Medical Service Efficiency And The Factors Affecting Of County-Level Public General Hospitals In Hainan Province

Objective:County-level public hospitals are the main places to provide basic medical services for grassroots residents.The comprehensive reform of county-level public hospitals can help provide efficient and high-quality medical services for residents.Hainan Province fully launched the reform and development work around county-level public hospitals in 2015 and has achieved a series of results until now,but the overall medical service capacity of county-level public general hospitals still needs to be further improved due to the slow start and inferior foundation of medical and health care in Hainan Province and the unbalanced and insufficient development of medical and health care.At this stage,Hainan is in a critical period of development,the construction of free trade port has put forward new challenges to the medical and health services in Hainan Province,and the state mentioned in the14 th Five-Year Plan to continue to promote the construction and reform of public hospitals.How to deepen the health care reform and how to further improve the efficiency of medical services in county-level public hospitals during the 14 th Five-Year Plan period to meet the needs of provincial residents,"migratory birds" and tourist population is one of the major issues at hand.This research analyzes the factors affecting the efficiency of medical services by measuring the efficiency of medical services and the trend of changes in county-level public general hospitals in different cities(counties)in Hainan Province since the implementation of the comprehensive reform of county-level public hospitals in 2015,to provide a qualitative and quantitative basis for continuing to deepen the reform of county-level public hospitals in the province and to help promote the high-quality development of county-level public general hospitals.Methods: In this research,the sample hospitals were selected using stratified whole-group sampling with a combination of data envelopment analysis methods and the minimum sample size requirement of a multilayer linear model,after balancing geographical,economic,and service population characteristics.The sample hospitals included in the research were 76,with a total sample size of 380,and the sample hospitals were numbered to facilitate the study.Four input indicators and four output indicators were identified through literature research,cluster analysis,and correlation analysis.The static efficiency of the sample hospitals was measured using Max DEA software,using a four-stage model of DEA,the dynamic efficiency changes of the sample hospitals from 2015 to 2019 were measured using Deap 2.1 software and through a DEA-Malmquist model,and the factors affecting efficiency were analyzed using Stata 14 software and a multilevel model.Results: 1.Static efficiency results.76 sample hospitals had a high level of overall efficiency in the first stage,with 93.5%,92.1%,81.6%,84.2%,and 85.5% of overall and weakly efficient hospitals,respectively,over the five-year period.After the fourth stage of restructuring,the mean of integrated efficiency and scale efficiency decreased and the mean values of pure technical efficiency increased compared with the pre-adjustment period.(1)Overall efficiency scores: from 2015 to2019,the overall efficiency scores of hospitals showed a trend of rising-declining-rising again,with the lowest mean value in 2017.25,28,26,33,and35 sample hospitals showed DEA validity from 2015 to 2019,respectively.(2)Pure technical efficiency scores: from 2015～2019,the pure technical efficiency scores of hospitals showed a rising-declining-rising-declining trend,and the number of hospitals above the mean value in 2019 was the largest in five years(54).(3)Scale efficiency scores: from 2015～2019,the average scale efficiency scores of hospitals showed a rising-declining-rising trend.from 2015～2019,there were 25,28,26,33,and 35 hospitals in the sample of 76 hospitals with scale efficiency of 1 and scale compensation in a constant state,indicating that the development scale of this part of hospitals is more appropriate.2.The dynamic efficiency results.The mean value of total factor productivity of 76 sample hospitals during five years is 0.85.Although the comprehensive efficiency and scale efficiency are decreasing,the technical efficiency is decreasing more,so it is the main reason for the decrease of total factor productivity.3.The results of influencing factors.The effect of hospital grade on the overall efficiency of hospitals is more significant(P < 0.01).The actual number of open beds,financial aid income,number of licensed(assistant)physicians,number of equipment over 10,000 yuan,total number of consultations,bed utilization rate,number of inpatient surgeries,GDP per capita,and health care costs all showed positive effects on the efficiency of hospital medical services,and liabilities and net assets,and number of health technicians per 1,000 population showed negative effects on the efficiency of hospital medical services.Conclusions: 1.From 2015 to 2019,the efficiency of medical services in county-level public general hospitals in Hainan Province did not achieve year-on-year growth.2.The number of hospitals with pure technical efficiency of 1did not exceed half of the number of hospitals in the sample,and the technical efficiency declined the most in the dynamic efficiency measurement,indicating that most hospitals need to improve their technology.3.The number of hospitals with scale efficiency of 1 is small,indicating that most hospitals still There is over-expansion of scale,resources are not effectively used,or the scale of development is not enough to reach the average level,and the scale efficiency is polarized.4.The total factor productivity of public general hospitals in Hainan Province declined from 2015 to 2019,and the decline is mainly due to technical changes,so efforts should be made to improve hospital technology.5.The efficiency of medical services in public general hospitals in Hainan Province is affected by A variety of factors,hospital managers should focus on the improvement of the hospital’s own technical level and the reasonable development of its scale,and can focus on improving the service level by strengthening the management of human,financial and material resources;the government should also strengthen financial investment to achieve a high level and high quality development of the hospital in all aspects.