| Interior efficiency of health systems that if additional health spending will be able to produce more and better health outcomes is an important issue for global health policy researchers. From an international point of view, in twentieth Century 80, the developed countries such as Britain and America have been carried out health re-form in health system to solve the problem of the waste of resources, lack of resources and low efficiency, to improve the efficiency and quality of the interior of the health system. In our country, county hospital and township health center are the leading and link of China’s three rural health service network, which has been the focus of reform. In 2009, with the introduction of new medical reform program, rural health has be-come the breach of reform which is related to the whole medical outcome. It has been three years since the new medical reform started, giving a lot of concern to the rural health, such as increasing the investment, improving the health service system, mak-ing the system of cooperative medical care perfect, giving more rural doctors training. By doing these the overall condition of rural health has been significantly improved than before. From the rural medical institutions in terms of their own, we are very concerned about if the current input has been converted into effective output, and bet-ter than before (2009). Ningxia is located in the west of China, Hui community and economic backwardness, the government has taken some policies to improve the effi-ciency of basic medical institutions, such as reform on hospitals owned by the gov-ernment in 2009 and basic medical institutions in 2010. In this context, whether the efficiency of the medical institutions of county and township level has raised than beore? This is the fundamental question we are going to answer.We are going to take the new medical reform (2009) as a time point and meas-uring the technical efficiency of medical institutions of County and township from 2000-2012 in Ningxia, and comparing the change before and after the new medical reform. The objectives are to build the efficiency evaluation model of Ningxia county and township medical institutions; make trend analysis of Ningxia rural health re-source before and after the new medical reform; measure the technical efficiency and find influence factors of two level of medical institutions in the rural district,finally we weill give recommendations of optimal allocation of health resources.Objects and Data resourceObjects:county.we are taking all the 14 county hospitals of Ningxia into re search, mainly including the county (city, district general) hospitals, mainly are the county people’s hospital. Because the measuring range is from 2000 to 2012, the time span is wide, and the change of administrative districts and such events is obvious, in order to ensure data integrity and consistency, we choose the existing county hospitals as sample according to the 2012 statistics, and merge or delete some earlier data. On the other hand, Ningxia area is mainly divided into plain area and the southern moun-tain area, the plain area’s economic and living conditions are good; while the south-ern mountains are poor in many ways. So the hospitals were classified into plain area and mountain area county hospitals. Hui nong District People’s Hospital, Pingluo People’s Hospital and other 5 hospitals belong to the plain region county hospitals; the southern mountainous county hospital including 7 county hospitals such as Xiji County People’s Hospital etc. according to geographical location.Township: there are 188 township hospital which the data is complete and match the needs of efficiency calculation. we make sampling from the existing DMUs from 2007 to 2012 and extraction principle is able to cover the Ningxia County mu-nicipalities (District). We make further division into the ordinary township hospitals and health center of township hospitals and extract one ordinary township hospital and one health center of township hospitals from one county, totally 37 township hos-pitals (because there is no health center of townshiop hospital in Hongsibu District)Data resource Collecting all the input and output dates including health work-ers,health resources,health capital and health outcomes from<Ningxia 2000-2006 health statistics material in paper edition and 2007-2012Health information reporting system in electronic edition. For the missing dates,taking the spot investigation method to supplement the data and interviewing the related people about some ques-tions like the change of medical institutions after the new medical reform, and the in-fluence factors of the efficiency etc.MethodsEnter all the data into excel form, after logical inspection, pre-treate the index includ-ing turning the undesirable variables into desirable variables using reciprocal method and standardizing all the dates. By some softwares such as spss18.0, DEAP2.1, MAXDEA, STATA(12) to realize the data description and efficiency calculation. By some statistical methods such as correlation analysis, principal component analysis to establish the index system. By DEA module such as DEA-CCR, DEA-BCC to calcu-late the efficiency score, super DEA to rank the DUMS and by DEA-malmquist and DEA-tobit to find the influence factors, finally by the curve estimation to explore the appropriate scale