| Objective: This study aims to explore the input-output efficiency and its influencing factors in health and medical institutions.The efficiency of health and medical service directly determines the economic burden of health in China and is an important issue to control the increase of medical expenses.Class a hospital health care institutions,intensive medical resources classification to the implementation of the diagnosis and treatment,the respect such as output quality supervision institutions and medical personnel has an important position,since the reform and national focus on the class health hospital medical institutions and investment increase year by year,but the input index redundancy also increase significantly,to evaluate the efficiency of resource allocation and intervention in time.At present,more and more countries around the world use DEA data envelopment analysis to evaluate the efficiency of resource allocation in health and medical institutions,and provide health policy suggestions and intervention empirical research programs based on this,so as to ease the health economic burden.In this study,DEA data envelopment analysis was used to measure the input-output efficiency of non-hospital medical institutions in China,so as to evaluate the current resource allocation efficiency of each institution and provide reference for national health resource allocation planning.Through empirical research and exploratory experiments on inefficient institutions,this paper discusses how to improve the input-output efficiency of institutions under the premise of ensuring quality and safety.Methods:In the first part of this study,based on discontinuous time series analysis,the input and output index data of 18 non-hospital health institutions in China Health Statistical Yearbook from 2011 to 2020 were summarized and descriptive analyzed.Secondly,the de A-TOBIT two-stage model was used to measure the resource allocation efficiency of each medical institution,evaluate the input-output efficiency,return to scale and redundancy,and select the institution with the lowest comprehensive benefit evaluation result as the low efficiency pilot institution,and analyze the influencing factors of its efficiency.Then,using information entropy weight method and principal component analysis method combined with the quality safety requirements of low efficiency pilot institutions,quality related output indicators are supplemented.Finally,in the second part of this study,the multi-population genetic algorithm is used to construct the intervention model and evaluate the intervention effect of the low efficiency pilot institutions in the perspective of the cost reduction of business activities.In the third part of this study,we conducted semi-structured interviews with three main stakeholders on how to improve the work efficiency of the pilot institutions under the premise of ensuring quality and safety,and conducted exploratory experiments on the main interest appeals.Results: In the first part of this study,DEA model measurement results showed that units that could provide medical services,such as specialized disease prevention and treatment hospitals,maternal and child health care hospitals,and primary health and medical institutions,had relatively ideal performance in health resource allocation efficiency,which increased year by year or remained stable.The efficiency levels of units that cannot provide medical services,such as centers for Disease Control and Prevention,health supervision institutes and medical scientific research institutions,are not uniform.However,the overall efficiency has been increasing year by year since 2017 and tends to be stable.Even the non-dea effective decision-making units have approached the effective state.In 18 subjects,clinical test center the comprehensive benefit of lowest,prompt more investment was rapid growth year after year and efficiency drops rapidly year by year,as inefficient pilot institutions into the next study,through the Tobit regression model business activity cost,personnel quantity,total cost of the equipment and the construction area of ten thousand yuan of above are the main factors affecting its efficiency.In the second part of this study,the information entropy weight method was used to screen the quality indicators of clinical laboratory center,and three quality-related output indicators were obtained,namely,the rate of inaccuracy of test report,the rate of unqualified room quality assessment and the rate of unqualified room quality control.Four clinical laboratory centers were selected as the research object,and the cost management of medical consumables in the three experimental groups was intervened.After two intervention cycles,the cost of medical consumables in the three experimental groups was lower than the control group under the premise of quality and safety.In the third part of this study,firstly,through sorting out the interview results of major stakeholders,suggestions for improving staff efficiency include optimizing the function of medical laboratory information system,using performance appraisal method to carry out staff quantitative output plan,and using two-level performance distribution system to carry out positive motivation for staff enthusiasm.Then a clinical laboratory center was selected as the experimental object for exploratory research based on business process reengineering method.The experimental group increased the quality management time 14.69 minutes/day,clinical service time 16.53 minutes/day and biosafety management time 18.98 minutes/day under the condition that rest time and related quality indicators remained unchanged.Reduced non-benefit output time by53.65 min/day.Conclusions: 1.The efficiency measurement model of health and medical institutions constructed in this study indicates that it is effective,and the measurement results have a high coincidence rate with the actual situation.Therefore,DEA data envelopment analysis and Tobit regression model can indeed be used to conduct a relatively high-quality evaluation and analysis of influencing factors on the efficiency of health resource allocation.2.In the efficiency evaluation of non-hospital health and medical institutions,the overall resource allocation efficiency of those institutions that can provide medical services is relatively ideal,while the efficiency measurement results of those institutions that cannot provide medical services are uneven,among which the comprehensive benefit evaluation of clinical laboratory center is the lowest.3.Since2017,most non-hospital health and medical institutions with non-DEA effectiveness have greater technical efficiency than scale efficiency.4.The cost of operational activities,total value of equipment,floor area and number of personnel are the main factors affecting the input-output efficiency of health and medical institutions.5.Due to the influence of market regulation factors,how to carry out efficiency rectification under the premise of ensuring quality and safety is a very important and urgent problem to be solved.6.By using the multi-population genetic algorithm to model the inventory replenishment strategy of medical consumables and applying it to the management of medical consumables,the cost of medical consumables can be reduced in a short time,the efficiency of warehouse administrators can be improved,and the time required for each unit to accumulate the experience of cost control of business activities can be optimized.7.Through semi-structured interviews with stakeholders by means of opinion sampling method,it can be seen that the lack of information system functions and the increase of working processes due to the lack of tacit cooperation between departments are the main factors affecting the efficiency of health technicians.8.Establishing the secondary performance distribution system,optimizing the scheduling system,using efficiency reminder software,improving the laboratory information system and providing opportunities to study abroad will improve the work enthusiasm of health technicians;9.Timely statistics and analysis of quality indicators can ensure quality safety,but may reduce personnel efficiency. |
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