| BackgroundsPublic hospitals are the "main force" of China’s medical system.Improving operation efficiency is one of the essential objectives of the comprehensive reform of public hospitals.Scientific and reasonable evaluation of the operational efficiency of public hospitals and the discovery of existing problems are of great practical significance to improve the operational efficiency of public hospitals.Weihai is a demonstration city of public hospital reform in China.All secondary and above public hospitals in Weihai city participated in the reform and achieved good results.Therefore,this study makes a comprehensive analysis of the operation status and efficiency change trend of public hospitals in Weihai,investigates the change trend of indicators,which can provide a reference for the comprehensive reform of public hospitals.ObjectivesThis study conducts a descriptive analysis of the operation status of public hospitals in Weihai City,uses linear ratio and DEA indicators to analyze their operational efficiency and change trend,applies ITS to analyze the changing trend of indicators,discusses the problems existing in the reform process,summarizes their practical experience,and provides a reference basis for policymakers and hospital managers to promote the comprehensive reform of public hospitals further.Materials and methodsThe study subjects were all secondary and above public hospitals participating in public hospital reform in Weihai City,Shandong Province.The data source was mainly from the monitoring database of public hospitals from 2015 to 2019 and relevant policy documents.The main contents included hospital grade(secondary/tertiary)and category(general/special),the number of hospital employees and their structure,assets and liabilities,equipment and facilities,income and expenditure structure,and hospital workload.Firstly,this study made a descriptive analysis of the input and output of public hospitals in Weihai,and then evaluated their operational efficiency using the linear ratio index,the DEA basic model,and the DEA-Malmquist index model,finally,ITS was used to analyze the change trend of operation indicators and explore the change of reform effect.The data analysis was conducted by Microsoft Excel 2019,DEAP 2.1 and STATA 15.0 software.Main research results1.Analysis results of inputs changes in public hospitals(1)Hospital staff Changes:The number of working employees,total number of health technicians,the number of licensed assistant physicians and registered nurses in public hospitals increased yearly from 2015 to 2019,and the average annual growth rate of secondary hospitals was faster than that of tertiary hospitals.The medical care ratio in public hospitals decreased from 1:1.48 to 1:1.31,and the average annual decline rate in tertiary hospitals(-3.62%)was faster than that in secondary hospitals(-1.32%).The structure of human health resources needs to be further optimized.(2)Changes in assets and liabilities:The asset scale of public hospitals increased steadily from 2015 to 2019,and total assets,current assets and fixed assets all increased gradually;The total liabilities also showed an overall increasing trend,and the average annual growth rate in secondary hospitals(7.88%)was faster than that in tertiary hospitals(6.85%).The growth rate of total assets in public hospitals was fast,and the average annual growth rate of total liabilities was also high,which reflected the rapid expansion of the scale of public hospitals.(3)Changes in equipment and facilities:The scale of public hospitals continued to expand from 2015 to 2019,and the average annual growth rates of hospital floor area(6.56%),number of actual beds(6.25%),number of equipment over RMB 10,000 yuan(16.18%)and the total value of equipment over RMB 10,000 yuan(18.00%)in secondary hospitals was faster than those in tertiary hospitals(4.90%,4.78%,10.55%and 10.94%).(4)Changes in expenditures:The total expenditures of public hospitals showed an overall increasing trend from 2015 to 2019,and personnel and drug expenditures showed a generally increasing trend.The average annual growth rates of total expenditure(10.47%),personnel expenditure(15.64%)and drug expenditure(4.75%)in secondary hospitals were faster than those in tertiary hospitals(8.03%,13.34%and 3.91%).2.Analysis results of outputs changes in public hospitals(1)Changes in outpatient workload:The number of outpatient patients in public hospitals showed an overall increasing trend from 2015 to 2019,and the number of outpatient appointments increased significantly.The average annual growth rates of outpatient visits(14.06%)and appointment visits(76.08%)in secondary hospitals were faster than those in tertiary hospitals(7.00%and 70.07%).(2)Changes in inpatient workload:the number of discharged patients and inpatient surgeries in public hospitals increased overall from 2015 to 2019,with tertiary hospitals experiencing faster average annual growth rates of discharged patients(5.74%)and inpatient surgeries(16.75%)than secondary hospitals(4.82%and 6.37%).(3)Income changes:The total income of public hospitals increased year by year from 2015 to 2019,and the average annual growth rate in secondary hospitals(10.10%)was higher than that in tertiary hospitals(7.69%).From the perspective of income composition,medical income(outpatient income+hospitalization income)accounts for a large proportion of total income.The proportion of drug income in public hospitals decreased year by year,and the average annual decline rate in tertiary hospitals(-5.27%)was faster than that in secondary hospitals(-4.88%).3.Analysis results of efficiency changes in public hospitals(1)Analysis of the change in linear ratio efficiency index:①In terms of the main workload undertaken by doctors,the number of visits per doctor in both secondary and tertiary hospitals showed an overall increasing trend from 2015 to 2019,and the average annual growth rate of secondary hospitals(2.79%)was higher than that of tertiary hospitals(2.43%).During the same period,the number of hospitalizations per doctor showed an overall decreasing trend.The average annual decline rate of tertiary hospitals(-0.75%)was lower than that of secondary hospitals(-2.83%).②From the perspective of bed use,the average hospital stay showed an overall decreasing trend from 2015 to 2019,and the average annual decline rate of tertiary hospitals(-5.62%)was higher than that of secondary hospitals(-1.26%);From 2015 to 2019,the number of bed turnover in secondary hospitals showed a decreasing trend,while that in tertiary hospitals showed an increasing trend.The bed utilization rate showed an overall decrease,and the average annual decline rate of tertiary hospitals(-4.95%)was higher than that of secondary hospitals(-1.97%).