基于数据包络分析的上海市市级医院运行效率研究

发布时间：2018-09-12 09:13

【摘要】：背景:医疗卫生行业是与全民生产、生活息息相关的行业之一。我国对医疗卫生领域高度重视,卫生投入逐步提高,卫生事业发展迅猛。近年来,中共中央、国务院印发的一系列政策文件明确指出,要提高医院运行效率、加强医院精细化管理,建立现代医院管理制度。上海市作为全国医改的先行者,率先探索医院“管办分开、政事分开、政资分开”改革,借鉴现代化企业的管理制度,提升信息化程度,建立专业、精细、规范的现代医院管理制度。科学、客观地评价医院运行效率,分析其变化情况及影响因素,不仅能够为医院管理者改进管理、制定发展战略提供抓手,也能为政府管理部门合理配置医疗资源、制定卫生政策提供参考依据。目的:本研究对上海市28家市级医院2012-2015年的运行现状进行分析,并运用数据包络分析法(DEA)中的C2R模型、BC2模型和Malmquist指数模型对上述医院的运行效率及效率变动情况进行分析,为客观评价医院运行效率、优化管理方案提供参考。方法:本研究资料来源于2012-2015年上海申康医院发展中心市级医院绩效简报。研究对象为上海市28家市级医院,其中包括综合性医院11家、专科医院17家。本研究广泛收集查阅国内外应用DEA法评价医院效率的理论方法、研究成果等文献资料,在对重点文献进行分析的基础上,归纳投入、产出指标,进行频次统计。在指标的初步筛选基础上进行专家咨询,结合聚类分析、相关性检验、变异系数等统计方法,确定研究使用的指标体系。对构建的指标体系进行描述统计,并采用DEA法中的C2R模型和BC2模型对样本医院的运行效率进行测算,并采用Malmquist指数模型分析生产率变动情况。本研究分析使用的软件包括:Microsoft Office Acess 2013、SPSS 17.0、Max DEA6.17和DEAP 2.1。结果:根据文献荟萃分析和专家咨询结果,结合统计分析,最终构建的指标体系包括:职工总人数、实际开放床位数、业务支出、门急诊均次费用、出院均次费用、门急诊人次数、出院人次数、业务收入、门急诊医疗费用、住院医疗费用、平均住院日。2012-2015年上海市28家市级医院整体运行状况稳中有进,表现良好。职工总人数、实际开放床位数和总资产均平稳增长;门急诊量稳中有升,住院业务量增幅较大;费用结构更加优化,与业务量增长趋势基本相符,药占比持续下降;服务效率高位运行,平均住院日连续下降,病床周转次数相应加快,床位效率总体提升,医院职工人均门急诊人次、人均出院人数和人均住院手术人次均呈现上升趋势,人力效率总体提升。本研究按照指标组合,构建了13个模型,根据模型区分度、稳定性和指标信息量,选择两个较优的模型进行效率评价。两个模型计算的综合效率值具有显著相关性,提示采用这两个模型进行评价是合适的。利用两个模型不同的区分度,得出2012-2015年DEA有效医院的个数分别为5、4、6、5;DEA无效医院的个数分别是12、7、9、10。在模型3体系下,28家医院2012-2015年综合效率均值分别为0.780、0.747、0.774、0.766;在模型11体系下,分别为0.941、0.943、0.940、0.941。评价结果体现了样本医院间相对效率的高低,也表明上海市28家市级医院在2012-2015年间的总体运行效率较高。Malmquist指数模型结果表明,2012-2015年28家市级医院的全要素生产率呈增长状态,技术进步对全要素生产率影响相对较大,技术效率略有下降,规模效率变化不大。基于以上测算、分析结果,建议上海市市级医院在现有技术优势下,结合现行的院长绩效考核、病种绩效考核等量化管理模式,发挥自身优势和医疗特色,进一步聚焦技术发展与科技创新,适应卫生经济领域改革新形势,以专业化的管理人才、现代化的管理理念、精细化的管理方式提高管理水平,最终目的为实现控制成本支出,提高资源利用率,进一步提高运行效率,更好地提升服务能力和服务质量。本研究结果可为医院运行效率的评价用于医院精细化管理实践提供一定的借鉴。
[Abstract]:BACKGROUND: The medical and health industry is one of the industries closely related to the production and life of the whole people. China attaches great importance to the field of medical and health care. Health investment has been gradually increased and health undertakings have developed rapidly. In recent years, a series of policy documents issued by the Central Committee of the Communist Party of China and the State Council have clearly pointed out that it is necessary to improve the efficiency of hospital operation and strengthen the fine management of hospitals. Shanghai, as a pioneer of the national medical reform, has taken the lead in exploring the reform of "separation of management and management, separation of government affairs and separation of government and capital". By drawing lessons from the management system of modern enterprises, Shanghai has upgraded the degree of informationization, established a professional, fine and standardized modern hospital management system. The analysis of its changes and influencing factors can not only help hospital managers to improve management and formulate development strategies, but also provide reference for government departments to rationally allocate medical resources and formulate health policies. The C2R model, BC2 model and Malmquist index model in DEA were used to analyze the operational efficiency and efficiency changes of the above hospitals, providing reference for objective evaluation of hospital operational efficiency and optimization of management plan. The subjects were 28 municipal hospitals in Shanghai, including 