| ObjectivesIn light of'the Guidelines of Further Reform of Medicine and Health Care System', we should improve the function and accountability of different level hospitals, promote the reform of management system of public hospital, establish standardized operative system of public hospital and promote the efficiency, service and quality of health care system at the end of 2011. What's more, the World Health Report 2000 issued by the WHO put forward the topic of improving the performance of health care system. The promotion of hospital performance will contribute to the development of whole health care system. Currently, most of health resources concentrated in the hospitals in China, especially in the general hospitals in the city. How to allocate efficiently different health resources in the current health circumstance and reduce the waste of health resources as well as improve the hospital performance, which became the focus to both the policymaker of health department and manager of hospital. Furthermore, the current reform of health care system pay more attention to the measurement of the financial need, improvement of quality and satisfaction of patients, all these will require us to measure hospital performance.This thesis pay more attention to research 14 Classâ…¢general hospitals and 21 Classâ…¡general hospitals of Wuhan city, evaluate the allocation efficiency of health resources, service efficiency and comprehensive effectiveness of these hospitals, analyze the outcomes and finally find out the problems. Therefore this thesis will provide suggestions for the policy-makers of the hospital and health administration department.ContentFor evaluating the general hospital performance comprehensively and accurately, this research surveyed and analyzed 14 Classâ…¢general hospitals and 21 Classâ…¡general hospitals of Wuhan city. The main contents include the followings:(1) The theories of hospital performance management and the development situation of foreign and domestic hospital. The details contain the meaning of performance, performance appraisal and performance management and the differences of the later two. In addition, this thesis introduces the cases of hospital performance management about WHO, USA as well as China and soon on. (2) The basic construction situation of hospital. The details include five aspects as the situation of health service provider, the human resources of health system, the situation of hospital's bed, medical equipment and facilities of health service provider as well as the investment to hospital. (3) the evaluation of the allocation efficiency of health resources, service efficiency and comprehensive effectiveness to the Classâ…¢general hospitals and Classâ…¡general hospitals. This research use the method of Descriptive Analysis to analyze the allocation situation of human resources, finance and resources etc. to understand the supply situation of medical services of these hospitals from 2007 to 2009, then to compare the change. What's more, this thesis implement the method of DEA to evaluate generally the medical service efficiency of the traced hospitals, use the Composite Index Analysis to measure generally the traced hospitals under the angle of the efficiency of inpatient and outpatient as well as the quality of work, finally exert the TOPSIS to evaluate the medical quality of hospital under the angle of work efficiency, quality of diagnosis and treatment. (4) summarization and problem analysis of hospital development. Based on the above mentioned areas, this research analyzed the detailed policies of medical services, sum up the experience of medical services and find out the existed problems of hospital in Wuhan city in order to provide suggestions for further improvement and development of hospital. MethodsThis thesis adopts the Literature Review, Field Investigation, Focus Group Discussion to discuss with officials of health departments and researchers of hospital performance management and survey 14 Classâ…¢general hospitals and 21 Classâ…¡general hospitals of Wuhan city, then understands the work planning and policies of hospital development, as well as the current situation about the allocation of hospital's resources, quality of service and efficiency of service, analyzes the updated theory of hospital performance management, technology, methods and policies in the hospital management area of the domestic and foreign country. The detailed methods of evaluation include the following:(1) To exert the method of Descriptive Analysis to analyze the allocation situation of human resources, finance and resources. (2) To exert the method of DEA to evaluate the medical service efficiency of the traced hospitals. (3) To exert the Composite Index Analysis to measure generally the traced hospitals under the angle of the efficiency of inpatient and outpatient as well as the quality of work. (4) Finally to exert the TOPSIS to evaluate the medical quality of hospital under the angle of work efficiency, quality of diagnosis and treatment.ResultsShown in this thesis, the problems of the hospital in Wuhan city are the following: (1) The increase of medical cost exceeds the economic burden capacity of the residents. With the fast development of medical care, improvement of medical condition, update of medical technology, application of new technology and new equipment, emergence of new medicine and imported medicine and so forth, the cost of medical service increase fast as well as the aggregate medical expenditure simultaneous increase fast. The problem of high expense in getting medical care is remarkable in Wuhan city in recent years. (2) Allocation of hospital resources is not rational. Because of the economic development discrepancy in different districts, most hospitals are located in developed area. Other areas lack hospital and high level medical resources. At the end of 2008, there are 42 Classâ…¡and above general hospitals in Wuhan city, the top three in hospital numbers are Wuchang district, Jiangan district and Qingshan district. These three districts have total 23 hospitals which account for 54.77% of total 42 hospitals; however the population of the three districts only account for 27.06% of total population in Wuhan city. Comparatively, the last three district in hospital numbers are Hongshan, Xinzhou and Huangpi. They only have 6 hospitals which account for 14.28% of total 42 hospitals, but the population of them account for 36.94% of total population in Wuhan city. Hongshan district have most advanced higher education institutions and high tech-company with 965,000 people, but there are not one Classâ…¢hospital. (3) The competence differentiation between hospitals is significant remarkable. A great deal of excellent medical talents work in a few large scale hospitals, which own advanced the medical equipments and facilities. However most of middle or small scale hospital lack professionals and assets, their survival face difficulties. What's more, not only are the competence differentiation of the different class hospitals remarkable, but also the competence differentiation of even the same class hospitals are outstanding. For example, the doctor numbers of Xiehe Hospital are 3.73 times to the Hubei People's Hospital which both belong to the Classâ…¢hospital, and are 86.9 times to Hubei worker hospital of Shipment Company as the minimum one in Classâ…¡hospital. In addition, the total income of Xiehe Hospital are 19.62 times to the Tongji Hospital which both belong to the same class, and are 562.87 times to Hubei worker hospital of Shipment Company. What's more, the total income of 14 Classâ…¢hospitals is 8.58 billion RMB including 394 million RMB from the government investment. However, the income of Tongji Hospital and Xiehe Hospital from the government is 176 million RMB which account for 44.83 of total government investment. (4) The medicine distribution system exists some problems. At the end of year 2008, the ratio of medicine income to the total revenue of hospitals is higher at 46.43% among the classâ…¡hospital or above. The cost of medicine affects the total medical expense significantly. And it is an important influencing factor to the problem of high expense in getting medical care. ConclusionsBased on the above mentioned results, this thesis put forward the five following suggestions:(1) Keep the medical expense level reasonable and reduce the medical burden to people; (2) Allocate the hospital's resources rationally and implement the balanced development and establish one or two Classâ…¢hospital in Donghu High Tech Development District and Wuhan Economic Development District respectively to meet the local medical need; (3) Establish scientific and rational medicine distribution system; (4) Establish rational and effective supervision system to hospital; (5) Pay more attention to the education and training of medical human resources.Features and creative points(1) Under the direction of the multi-discipline theories as the medicine, sociology, management, economics and health statistics, exert the methods of Descriptive Analysis, DEA, the Composite Index Analysis and the TOPSIS to analyze and evaluate traced hospital performance.(2) Conduct a comprehensive, systematic, objective research about all Classâ…¡and Classâ…¢General Hospitals in Wuhan city for the first time. This research investigate the development situation of traced hospital and measure their performance, finally, put forward some found problems and its solution.The limitations and the further study suggestions(1) Due to the short time span of the database, it is difficult to compare long time data in order to better find the development features and trend.(2) Due to the limitations of original data, it failed to conduct the survey and analysis about patient responsiveness, which will be the next focus of this research.(3) Further to research the performance management of human resources. |
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