| BACKGROUNDSummary Background: Since the party’s 18,the CPC Central Committee,which is the core of Comrade Xi Jinping,will deepen reform into the overall deployment,and the 19 report of the party also points out that deepening the reform of medical and health system,comprehensively establishing the basic medical and health systems with Chinese characteristics,the medical security system and the quality and Perfect modern hospital management system,implement "healthy China" strategy.County-level Public General Hospital is a medical service center in county area,is a rural three-level medical and health service network leading,is the link between the city and the rural "nexus" of the hub,is still the key to solve the problem of the masses,but also to promote the "three medical linkage and the regional public medical institutions synchronized reform" core.In 2015,the State Council issued the "Comprehensive reform of county-level public hospitals," the implementation of ideas,clearly put forward the operation mechanism,management system,adjust the price of services,personnel pay system reform and health care payment,etc.as the focus.In response to national calls and policy documents,the Guangxi Zhuang Autonomous Region issued the relevant documents,"on the issuance of the first batch of county-level public hospitals in the implementation of comprehensive reform of the pilot program of the Notice"(Guifa change to the <2012>No.1045th),"on the overall promotion of comprehensive reform of county-level public The comprehensive <2015>reform of county-level public hospitals is comprehensively promoted by the number 61 st.Guangxi,in 2012 and 2013,launched two batches of county-level public hospitals in 40 counties,119 County Public hospital comprehensive reform,covering more than 50%,in the "guarantee basic,strong grass-roots,the establishment of mechanisms" has made significant progress.2015,in order to completely push the comprehensive reform of county-level public hospitals,our district will not be included in the comprehensive reform of the 35 counties and 103 county-level public hospitals as the third batch of comprehensive reform units,the implementation of comprehensive reform of county-level public hospitals,so as to achieve comprehensive reform of Guangxi County-level By 2017,the county-level public hospital reform achievements,the basic realization of big disease not out of county.But the outline of the plan points out that the reform of public hospitals is still not in place,and problems such as the construction of debt,the expansion of scale and the loss of health personnel still affect the overall efficiency of health service system.In addition,it is urgent to analyze and evaluate the efficiency of county-level public General Hospital under the background of the relative lack of quality medical resources in the impoverished counties in the western minority areas.To improve the efficiency of county-level public hospitals and evaluate the effectiveness of comprehensive reform experience,improve the policy to provide basic information and control basis. OBJECTIVESThrough the evaluation of economic operation and operation efficiency before and after the reform of the third batch of county-level public general hospitals in Guangxi Zhuang Autonomous Region(2014-2016),the paper evaluates the effect and efficiency of the comprehensive reform,and further explores the effects of comprehensive reform and other factors on efficiency.Provide policy recommendations for efficiency improvement;Specific research objectives: to understand the analysis of the third batch of county-level public hospitals in Guangxi before and after the comprehensive reform of the service situation and economic and other aspects of the operation and changes;compare the traditional DEA and three-stage DEA method to calculate its efficiency,analyze its comprehensive efficiency,pure technical efficiency and scale efficiency,The dynamic evaluation of efficiency is carried out by using the Malmquise index method,and the projection value of the non DEA effective unit is further analyzed,the effect factors of efficiency are comprehensively analyzed by using the Panel-tobit regression method,and the effect mechanism is discussed.METHODSThis study nonporous the combination of qualitative and quantitative research,monitoring data and field research to complement each other,and strive to scientifically and objectively reflect the actual situation of the reform of county-level public General Hospital in Guangxi.Select the third batch of Guangxi comprehensive reform 36 pilot county Public General Hospital as the object of study,regional per capita GDP and resident population and other data from the 2014-2016 "Guangxi Statistical Yearbook",the application of epidate to establish a database,double check data entry,Using Excel and other software to clean the survey data,apply SPSS17.0 to the data descriptive and other statistical analysis,data comparison using the card-side test,T-Test and variance analysis of statistical methods,drawing software using GraphPad;On the selection of efficiency Evaluation Index by literature review method,Depth interview method,coefficient of variation,correlation coefficient and cluster analysis and other research methods,efficiency measureme nt and application of