11 general hospitals and 17 specialist hospitals. This study collected and consulted extensively the theoretical methods and research results of evaluating hospital efficiency by DEA at home and abroad. On the basis of analyzing the key literature, the input and output indicators were summarized and the frequency statistics were carried out. On the basis of preliminary screening, expert consultation is conducted, and the index system used in the study is determined by cluster analysis, correlation test, coefficient of variation and other statistical methods. The software used in this study included Microsoft Office Acess 2013, SPSS 17.0, Max DEA 6.17 and DEAP 2.1. Results: According to the results of literature analysis and expert consultation, combined with statistical analysis, the final index system was composed of the total number of employees, the actual number of open beds, business expenditure, the average number of outpatient and emergency services. From 2012 to 2015, 28 municipal hospitals in Shanghai were running steadily and well. The total number of staff and workers, the actual number of open beds and total assets increased steadily. The service efficiency is high, the average hospitalization days are continuously declining, the number of hospital bed turnover is accelerated accordingly, the bed efficiency is generally improved, the hospital staff per capita emergency and outpatient visits, per capita discharges and per capita hospitalization operations are increased. According to the index combination, thirteen models were constructed. According to the model discrimination, stability and index information, two better models were selected to evaluate the efficiency. The comprehensive efficiency values calculated by the two models were significantly correlated, suggesting that the two models were suitable for evaluation. The number of effective DEA hospitals in 2012-2015 is 5,4,6,5, and the number of ineffective DEA hospitals in 2012-2015 is 12,7,9,10. Under the model 3 system, the average comprehensive efficiency of 28 hospitals in 2012-2015 is 0.780,0.747,0.774,0.766, respectively; under the model 11 system, it is 0.941,0.943,0,0.941.941. The results show that the total factor productivity (TFP) of 28 municipal hospitals in Shanghai is increasing from 2012 to 2015, and the impact of technological progress on TFP is relatively large. Based on the above calculation and analysis results, it is suggested that Shanghai municipal hospitals should take advantage of their own advantages and medical characteristics to further focus on Technological Development and scientific and technological innovation to adapt to the health economy by combining the existing technological advantages with the existing quantitative management models such as president performance appraisal and disease type performance appraisal. The purpose of this study is to control the cost and expenditure, improve the utilization rate of resources, further improve the operational efficiency, and better enhance the service ability and quality. The results of this study can be used to evaluate the operational efficiency of hospitals. It can be used for reference in the fine management practice of hospitals.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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