Research Of Township Hospitals' Efficiency Based On DEA In Poverty-stricken Areas

Objective: To establish the efficiency evaluation index system which is adapt to the township hospitals; To understand the reasons for the township hospitals'low efficiently, and propose the solution; To evaluate the efficiency of the township hospitals in poverty-stricken areas in Shanxi Province and find whether they can perform their functions; To explore the factors affecting township hospitals'scale benefit;To explore the application of data envelopment analysis of township hospitals'efficiency evaluation.Methods: The sample survey was conducted in the township hospitals of poverty-stricken areas ,then to study the basic conditions , the staff frame , the sources and using of funding and the equipment configurations by descriptive epidemiology method; literature study,clustering analysis and principal components analysis were used to establish the efficiency evaluation index system;the data of overall efficiency, scale benefit and technical efficiency of sample township hospitals were got by the DEA's C2R and C2GS2 model;linear regression model was used to find the affecting factors of scale benefit of township hospitals; allocative efficiency of township hospitals was studied based on its technical efficiency which is measured by DEA , then the overall economic efficiency of township hospitals was got.Result:(1)The township hospitals'basic conditions: The average operational area is 602.4 square meters,44.78% are dilapidated houses. There are 842 working personnel, including 787 health technical personnel (HTP 93.5%). The number of HTP,public health personnel and hygiene supervisory per thousand persons on average was 1.68,0.27,and 0.16 on each. The people who didn't have the certification of graduate accounted for 77.4%;The proportion number of senior, mid and junior title is 1:152:536; the quality of every county hospital's talents is almost at the same level . The posses rate of B ultrasound, ECG machine, biochemical is 66%, 52%, 50% on each. The largest part of the source of the township hospitals'funding (43.3%) is from government funds, the second part is the income of drug selling, accounting for 40.2%; 51% of the expenditures of township hospitals is account for the workers'wages, 34% is used to the cost of drugs,12% for the management of hospitality and other business expenses.(2)The output of the township hospitals: 30% of township hospitals can carry out five Public Health Services,including planned immunization, maternal and child health, health education, disease reporting, Family planning technical service . Every township hospital carry on 4.46 health education on average every year, but the conducting is different . About the Basic medical services, annual outpatient number on average is 5046.9, the emergency number is127.66, the physical examination number is 649.8, the hospital discharge is 264.86, the numbers of delivers and operations is 92.54 and 11.54. Besides, about the public health management capabilities, the township hospitals didn't make any quarter and the annual working schedule of the shares hygiene; and they didn't carried out any health supervision and law enforcement in their dominating area; they didn't do any checking of the village health supervisors either.(3)The index evaluation system establishment and DEA analysis: After the literature analysis, cluster analysis, principal component analysis,6 input indicators and 15 output indicators were picked out to bring to the DEA model. After having been tested, 29 (58%) township hospitals'general efficiency has proved effective based on DEA model; while others are ineffective. The main reasons for non-DEA effective are that the input of revenue charges and medical equipment are too much,and the output of planned immunization, health education, surgery, emergency is inadequate. Non-DEA general effective hospitals all are the type scale of diminishing returns;5 township hospitals technical efficiency were invalid. The factors affecting the returns to scale are the scores ranks,fund from government and operational area.(4)The functional weighted efficiency: The figure of functional efficiency weighted value of township hospitals less than 0.5 is 14, which accounts for 28%; 05 ~ 0.8 is 35, accounting for 70%; one is more than 0.8, accounting for 2%. The functions of the weighted efficiency and DEA general efficiency have some statistical differences.Conclusion:The focus of the function of township hospitals in poverty-stricken areas are unreasonable, public health management capabilities are in serious shortage, public health service functions are in slight lack. The DEA general efficiency always focuses on the economics scale efficiency of township hospitals; functional weighted efficiency combined the technical efficiency and allocative efficiency, which mainly reflects the economic functions of township hospitals. During using the DEA to evaluate the efficiency of township hospitals, the returns to scale and economic efficiency should be considered.