realizing construction goal of the medical consortia and optimizing allocation of health resources. Methods The efficiency value served as the explained variable, the influencing factors as the explanatory variables, and Stata as statistical software. An analysis was performed by random-effect panel Tobit regression model. Results A model with 4 influencing factors was screened out by stepwise regression. The F value of the model was 20.70, P was less than 0.001, and the original hypothesis of significance test of the regression equation was rejected. Among them, secondary hospital-proportion of personnel with vice senior and above professional titles was positively correlated with efficiency of the medical consortia, and the partial correlation coefficient was 1.060 (P=0.014). Tertiary hospital-discharged patients'average length of stay in hospital, secondary hospital-discharged patients' average length of stay in hospital, and secondary hospital-average cost of outpatient and emergency treatment per time were negatively correlated with efficiency of the medical consortia, and the partial correlation coefficients were -0.036 (P<0.001), -0.014 (P<0.001) and -0.001 (P=0.007), respectively, all showing statistically significant differences. Conclusion Standardizing the two-way referral process can shorten the average length of stay in hospital so as to improve efficiency of the medical consortia. Implementing relevant medical insurance systems within the medical consortia can reduce the average cost of outpatient and emergency treatment per time so as to improve operation efficiency of the medical consortia. Creating conditions to encourage the optimization of grass-roots talents and increasing secondary hospital-proportion of personnel with vice senior and above professional titles are conducive to improving internal operation efficiency of the medical consortia.