③From the intermediate cost burden level of secondary public hospitals or above,the overall average outpatient expenses of secondary hospitals decreased from 2015 to 2019,while that of tertiary hospitals increased overall.During the same period,the average inpatient expenses of secondary hospitals increased overall,while that of tertiary hospitals decreased.During the same period,the overall medical daily expenditures per bed of secondary and tertiary hospitals increased,and the average annual increase rate of secondary hospitals(3.08%)was slightly lower than that of tertiary hospitals(3.93%).Overall,the operation effciency of public hospitals has been improved and the medical expense of patients decreased.(2)Analysis of DEA comprehensive efficiency index changes:①DEA efficiency:DEA efficiency in tertiary public hospitals decreased from 77.78%in 2015 to 55.56%in 2019.DEA efficiency of secondary public hospitals fluctuated wildly between 2015 and 2019,showing a trend of decreasing first and then increasing.②Comprehensive efficiency:The comprehensive efficiency of secondary public hospitals reduced yearly from 2015 to 2018 but increased significantly in 2019 to 0.992.The average comprehensive efficiency of tertiary public hospitals remained stable from 2015 to 2017,reaching 1 in 2018.③Pure technical efficiency:The average pure technical efficiency of secondary hospitals from 2015 to 2018 decreased year by year but increased significantly in 2019,reaching 1.The average change trend of pure technical efficiency of tertiary hospitals is relatively stable,all of which maintained above 0.992 but decreased in 2019 to 0.993.④Scale efficiency:The average scale efficiency of secondary hospitals increased from 2015 to 2018,reaching 0.999 in 2018 but reaching 0.992 in 2019.The changing trend of comprehensive efficiency of tertiary hospitals remained consistent with secondary hospitals,and the average scale efficiency reached 1 in 2018 and also showed a significant decline in 2019,reaching 0.987.(3)Analysis of changes of total factor productivity:In general,the average change index of total factor productivity in public hospitals from 2015 to 2019 was 1.005,up by 0.5%,and the average change index of efficiency,technology and scale efficiency all increased.The average change index of total factor productivity in secondary hospitals was 0.992,down 0.8%,mainly due to a 1.0%decrease in the average change index of technology.During the same period,the average change index of total factor productivity in tertiary hospitals was 0.969,down 3.1%,mainly due to the decline in the average change index of technology by 4.2%.Technological development is the main reason restricting the improvement of the operation efficiency of public hospitals.4.Results of Interrupted Time Series analysisTertiary public hospitals:before the reform,except for beds,the total income,total number of diagnosis and treatment,number of discharge,number of on-the-job employees and total expenses showed an upward trend,And it had statistical significance in the total income(P=0.039),the number of on-the-job employees(P=0.032)and the total expenses(P=0.028);after the reform,all indicators showed an upward trend,and the most obvious upward trend was the total number of patients.The total income showed a significant difference before and after the reform(β3=-0.029,P=0.062),which was 2.85%lower than that before the reform(exp-0.029-1).Secondary public hospitals:all indicators showed an upward trend before the reform,Among them,the total income(P=0.065),the total number of visits(P=0.039),the number of on-the-job employees(P=0.099)and the actual beds(P=0.095)were statistically significant;after the reform,the number of on-the-job employees and total expenses showed an upward trend,and other indicators showed a downward trend.The total income(P=0.059),the total number of visits(P=0.036)and the actual beds showed a significant difference before and after the reform(P=0.087),which decreased by 11.49%(exp-0.122-1),17.3%(exp-0.19-1)and 13.76%(exp-0.148-1)respectively after the reform.Conclusion and suggestionsAccording to the analysis of the operation status and efficiency change trend of public hospitals in Weihai City,it was found that:The scale of public hospitals in Weihai generally showed an expanding trend,with increased input and output.The linear ratio efficiency index showed that the operation efficiency of the public hospital was improved and the burden of patients’ medical expenses was reduced.The results of DEA analysis showed that the DEA effective rate of tertiary hospitals decreased by 22.22 percentage points,the comprehensive efficiency decreased by 15%,and the average change value of total factor productivity was 0.969;The DEA effective rate of secondary hospitals remained unchanged,the comprehensive efficiency increased by 15%,and the average change value of total factor productivity was 0.992.Technological development was the main reason restricting the improvement of operation efficiency of public hospitals.ITS analysis results showed that with the deepening of public hospital reform,the expansion speed of public hospital scale gradually slowed down,there was still a gap in revenue and expenditure level,and the medical service workload had increased,but the service workload of secondary public hospitals had decreased.The following suggestions were put forward according to the research results and discussions,combined with the relevant policies of the comprehensive reform of public hospitals in Weihai.For public hospitals:(1)Strengthen connotation construction and promote the high-quality development of public hospitals;(2)Optimize the allocation of human resources and activate the new driving force for the development of public hospitals;(3)Strengthen the internal mechanism reform of public hospitals and improve their new development efficiency.For tertiary public hospitals:(1)To meet the clinical needs of major diseases and promote the improvement of diagnosis and treatment ability and level with the development of specialties;(2)Facing the major needs in the field of medicine and health,promote the innovation and development of original disease diagnosis and treatment technology;(3)Promote the construction of a "Trinity"of smart hospitals with electronic medical records,intelligent services and intelligent management and the standardization of hospital information.For secondary public hospitals:(1)Comprehensively promote the construction of county medical community and give play to the leading role of secondary public hospitals;(2)Accelerate the construction of hierarchical diagnosis and treatment system and improve the utilization efficiency of medical resources in secondary public hospitals;(3)Control the development scale,reasonably allocate financial personnel,and encourage the transformation of small-scale secondary public hospitals. |
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