| In recent years, a large number of literatures presented in theory horizon which investigated production effects in manufacturing, agricultural, commercial and other industries from a perspective of production efficiency, which makes the study on economic operating quality and effectiveness during China's reform be an enduring topic in the theoretical circle. On the basis of study on production efficiency from manufacturing, agricultural, commercial and other industries, many scholars began studying on production efficiency in medical services. With deepening research on production efficiency of medical services, we gradually realized that "the production efficiency of medical services" is a concept different from the traditional production efficiency. However, it is often difficult to get rid of the traditional way of thinking to production efficiency when we try to define, measure, evaluate or improve the production efficiency of medical services, and always consciously or unconsciously attempt to understand production efficiency of medical services with way to traditional production efficiency. Therefore, in practice, the concept of production efficiency of medical services is often used roughly, and thus it is often measured and evaluated inappropriately.All of these questions have proposed a lot of problems. For example, how the qualities of medical services affect production efficiency of medical services? What are determinants of inputs and output of production efficiency of medical services? What kind of effects does the heterogeneity of medical service output have on production efficiency of medical services? How could input factors be turned into output factors of production efficiency of medical services? And so on. All these issues require us to redefine production efficiency of medical services at a conceptual level, and make a detailed analysis on the effects of medical service inputs, output and quality on production efficiency of medical services on the base of it. Therefore, the purpose of this study is to redefine the concept production efficiency of medical services, and measure and evaluate China's regional production efficiency of medical services on this base, and then put forward to effective measures to improve production efficiency of medical services.Firstly, the article analyzes and elaborates non-applicability of the traditional concept of production efficiency to production efficiency of medical services in details. The characteristics of medical services and the production process determine the traditional concept of production efficiency has not been suitable to production efficiency of medical services, so that it can not describe production efficiency of medical services completely and accurately. Reasons are as follow:(1) there is a basic assumption in the traditional definition of production efficiency, that is the traditional production efficiency was established in a closed system, and would not affected by any external factors. However, obviously patients can not be excluded from the closed system during the production process of medical services. Therefore, it is clearly improper to define production efficiency of medical services as an input-and-output function in a closed system.(2) the traditional view that defines and measures the output of general material goods purely by quantity could not fully reflect the quality of the output level in medical services. Moreover, because of the characteristics of medical services, it is clearly not enough to explain the quality of medical services with the traditional quality point of view.(3) due to synchrony and non-storage nature of production and consumption of medical services, medical services could not be pre-manufactured and stored for sale, which determines it is not sufficient to measure the level of production efficiency only by achieved output while evaluating production efficiency of medical services, utilization of medical services should also be one of the elements of production efficiency of medical services.It could be seen that the traditional production efficiency can not meet the basic requirements of medical service industry, and it is imperative to define the production efficiency of medical services from a brand-new perspective.Secondly, it proposes a brand-new concept of production efficiency of medical services, and makes a detailed analysis on factors of the production efficiency of medical services.In view of above reasons, the author defines production efficiency of medical service as "A measurement to efficiency of production, utilization of medical resources and quality of medical services patients perceived in this medical service institution acquired by calculating the ratio of the economic value of output to the economic value of input that produces this output within a production cycle in a specific country or region".This concept includes several aspects of the production efficiency of medical services, that is input and output of medical services, and external factor affecting the production efficiency of medical'services, i.e. quality of medical services.Input resource from medical institutions is the basis for existence of production efficiency of medical services, which is divided into two categories:input from medical institutions and input from patients. Factors of production in medical institutions is similar to input factors of traditional manufacturing, and its effect on production efficiency of medical service is similar to that on traditional manufacturing, the impact is also similar to the traditional manufacturing. Factors of production invested by patients during the producing process of medical services could be both tangible and intangible. It is noteworthy that, different from traditional manufacturing, patients do not just a source of demand for medical services in the field of medical services, but an important source of inputs to medical services. By expressing their demand for medical services, patients provide partial inputs during the production process of medical services.According to target involved in the production process of medical services and its contribution to the output of medical services, medical services can be divided into service output from medical institutions and service output from patients. The characteristics of medical services determine output elements of production efficiency of medical services are different from that of the traditional production efficiency (the output elements of traditional production efficiency include only the final product so that customer behavior outside the closed system will