宁夏县级公立医院医疗资源配置效率研究

发布时间：2018-04-12 08:02

本文选题：县级公立医院 + 医疗资源　；参考：《宁夏医科大学》2016年硕士论文

【摘要】：背景:县级公立医院是基层医疗服务体系建设的重要部分。新医改提出要全面推进县级公立医院综合改革,从中我们可以看到优化医疗资源布局,合理配置医疗资源是此次改革的重点。在此背景下,县级公立医院是否实现了资源的合理配置和产出的最大化是当前需要关注的重要问题,因此开展对县级公立医院的配置效率的评估具有重要意义。目的:本研究通过选取宁夏27家县级公立医院,以医疗资源配置效率的相关理论为基础,结合宁夏社会经济发展状况和医疗资源配置实际情况,采用因子分析法和离散趋势分析法筛选指标,构建医疗资源配置效率评价模型,运用数据包络分析测算县级公立医院医疗资源配置效率情况,为优化卫生资源配置,找到存在的问题与不足,提供改进建议。方法:运用SAS统计软件结合描述性分析对宁夏社会经济以及卫生资源现状进行分析;采用因子分析法和离散趋势分析法构建医疗资源配置效率评价模型;运用数据包络分析测量27家县级公立医院医疗资源配置效率。结果:1.宁夏县级公立医院卫生资源配置情况:从资源总量来看,2009~2014年宁夏县级公立医院的卫生资源呈增长趋势。2009~2014年县人民医院和县中医院在岗职工数、固定资产、财政补助收入和床位数分别以14.30%、32.37%、22.53%、5.28%和10.14%、18.23%、43.42%、7.36%的速度递增。2.结合因子分析方法和变异系数结果,最终确定了用于DEA医疗资源配置效率评价的4个投入指标与3个产出指标,分别为投入指标包括:床位数、在岗职工数、财政补助收入、固定资产;产出指标包括:总诊疗人次、业务收入、出院人数。3.横向评价:2009~2014年在宁夏地区27家县级公立医院中,技术效率、纯技术效率和规模效率有效的县级公立医院个数分别为11家、19家和11家。2009~2014年,处于规模收益递增的个数有16家,处于规模收益递减的10家。从投入产出松弛变量值来看,效率低的原因以投入不变,主要由医疗服务量不足引起。4.纵向评价:2009年和2010年配置结果在2009~2014六个年份中呈现相对无效的状态。其中2009年规模收益处于递减状态,2010年规模报酬递增。2011~2014年DEA有效,规模报酬保持不变。5.2009~2014年宁夏地区县级公立医院全要素生产率总体上下降了14.5%,主要由技术水平退步引起。逐年分析,2011~2012年、2012~2013年生产率提高,前者因技术效率提高,后者因技术进步,2010~2011年生产率逐年下降,由技术进步的衰退所致;从生产率升降情况来看,2009~2014年全要素生产率提高有12家,技术效率提高的有19家,技术进步的达到16家;除了2010年度和2011年度,全要素生产率变动指数都有一定的增长,其中2013年度增长幅度最大。建议:1.加强人力资源建设,促进技术、技术效率与规模效率的改善。2.发挥政府主导作用,引导县级公立医院规模合理发展。3.合理配置卫生资源,提高资源利用效率。
[Abstract]:Background: county-level public hospitals are an important part of the construction of primary medical service system.The new medical reform proposes to comprehensively promote the comprehensive reform of county-level public hospitals, from which we can see that the optimization of the distribution of medical resources and the rational allocation of medical resources are the key points of the reform.In this context, whether the county public hospitals realize the rational allocation of resources and maximize the output is an important issue to pay attention to at present, so it is of great significance to evaluate the efficiency of the allocation of county-level public hospitals.Objective: this study selected 27 county-level public hospitals in Ningxia, based on the theory of medical resource allocation efficiency, combined with the social and economic development and the actual situation of medical resources allocation in Ningxia.Factor analysis and discrete trend analysis were used to screen the indexes, and the evaluation model of medical resources allocation efficiency was constructed, and the data envelopment analysis was used to calculate the medical resources allocation efficiency of county-level public hospitals in order to optimize the allocation of health resources.Identify existing problems and deficiencies and provide suggestions for improvement.Methods: the present situation of social economy and health resources in Ningxia was analyzed by SAS statistical software and descriptive analysis, and the evaluation model of medical resources allocation efficiency was constructed by factor analysis and discrete trend analysis.The efficiency of medical resource allocation in 27 county-level public hospitals was measured by data envelopment analysis.The result is 1: 1.The distribution of health resources in public hospitals at county level in Ningxia: from the total amount of resources to the total amount of resources, the health resources of public hospitals at county level in Ningxia showed an increasing trend from 2009 to 2014. From 2009 to 2014, the number of staff and workers in the county people's hospital and the county traditional Chinese medicine hospital were on the job and the fixed assets.The financial subsidy income and the number of beds increased by 14.30% to 32.37%, 22.53% and 10.14% to 18.23%, 43.42% and 7.36%, respectively.Combined with factor analysis method and coefficient of variation, four input indicators and three output indexes for evaluating the efficiency of DEA medical resources allocation were determined, respectively, which included: number of beds, number of in-service staff and workers, income of financial subsidy.Fixed assets; output indicators include: total number of visits, business income, discharge. 3.In the 27 county-level public hospitals in Ningxia from 2009 to 2014, the number of county-level public hospitals with technical efficiency, pure technical efficiency and scale efficiency were 19 and 11 from 2009 to 2014, respectively.Ten are in diminishing returns on scale.From the value of input-output relaxation variable, the reason of inefficiency is the same as input, mainly caused by insufficient medical service.Longitudinal evaluation: 2009 and 2010 configuration results were relatively invalid in 2009 / 2014.In 2009, the scale returns were in a decreasing state, the scale returns increased in 2010. The DEA was effective from 2011 to 2014, and the scale returns remained unchanged. The total factor productivity of the county public hospitals in Ningxia region decreased by 14.5g, mainly caused by the technical level retrogression.The productivity increases from 2011 to 2012 and from 2012 to 2013 are analyzed year by year. The former is due to the improvement of technical efficiency, while the latter is due to the decline of productivity from 2010 to 2011, which is caused by the decline of technological progress, and the total factor productivity has increased by 12 from 2009 to 2014 in terms of the rise and fall of productivity.Technical efficiency improved by 19 and technological progress by 16. In addition to 2010 and 2011, the total factor productivity index (TFP) increased, with the largest increase in 2013.Suggestion 1.Strengthen the construction of human resources, promote the improvement of technology, technical efficiency and scale efficiency.Give play to the leading role of the government and guide the rational development of the scale of county-level public hospitals.Reasonable allocation of health resources and improvement of resource utilization efficiency.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.3

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