of Ningxia county hospitals.Main results and findings1.The total health expenditure is rising in recent years, especially the local fiscal health expenditure which growth rate is more slow than before. The chain speed growth after 2009 is faster than that before the new medical reform. The health ex-penditure has an increase of 9 times from 2000, the chain grow rate after 2009 is 17.93 which is faster than 12.74 before the new medical reform. And for the local fiscal health expenditure, the chain growth rate is 0.27 lower than0.36 before the new medical reform, which suggests the growth rate slows down since 2009.2.Although the health conditions and health outcomes of Ningxia two-level basic medical institutions is increasing after the new medical reform in quantity and growth rate,the shortage of health human resource is still grim. In all of the health resource, health manpower grow slowly most, through investigation, we find that the current number of health manpower resources can not meet the development of two level medical institutions.3.The overall technical efficiency declined after the new medical reform, and the pure efficiency improved. While the conditions of effectiveness of DEA have no improvements even lower than some year before the new medical reform, which is mainly caused by the un-scale economy and the slowdown of technique pro-gress. It is found that the technical efficiency has declined about 5 percent, and the pure technical efficiency has arisen about 1.9 percent. Studying the effectiveness of DEA, the non DEA efficient DUM is much more, the efficiency value of only 50-57% DMU is more than 1. The level is less than some year before the new medical reform such as 2001,2002,2004 and 2006. The overall technical efficiency has two aspects including pure efficiency and scale efficiency. We have known the pure technical effi-ciency is improving, while the scale efficiency is 0.905 which is lower than 0.914 be-fore the new medical reform, and the scale efficiency of plain area is much worse than the whole and mountain area which is only 0.885. By DEA-malmquist analyze, the TPF of Ningxia county hospitals is 0.60 lower than 0.93 before the new medical re-form.4.The better beds size is 120-220 for the Ningxia county hospital. Take the number of actual open beds as the scale of Ningxia Conty hospitals, the relationship of this two indexes is three cubed function:Y=-3.123*10-8*X3+0.07*X+0.422. If the actual open beds is valid, when the number of actual beds is in [60,120],it is mono-tone increasing function,the scale efficiency score is growing with the increase of the actual open beds;when the number of actual beds is in [120,220],the scale efficiency score is in highest level;when the number of actual beds is in [220,420], the scale ef-ficiency score is decreasing. So the most appropriate number of actual open beds is 120-220.5.The overall technical efficiency of the new medical reform in Ningxia township hospitals increased slightly, but the efficiency is still in low level,which has the very big promotion space. The efficiency in public health is lower than that in basic medical service. By DEA-tobit analyze, the scale of township hospitals, the ratio of NCMS, the density of population, the ratio of average finance and the invest from the government will influence the efficiency of township hospitals. The average technical efficiency before the new medical reform is 0.48 less than 0.569 after 2009, the utility of resource in Ningxia township hospitals needs to be im-proved. The efficiency in public health service of Ningxia township hospitals is lower than which in the medical service. By the two stage module of DEA, we can calculate the efficiency of basic medical service and public health service. It turns out that pub-lic health service efficiency is obviously lower than the medical service efficiency, which is only 0.5-0.6. we take the efficiency score as the dependant variable, the scale of township hospital and other factors as the independent variables, we find the out-side influence factors are the scale of township hospital, the ratio of NCMS, the den-sity of population, the ratio of average finance and the invest from the government.6.Since 2008, the return of scale of the local fiscal expenditure in Ningxia is in the declining state, the continuous investment did not bring the corresponding reve-nue. From 2007-2012, the scale efficiency of the local fiscal expenditure in township hospitals is less than 1 in six consecutive years. The return of scale is declining con-tinuously since 2008, which means the continuous investment did not bring the cor-responding revenue. The government should adjust the structure and orientation of investment.SuggestionsFocus on the problems of operational efficiency in Ningxia two level basic hos-pitals such as the low efficiency level, scale un-aspirate, the lower efficiency in the public health service and the fiscal expenditure, giving the below suggestions:1. promote the utility of resource of Ningxia two level basic medical institutions;2. control the scale of Ningxia county hospitals;3. enhance the incentives and compensations measures;4. Continue to increase government investment on health, when reflect the health welfare, pay attention to government investment structure and direction. |
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