Research On The Application Of DEA Model Based On Directional Distance Function In The Evaluation Of Hospital Efficiency

Since2012,the State Council has promulgated the "Notice on the Pilot Opinions on the Comprehensive Reform of County-Level Public Hospitals"(Guo Ban Fa[2012]No.33)and’Guiding Opinions on the Comprehensive Reform of Urban Public Hospitals"(State Council issued[2015]No.38),"The 13th Five-Year Plan for Deepening the Reform of the Medical and Health System"(Guo Fa[2016]No.78)and a series of policies and measures aimed at ensuring the efficiency of hospitals under the premise of public hospitals to maintain public welfare.Standardize the efficient operation mechanism and accelerate the construction of modern hospital management system.It can be seen that improving hospital efficiency is one of the core issues in building a modern hospital management system.The improvement of hospital efficiency means that medical resources are more effectively and rationally utilized,which is crucial to alleviate the current relatively tight medical resources.Under the background of medical system reform,improving hospital efficiency is not only a problem that government departments should care about,but also an aspect that hospital administrators should pay attention to.The measurement and evaluation of efficiency will help to find out the problems in the operation of the hospital in time,determine whether the input factor is too much,and whether the output factor is insufficient,so as to adjust and improve in time.Therefore,using scientific and effective methods to accurately measure hospital efficiency and analyze the improvement plan of efficiency improvement will provide necessary reference for hospital management decision-making.Data Envelopment Analysis(DEA)is applicable to the efficiency evaluation of decision units with multiple input factors and multiple output factors.In the current hospital efficiency evaluation,researchers use the basic CCR and BCC models of the DEA method to evaluate hospital efficiency.However,the basic DEA model also has some defects and shortcomings in the process of efficiency measurement:1)The improvement strategy of the basic DEA model for the non-effective decision-making unit is to reduce all the inputs in the same proportion and expand the same ratio for all the outputs.2)The improvement of the non-effective decision-making unit of the basic DEA model is to adjust the output under the assumption of a certain investment,or to adjust the input under certain conditions to make the hospital efficiency relatively effective.Changes in hospital efficiency should be accompanied by changes in inputs and outputs.It is not appropriate to analyze only from a single perspective of inputs or outputs;in practice,inputs(outputs)are often constrained by objective conditions or due to policy maker preferences.The impact cannot be met by the requirement that all indicators are reduced or increased in the same proportion,ie it is difficult to achieve radial direction adjustment.For example,the number of hospital beds appears as an input indicator in many evaluation problems,but in general,the number of hospital beds is approved by the competent department,and the hospital itself cannot adjust at will.Therefore,the more general non-radial DEA efficiency measurement method has become a hot topic for foreign scholars,and has also attracted the attention of domestic academic circles.As a non-radial DEA efficiency measurement method,the directional distance function can be used to measure the efficiency,and can consider the simultaneous change of input and output,and can make the non-effective decision-making unit to the effective production frontier according to the given direction vector.Adjustment,the reduction of input factor indicators,or the expansion of output factor indicators to meet the requirements of different proportions of different factors,is a generalization of the radial technical distance function.At present,this method is mostly used in the fields of economics,finance and energy efficiency research,and is rarely used in the research of efficiency in the field of health care;and there are few studies on the efficiency of the field of health in the setting of direction vectors.Therefore,this study will apply the DEA model based on the improved distance function of the orientation technology to measure the hospital efficiency,and provide the improvement strategy of the input and output indicators by means of the custom direction vector,and provide the efficiency improvement plan for the decision-making unit.Research purposes and significance:Introduce the directional distance function method in the data envelopment analysis of hospital efficiency evaluation,based on the analysis of the changeable degree of hospital input and output indicators,considering the policy significance and decision makers’ preferences,by customizing the direction vector Different from the basic DEA model,the improvement method of adjusting the input or output from a single angle in the same proportion,giving the improvement strategy of input and output indicators,making the efficiency evaluation result closer to the practical application,providing more feasible for hospital decision makers.Strong efficiency improvement program.Research methods:The research methods used in this study include literature research method,expert consultation method,DEA directed distance function method,and R language programming.This study,by consulting the three Chinese literature retrieval platforms of Zhiwang,Wanfang and Weipu,comprehensively searched and searched the similar research literature materials,selected Chinese science and technology core journal articles,combed