| [Purpose]The aim of this study is to explain the health service capacity and competitive advantage of county-level public hospital with the utility of dynamic capability theory(DCT).[Methods](1)Literature analysis.Using non-structural,non-quantitative literature analysis method to review the evolution of DCT,combing the development process of hospital service capacity,summed up the theoretical research and practical application results of service capabilities on health services system.Meanwhile,being acknowledge of hospital service capabilities construction experience of national and regional,sorting and analyzing its reference significance to the evaluation of health service ability of public hospitals in China.(2)Entropy weight-Comprehensive Index Evaluation.The basic conception of entropy method is according to the size of the target variability to determine the objective weight.With health service competitive advantage as the goal layer,this study determined the county-level public hospital service capability advantage development index(HSCI)including medical and health resources,health care,medical service work efficiency,the effect of diagnosis,treatment and services,such as the rule layer,with 22 entrie.Through the statistical analysis of the data of the hospital,the objective weight of the evaluation index was calculated by using the entropy method,and the comprehensive index method was used to calculate the integrated value,the evaluation index of health service capacity of the county-level public was established and summarized.(3)Propensity Score Matching-Difference in Difference analysis(PSM-DID analysis).In quasi-experimental study,PSM was used to determine the matching situation of public hospital in the control group and experimental group.Based on this,the paper used DID method to analyze the impact of the role of environment and the influence of reform policy on the construction of hospital health service capacity during the public hospital reform.(4)Dynamic panel data(DPD)analysis.The current data of 1100 county general public hospital health service capacity which consisted of 7 year data,originating from one of CMB founded program(CMB-OC 15-223),could set as DPD using panel data analysis to explore the relationship between investment from government/hospital and the development of competitive advantage and capacity of health service of general public hospitals in county-level,and the full reflection of government behavior and hospital behavior in medical capability improvement.(5)Data Envelopment-Malmquist index Analysis.Using data envelopment analysis(DEA)and Malmquist index together to evaluate the efficiency of resources utilization of 12 county-level public general hospital.In this paper,the development of resource utilization and the main influencing factors were analyzed with the combination of static analysis and dynamic measurement.[Results](1)Build the theoretical framework and conceptual model of hospital health service capacity based on DCTUsing the method of literature analysis,learning from the related research in DCT,the study was based on the correlation analysis of the relationship between capacity construction and competitive advantage of public hospital health service,which was the main manifestation of hospital health service capacity defined as a dynamic competitive advantage.The competitive advantage is decomposed into business capabilities(medical service capability)and resource utilization capability.The DCT developing model of health service capacity at the county level public hospital was built based on the definition of dynamic capability,which was illustrated into three dimensions and four key linking path.(2)Empirical study of service capability advantage at county-level general public hospital ,100 county-level general public hospitals in China were analyzed?Reform before the sample hospitals scored an average of 106.96 points,scored an average of 108.77 points after the reform,there is significant difference(t=-4.17,P<0.01),and in the medical and health resources,medical work,medical service efficiency,therapeutic effect and security of the ability of the five dimensions advantage significantly increased(p<0.01).Central medical service ability raise the eastern region and western region is obviously better than the advantage(t=-2.76,p<0.01)The experimental results show that the capacity improvement of health services is less sensitive to the policy environment at a significant level of 10%.However,government investment and hospital management have a certain influence on the cultivation of hospital medical service competitive advantage,and the influence of government behavior is greater than that of hospital??1=9.50,?2=4.33),and more important than the effect of time(?=0.85).(3)Empirical Study on the advantages of utilization of health service resources at the county-level general public hospital Hospital staff,beds and assets were selected as input indicators,while inpatient and outpatient numbers were presented output indicators of health service.It is found that there are different degree of resources wasting and insufficient output phenomenon with the empirical study in 12 sample hospital in Three Gorges city group,and the general level of hospital is not effective(crstey1 = 0.90,crstey2 = 0.82,crstey3 = 0.83,crstCy4 =0.93,crstCy5 = 0.92).But the redundancy on the capital investment and hospital expansion were gradually reduced.Hospitals achieved DEA effective(E=1)increased from 4 to 6.Dynamic analysis found that the utilization of resources in the sample hospitals was not optimistic and there was a slight downward trend(M = 0.98).Although the Efficiency change(effch) improved 1.7%,the Pure efficiency change(pech) increased by 1%,the scale efficiency change(sech)increased by 0.6%,but the total factor productivity decreased due o the 3.8% decline in the technical change(tech).