| Objective: Analyze the operational efficiency of county-level public general hospitals in the pilot area of Xinjiang compact county medical community and its influencing factors,and analyze the changes in the operational efficiency of the hospitals before and after the implementation of the compact county medical community reform through the pre-and post-control and parallel control of the pilot hospitals.It aims to timely summarize the implementation results of the compact county medical community in Xinjiang pilot areas and provide strategic suggestions for further implementation of the policy.Methods:Research group: 15 county-level public general hospitals in pilot counties were selected as the research group,and 8 county-level public general hospitals without compact county medical community were selected as the parallel control group according to economic level,hospital scale,geographical location and other factors.According to previous research and data availability,the number of employees in the hospital,fixed assets,and the actual total number of open beds are used as the evaluation indicators of operational efficiency.Analysis method: Excel is used for data pre-processing,and SPSS22.0 is used for index screening of alternative indicators;The three-stage DEA model and Malmquist index model are used to analyze the changes in the operational efficiency of 15 hospitals before and after the pilot of the compact county medical community through DEAP2.1 and Frontier4.1 software,and compared with 8 hospitals;The Tobit model is used to analyze the factors affecting the hospital operational efficiency by Stata16.0 software.Results:Comparison before and after the pilot hospital:(1)Compared with that before the pilot,the number of hospital diagnosis and treatment services after the pilot increased by 12.40%,the number of hospitals carrying out Internet services increased to 13,the number of service personnel reached 28072,and the number of discharged patients transferred to primary medical and health institutions increased by 90.23%compared with 2016.(2)The results of hospital operational efficiency(comprehensive efficiency,pure technical efficiency,scale efficiency)in the first stage and the third stage have no statistical difference(P=0.925,P=0.191,P=0.056).The mean value of DEA has increased first and then decreased,and the change node is in 2019.After the implementation of the policy,the hospital operational efficiency has decreased from 0.901 to 0.890.(3)DEA results showed that there was no statistical difference in hospital efficiency before and after the trial(P=0.137,P=0.059,P=0.361).(4)Malmquist index model found that the difference between pure technical efficiency change index and efficiency change index was not statistically significant(P=0.364),and pure technical efficiency was the main reason of efficiency change.Compared with parallel control: there was no statistically significant difference in the average comprehensive efficiency,pure technical efficiency and scale efficiency between the pilot hospital and the control hospital(P=0.364,P=0.391,P=0.141);After the implementation of the policy,the comprehensive efficiency,pure technical efficiency and scale efficiency of the pilot hospitals were reduced by 3.79%,3.11% and 0.86% respectively,excluding the impact of environmental factors and random errors.Analysis results of factors affecting operational efficiency: Tobit regression analysis found that the fixed assets and total income of internal factors and the year-end population and government health expenditure of external factors at the level of α =0.05 has passed the statistical test,which jointly affects the hospital operational efficiency.Among the policy factors,only the fiscal subsidy income has an impact on the scale efficiency(P=0.029).Conclusion:(1)After the implementation of the policy,the number of hospital diagnosis and treatment services has been significantly improved,and the number of hospitals carrying out Internet services has increased significantly,effectively improving the number of online diagnosis and treatment services and two-way referral,and the implementation of the policy has achieved initial results;(2)After the implementation of the policy,the operating efficiency of the hospital has been significantly reduced,and the change in pure technical efficiency is the main reason for the change in comprehensive efficiency.Pilot hospitals should take relevant measures to improve technical efficiency;(3)Pilot hospitals should control the scale of hospital fixed assets,improve hospital revenue and improve hospital operational efficiency;(4)Government health expenditure is the key factor to improve hospital operational efficiency.The government should continue to increase health investment. |
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