DEAP2.1 and Frontier4.1 software,tobit regression of efficiency factors analysis application Eview6.0 software;RESULTS 1.Health WorkforceThe pilot hospital Health talent team takes shape,after the medical reform 2016 years the total number of workers 20263 people,including health technical personnel 16284 people;The number of medical and health technicians increased with the average 7.05% growth rate,among which the number of registered nurses grew by 11.84% in 2016.The number of practicing assistant physicians increased by 6.87% in 2016,while the numbers of general practitioners stagnated;staffing,the vacancy rate has been increasing year,the rate of allocation and the rate of preparation has declined year,the total number of units and the vacancy rate is the first drop in the fluctuation trend,the air and vacancy contradictions coexist;2.Income and expenditure The total income and total expenditure of the pilot hospitals before and after the medical reform showed a trend of growth,the balance of balance of payments,the balance of medical service and the income of medicine were all positive,but the drug expenditure was increasing year to year.The drug balance was reduced from 5.4415 million yuan before medical reform to 96,600 yuan after health care,the income composition of hospital income is lower than that from the first 92.04% of health reform to 87.42%,the revenue from 7% to 9.78%;The number of national essential medicines is increasing year 2016-year growth rate of 5.21%,an annual growth of 3.5%,but health materials income from the previous 4.8% to medical reform 6.12%;3.Quantity,quality and efficiency of medical servicesThe total amount of medical service in the pilot hospital increases every year and the quality of medical service meets the relevant national standards.The number of beds,emergency attendance,number of discharges,and the actual open occupancy total bed days all showed a certain increase.In 2016,the growth rate of the number of discharged patients was up to 41.35%,with the minimum growth rate of the total bed of discharged people,1.3%;the quality of medical service and the efficiency of health care reform are not very ideal,of which aseptic surgery infection rate after the increase of higher,reached 56%;4.Physician-Patient relationshipOn the relationship between doctors and patients,the average number of medical disputes in 2016 decreased by 31.84% compared with 2014,but the amount of compensation for disputes increased by 54.29%;5.Operating efficiency Through the three-stage DEA analysis of the efficiency of the experimental hospital,it is found that the operating efficiency of 2014-2016 pilot hospitals is less than 1,that is,the efficiency is not achieved,but the operational efficiency of 3 years,including comprehensive efficiency,pure technical efficiency,The efficiency of scale is higher than 0.940,which indicates that the efficiency of the pilot hospital is in a high state,but there is still some invalid resource utilization.With the 2015 as the new Medical reform node,the study found that the operation efficiency after medical reform than before the reform of a certain degree of volatility,the comprehensive efficiency is slightly lower than before health reform,but it appears to fall first and then rise;pure technical efficiency health reform is slightly higher than before health reform,but it also shows a small decline before the rise,scale efficiency is slightly lower than before health reform,and appears to continue to decline While the pure technical efficiency showed a small increase and a small decline,the scale efficiency showed the opposite small amplitude decreased and the small amplitude increased,but the pure technical efficiency drop was slightly higher than the scale efficiency,which suggested that pure technical efficiency decline was the main factor affecting the overall efficiency decline.The comprehensive efficiency of the pilot hospital decreased from 2014 0.961 to 2016 years 0.957,fell 0.004,the range is small,the overall efficiency is higher.2014-2016 Total Factor Productivity Change(TFPCH),Efficiency change(EFFCH),Technology change(tech)and pure technical efficiency change(Pech)all have a certain increase,among them tfpch,Effch,Tech,Pech average annual growth rate is 12.3%,0.2%,12.1%,0.3%;from the angle of efficiency contribution,Tech(1.121)contribution intensity is higher than effch(1.002).In the same period only the scale efficiency(Sech)was 0.999,has a certain degree of reduction,an annual reduction of 0.1%;As the average annual growth of Pech 0.3%,sech annual decline of 0.1%,and effch annual growth of 0.2%,it can be seen that the tfpch growth mainly from tech growth,That is,the continuous progress of technology.6.Factors affecting efficiencyThe results of Tobit regression analysis showed that there were 4 internal factors and 4 policy factors which were statistically significant to the comprehensive efficiency of the pilot hospital.The internal factors,namely,the ratio of assets and liabilities and the medical expenses of the insured personnel,have negative effect on the comprehensive efficiency.The cure rate,the medical care ratio has the positive effect to it;the comprehensive reform policy factor namely the retiree funds investment,the government input compensation cancels the drug addition reduced