not affect production efficiency). Therefore, when defining output of medical services, it is not sufficient that final result of production is included only, quality of output could be included as well in the definition of medical services, including the production of the final result just is not enough, and quality of output of medical services will make significant impact on production efficiency.The author believes that patients'experience to the quality of medical services during the production process of medical services is an important factor to measure output of medical services. Thus the paper utilizes patients' evaluation to the quality of medical services to adjust the output of medical services. Meanwhile, in order to reflect the impact of patient's perception on the quality of medical services, the paper constructs a new model of customer satisfaction index for China's medical service, uses questionnaires, applies to the model of dealing with double-cross-section data by resistance analysis to estimate customers satisfaction index for China's regional medical services, and includes customer satisfaction index into adjustment indicators of medical service outputs for the first time.Thirdly, based on the concept of production efficiency of medical services, the paper designs evaluation methods and evaluation index system of production efficiency of medical services.At present, the common method to measure production efficiency of medical services is the production frontier analysis. The production frontier analysis is divided into parametric method and non-parametric method according to whether the specific form of production function are known or not; the former is represented with Stochastic Frontier Analysis (SFA for short), the latter is represented with Data Envelope Analysis (DEA for short). Chinese scholars have applied two methods widely in many fields, but a lot of practices also showed that both methods had their advantages and inherent limitations. So it could not simply evaluate which method is better and should judge according to specific issues and actual measurement results. Therefore, the major problem confronted with currently is how to use two methods properly and reasonably. In response to above problems, the article adopts these two methods to measure production efficiency of regional medical services, and conducts combining research to measured results on the base of statistical tests with expectation of maximizing the advantages of both methods and overcoming their inherent limitations as for as possible.In view that the production efficiency of medical services is defined as the ratio of inputs and outputs in this paper, and output elements cover both quantitative and qualitative factors, therefore measurement of the production efficiency of medical services is actually a indicator system constituted by a series of inputs, and quantitative and qualitative output indicators to reflect the status of targeted medical service. It is a systematic work to evaluate the production efficiency of regional medical services; so based on domestic and oversea constructing practices of the indicator system that measures the production efficiency of medical services, following to scientific, measurable and comparable principles, adopting scientific methods, the article designs an indicator system from perspective of hospitals and patients to measure the production efficiency of medical services, which including either hospital inputs, outputs and patients' inputs, outputs, and conforming to china's actual conditions.in full of domestic and foreign medical care productivity measurement index system based on, follow the and use of scientific approach, and patients from the hospital a different approach to the incorporates both the inputs, outputs, but also on patient input, output, consistent with the facts of China's medical service productivity measurement index system.Then, applying to data envelopment analysis and stochastic frontier analysis, the paper measures the production efficiency of regional medical services in China. Using sample pairing of T test and Spearman correlation test, the paper makes a comparative analysis on results of two methods, gets the following conclusions:Firstly, because of regional fundament differences among the economic development level and the basis of medical services, it leads larger differences in medical resources investment that affects the quality and quantity of output in regional medical service to a large extent, and further influences the production efficiency of regional medical services.Secondly, the values of integrated efficiency in regional medical services are not high, especially in Beijing, Shanghai, Zhejiang and other developed regions whose values of integrated efficiency in medical services are much lower than the national average. This result shows that, with the existing output scale of medical services, there are lots of redundancy in medical resources investment in those developed regions on the one hand, it also reflects the allocation of medical resources in these areas is inefficient on the other hand.Thirdly, the reason for relative lower overall efficiency in regional medical services is not because scale efficiency of medical services is low, but technical efficiency of medical services is low. Fourthly, the value of technical efficiency in medical services in the central, eastern and western regions are relatively close. The results show that the gap of technical efficiency in medical services in the central, eastern and western regions is gradually narrowing.Fifthly, comparing with the eastern and western regions, although the lack situation of medical resources investment in the central region is a more prominent, the average level of integrated production efficiency, technical efficiency and scale effects of medical services is higher than those in the eastern and western regions.Sixth, there are diseconomies of scale in medical services production in most regions, medical services production in most regions are in a state of diminishing returns to scale.Seventhly, there is a big regional difference to the allocation of the total cost of medical expenditures. Finally, the author proposes effective measures to enhance the production efficiency of regional medical services:1. to strengthen the supply functions of government; 2. to strengthen the regulatory functions of government; 3. to allocate medical resources rationally; 4. to bring a positive role of market mechanism into play; 5. to strengthen other supporting reforms.
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