(4)Analysis on the development of health service dynamic capacity of county-level general public hospitals Through the conjoint analysis of the advantages of medical service capability and the advantage of resource utilization,it is found that the county public general hospitals are only focused on one of the advantages of service delivery and resource utilization.The imbalance of development leads to the competitive advantage of the hospital being not obviously or offset.At the same time,the core stakeholders,namely,hospital managers,medical staff and patients and their families were interviewed.In the typical case analysis,it is found that there are problems in the management system construction,personnel training and innovation capability of the hospital in the general public hospitals.It is necessary to further strengthen the management system oriented by patient.Meanwhile,with the development of innovation mechanism,to stimulate the vitality of the hospital,cultivate competitive advantage,it would enhance the dynamic capacity of health services of hospitals.(5)Develop and use the experience scale to the patientOn the basis of the actual situation of the development of health service capacity of county-level hospitals,the Picker Patient Experience Scale(PPE-15)was selected to evaluate the patients' experience of county-level public hospital to understand the whole process and problems during the visit of patients in hospital.A total of 440 questionnaires were distributed,including 427 valid questionnaires(effective recovery rate of 97.05%).Questionnaire reliability validity test results(Cronbach's a = 0.82,KMO = 0.77)showed good internal consistency and structural validity.The mean of patient experience evaluation of 15 indicators total score was 40.15,the score of outpatients was 40.03,while inpatients was 40.21.The average score for possibility of patients with health demand visiting again was 3.35,which the outpatient was 3.34,and inpatient was 3.35.In the six main dimensions,the score of the physiologic comfort dimension was the highest,while the patient preference respect dimension was the lowest.At the same time,there was a strong correlation between the patient preference respect dimension and the overall satisfaction of the patient's treatment experience.[Conclusions]The comprehensive reform of public hospitals will help to improve the health service capacity of public hospitals at county-level and improve the quality of health services.However,the reform efforts still need to be strengthened.Hospital should continue to strengthen the competitive advantage of health service in the process of reform to meet the health needs of county residents,finally achieving the reform goal that "Serious illness is not the county".The main conclusions of this study are as follows:(1)The health service capacity of the county-level public hospitals has improved during the New Health Reform,but it is not directly affected by the reform policy,especially the health service capacity of general public hospital was not sensitive to the reform policy.(2)There was a significant difference existed between the pilot hospitals and control group on the health service capabilities,where pilot hospitals was in a disadvantage position,showing that the pilot hospital is a weak pot of health service delivery system at county-level,should strengthen the hospital health services capacity.(3)Hospital still has different kinds of resources waste and insufficient output phenomenon,but the wasting phenomenon has been clearly controlled.Due to the lack of innovation capability of county-level public hospitals,tech of hospitals decreased greatly,which led to the prevalence of effch and the total factor production efficiency of general public hospitals.The situation of hospital resource utilization was not optimistic.(4)As the core dimension of the dynamic capabilities of hospital health services,the managers and staff of the county-level public hospitals should pay equal attention to both health service capabilities and utilization capabilities of health service resources.Therefore,as in different operation and development process,hospitals must keep clear value orientation,to ensure the value to meet the requirements of the reform of public hospitals..[Innovation and deficiency](1)innovationBased on the theory of dynamic capacity,a dynamic model of the development of medical service capacity has been constructed,which is in line with the requirements of the development of county-level public hospital.Based on the empirical study of the use of experimental research,this paper analyzes the competitive advantage of health service in county public hospitals by PSM-DID,DPD and DEA-Malmquist index analysis.And put forward of the optimization strategy for the public hospital reform,county public general hospital capacity development and competitive advantage to provide a reference basis.(2)deficienciesIn the follow-up study,we should gradually strengthen the accuracy and systematicness of data collection in the process of information system construction,and make a further analysis on the development dimension and the main influencing factors of health service dynamic capabilities. |
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