expense to have the negative effect to the comprehensive efficiency;performance is linked to wages,By adjusting the price compensation of medical service to eliminate the increase of drug to reduce income,there is a positive effect;in pure technical efficiency,there are 4 internal factors and 4 policy factors have statistical significance to the pure technical efficiency of the pilot hospital.internal factors,that is,the asset-liability ratio and the per capita hospitalization cost have negative effects on the pure technical efficiency,and the cure rate and the ratio of medical care have positive effect;the comprehensive reform factors,namely the investment of medical equipment and the investment of retirees,have negative effect on the pure technical efficiency;the investment in medical equipment purchase The establishment of remote consultation system with the grassroots has a positive impact on it;in terms of scale efficiency,a total of 5 internal factors and 4 policy factors have statistical significance for the pure technical efficiency of the pilot hospital.The internal factors,namely the actual open beds,the regression coefficients of the ratio of assets and liabilities,per capita hospitalization expenses and the cost of participation are all negative,indicating that the four variables have negative effect on the scale efficiency,and the regression coefficient of the total number of health technicians is positive,indicating that the variable has positive effect on the scale efficiency.the comprehensive reform factor namely the capital investment has a positive effect on the scale efficiency,the investment of medical equipment,the investment of retirees,the elimination of the income by the Government input,and the reduction of the revenue has negative effect on the scale efficiency;CONCLUSION 1.The comprehensive reform of the pilot county-level public General Hospital has been successful,but there are still many problems.such as the unreasonable allocation of health human resources,brain drain,financial investment structure is not reasonable,some hospitals are facing financial risks;2.The overall operation efficiency of the pilot county-level public General hospital before and after medical reform is relatively high,the change is not very significant,before and after the health reform,the fluctuation trend of first descending and rising is increased.The overall efficiency of the pilot county-level public General hospital is lower than that before the reform,while the total factor productivity is increasing year in,although the pure technical efficiency has been improved,but the overall efficiency decrease mainly originates from the reduction of scale efficiency and the difference of efficiency is not statistically significant.3.The operational efficiency of the pilot county-level public General hospital is influenced by both internal and external factors,but it is insensitive to external economic and demographic factors.internal factors: Health care ratio,the cure rate,the number of health technicians,the ratio of assets and liabilities,the proportion of medical expenses of the insured persons,the actual number of open beds,the hospitalization cost per capita,the comprehensive reform policy factors: capital investment,investment in medical equipment purchase,retirement funds investment,performance appraisal and wage linkage,through government investment,Adjusting the price compensation of medical service to eliminate the cost of reducing drugs and establishing a remote consultation system with the grassroots;4.The effect of each factor on efficiency can be negative,and some factors can be differentiated.The ratio of the ratio of assets to liabilities and the medical expenses of the insured persons have negative effect on the comprehensive efficiency.The cure rate and the ratio of medical care have positive effect;some comprehensive reform measures,such as the retirement fund input,the Government input compensation and the elimination of the reduction of drug addition,have a negative effect on the comprehensive efficiency of the pilot hospital;performance is linked to wages,By adjusting the price compensation of medical service to abolish the drug and reduce the income,it has a positive effect;POLICY RECOMMENDATIONS 1.Optimizing the allocation of health resources and improving the utilization efficiency of health resources;2.With "government-led,market regulation supplemented by" the introduction of excellent health technical personnel,tamping the grassroots health team construction,improve the quality of health human resources,promote the efficiency of county-level public hospitals;3.We will continue to implement the Government’s responsibility,break the medicine,strengthen the linkage,control the proportion of medicine,rationalize the price of service,and protect the public welfare of county-level hospitals;4.Perfect the modern hospital management system,prevent the hospital financial risk,strengthen the informationization construction,promote the health insurance payment reform,realizes the hospital high efficiency sustainable healthy development;5.To realize the hospital’s multiple methods and regular efficiency evaluation,standardize and improve the efficiency evaluation system;... |
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