and summarized the evaluation of the efficiency evaluation of public hospitals in China,and selected the input-output indicators.The situation,and based on the data envelopment analysis method for the evaluation indicators,preliminary determination of indicators.Set the changeable scores for the selected indicators,consult the hospital’s top management and hospital management experts,calculate the average score of the indicators based on the expert scores,as the index’s variable degree score,on this basis,combined with the evaluation of hospital investment The output indicator value sets the direction vector.The DEA model based on the directional distance function is used to realize the non-radial adjustment of the decision unit by setting the direction vector.According to the research design,set different parameter variables,scale return situation,input-output angle,combined with expert advice,set different direction vectors,measure hospital efficiency and propose improvement schemes,and use R language package of Benchmarking,lpSolveAPI,unminf and other functions to program implementation.Research results:This study applied the data envelopment analysis method based on the directed distance function to measure the input and output efficiency of 22 municipal hospitals in B city,and discussed the improvement plan of non-effective hospitals,and the results of the basic DEA model.Conduct a comparative analysis.The study results:1 based on the basic DEA model and the DEA model based on the directional distance function to measure the hospital efficiency of the same indicator combination,in the input-oriented,output-oriented and input-output guidance(only for the DEA model based on the directional distance function)In all three cases,hospitals with a combined efficiency value of I(ie,effective hospitals)were identical.Specifically:in combination 5,H1,H7,H8,H21 4 hospitals are in a n overall effective state;in combination6,H2,H5,H6,H8,H15,H20,N21 7 hospitals are in an overall effective state;Next,H1,H7,H8,H13,H 17,H21 6hospitals are in an overall effective state.In combination8,H2,H5,H6,H8,H15,H20,H21 7hospitals are in an overall effective state.2 Under the combination of different indicators,there are more effective hospitals when the number of medical services is the output index compared with the output indicators of capital income.3 Applying the DEA model based on the directional distance function,setting different direction vectors,and calculating the input-output orientation of the four combinations,there are differences in the efficiency value and indicator improvement of each hospital.4 Compared with the basic DEA model calculation results,the DEA model based on the directional distance function measures the improvement of the index,and when setting a single input or output orientation,the number of employees and the number of beds in the input indicator are generally small,and the business expenditure(or The total expenditure)is relatively close,and the improvement of output indicators is generally large;when the input-output orientation is set,the improvement of each indicator is small.5 Based on the DEA model of the directional distance function,the average value of the direction vector and the original value of the index multiplied by the corresponding weight(considering policy factors,distinguishing the degree of change of different indicators)as the direction vector,for different hospitals,improve the size relationship There is no uniform trend in efficiency and value improvement.Therefore,the research suggests that the choice of improvement plan can be comprehensively compared and selected,and a more feasible improvement strategy is selected to improve hospital efficiency.Conclusion and significance:There are significant differences in efficiency measurement results under different combinations of indicators.Compared with the comparison,the combination of 5 is higher,but the selection of specific input and output indicators should be based on the research purpose;the same indicator is combined with different models,and different model angles are selected.The measured effective units are the same,that is,the results of the DEA model based on the directional distance function are consistent with the basic DEA model;compared with the basic DEA model,the DEA model based on the directional distance function,the researcher or the hospital decision maker can According to the degree of change of indicators,the corresponding direction vector is set,so that the indicator improvement is closer to the actual situation of the hospital,so it is more feasible.The direction vector is set to the average value of the hospital indicators or multiplied by the original value of the indicator.The hospital depends on the situation.Based on the DEA model of the directional distance function,when the input-output orientation is set,the improvement of the index is small,and the reduction or increase ratio of each index varies according to the index.The indicators are reduced by the same ratio compared with the basic DEA model.Or increase,this kind of improvement plan is more applicable to the degree of change of indicators and the actual situation of the hospital.Based on the previous research,the DEA model based on the directional distance function is combined with the expert advice to assign different weights to different indicators,set the direction vector,measure the hospital efficiency and propose improvement strategies,so that the efficiency improvement program can consider policy factors and hospital resources.Happening.Compared with the improvement based on the basic DEA model and the improvement of the index,the feasibility of the research program is enhanced.