| BackgroundThe efficiency and quality of medical and health services directly determine the level of human health development,which is the fundamental guarantee of human health.With the development of social economy,the emergence of new medical technology,the acceleration of population aging and the low efficiency of health system,the cost of health has been rising.Hospital is the unit that consumes the most health resources in the health service provider.China has been deepening hospital reform and improving the efficiency of medical service by optimizing the allocation of hospital health resources.Therefore,it is particularly important to pay attention to the efficiency of hospital health resource allocation and its influencing factors since the launching of the new medical reform。ObjectivesThrough the evaluation of the efficiencies of hospital health resource allocation in31 regions since the launching of the new medical reform,and through the in-depth analyses of the influencing factors,this study identified the development trend and key influencing factors of the efficiency of hospital health resource allocation in China since the launching of the new medical reform.The study also aimed to provide the references for formulating the plans of the hospital health resource allocation for the country and regions and the deepening of hospital reform.MethodsIn this study,DEA model was used to evaluate the efficiency of hospital health resource allocation in 31 regions since the new medical reform:σ convergence,absolute β convergence were used to analyze the convergence of the efficiency of hospital health resource allocation since the new medical reform;at the same time,the mixed effect and random effect Tobit regression model were used to analyze the factors affecting hospital efficiency from the perspective of mean regression.On this basis,Bayesian quantile Tobit regression model was used to analyze the factors affecting hospital efficiency from the quantile regression level.Results1.In this study,DEA model was used to measure the efficiency of hospital health resource allocation in 31 regions since the new medical reform.It was found that since the new medical reform,the comprehensive technical efficiency and pure technical efficiency of hospital health resource allocation in China have been improved year by year and the scale efficiency has not changed much,and higher than the pure technical efficiency.Generally speaking,the number of provinces with effective comprehensive efficiency of hospital health resource allocation in China is decreasing year by year with time.The number of provinces with pure technical efficiency is always higher than the number of provinces with effective comprehensive technical efficiency.In some areas,the comprehensive technical efficiency is in an invalid state due to the invalid scale efficiency.The efficiency of hospital health resource allocation varies greatly among regions.2.According to the projection analysis of input and output of hospital health resource allocation,this study found that the inefficient provinces of hospital health resource allocation all had the problem of insufficient utilization of health resources,and some provinces also had the problem of insufficient output.3.By analyzing the convergence analysis of the efficiency of hospital health resource allocation in the new era,this study found that there wereσconvergence,absoluteβconvergence in the comprehensive technical efficiency and pure technical efficiency of hospital health resource allocation among provinces in China.4.Based on the common Tobit regression analysis,this study used the Bayesian quantile Tobit regression method to analyze the influencing factors of the efficiency of hospital health resource allocation.It found that the efficiency of hospital health resource allocation and urbanization rate,the proportion of total health expenditure to GDP,the proportion of government health expenditure to total health expenditure,and the proportion of personal cash health expenditure to total health expenditure,the proportion of utilization,the proportion of examination fee of outpatient and emergency patients in medical expenses,and the proportion of operation fee of inpatients in medical expenses were negatively correlated,and these influencing factors were gradually weakened with the increase of efficiency value;they were positively correlated with the proportion of hospitals with 300-499 beds,the ratio of medical care,the ratio of bed nurses,the number of doctors who were responsible for daily diagnosis and treatment,and the admission rate of outpatient and emergency patients.Part of the influencing factors,with the increase of efficiency value,gradually strengthened the effect;it has nothing to do with the per capita health cost,the proportion of per capita outpatient and emergency patients’medical expenses,and the proportion of per capita inpatients’medical expenses.Conclusions1.Since the new medical reform,the comprehensive technical efficiency and pure technical efficiency of hospital health resource allocation in China have been improved year by year.Hospitals have improved the efficiency of health resource allocation through continuous system and mechanism innovation,but the scale efficiency at this stage has always been higher than the pure technical efficiency.To some extent,the development of hospitals still relies excessively on the scale expansion of"extensive type".2.At present,there is a large gap in hospital efficiency among the regions in China.In most regions,the allocation of hospital health resources is inefficient.There are problems of input redundancy and output insufficiency,and the waste of health resources is serious.3.With the advancement of new medical reform,the comprehensive technical efficiency and pure technical efficiency of hospital health resource allocation in China gradually narrow the efficiency gap between regions and develop towards their own stable state.4.Hospital health resource allocation efficiency and external environmental factors(urbanization level,proportion of total health expenditure to GDP,structure of financing sources of total health expenditure),internal medical service price structure factors(composition of medical expenses per capita outpatient and emergency patients and inpatients),internal health resource allocation structure factors(size structure of hospital beds in the region,health human resources structure)and internal management factors(average number of doctors per day and admission rate of outpatient and emergency patients).With the increase of efficiency value of hospital health resource allocation,the influence of external environmental factors and internal medical service price structure factors is gradually weakened,while the influence of internal health resource allocation structure factors and internal management factors is gradually strengthened with the increase of efficiency value of hospital health resource allocation.5.Suggestions for improving the efficiency of health resource allocation in regional hospitals:(1)make a scientific health resource allocation plan centering on the economic development level and the medical service demand of the people;(2)promote the reform of hospital system and mechanism,further strengthen the construction of medical alliance,and deepen the reform of medical service price system;(3)increase the government’s health expenditure and expand social health expenditure and reduce the stress of medical treatments.At the same time,we should strengthen the supervision and use of health expenses.Innovations and limitations1.Research innovations:This study evaluates the efficiency of hospital health resource allocation in 31 regions of China since the new medical reform from the macro level,and analyzes the convergence of efficiency;the Bayesian quantile regression to used to analyze the influencing factors of hospital health resource allocation efficiency and broadens the research thinking of the influencing factors of efficiency.The study focuses on the impact of health policy(total health expenditure,health expenditure financing structure,medical service price reform,hospital scale structure)on the efficiency of hospital health resource allocation and enriches the content of influencing factors of the efficiency of hospital health resource allocation.2.research limitations:This study focuses on the quantity of hospital medical service output,and does not introduce the quality of medical service into the efficiency evaluation model.In addition,this study is a non-empirical study.The next step is to focus on both quantity and quality,and combine with the specific empirical study to further carry out the research on hospital health resource allocation and its influencing factors. |
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