Analysis On The Economical Running And Efficiency Of 20 Central Hospitals In Shanghai From 1999 To 2009

With a dominant role in our country's health care market, public hospitals have done great contributions in meeting health demand of the people as well as promoting the welfare of the public. However, recent evidence shows that the development of public hospitals across different levels is imbalanced. Public hospitals of the third level (the highest) continues to expand their scale, by which they provide services to almost 90% of total patients; public hospitals of the first level (lowest level) are accelerating their development due to the support of national health policies; but on the contrary, health care market of the second-level hospitals are shrinking, for the unsoundness of their development strategies. Therefore, it's imperative for public hospitals of the second level to seek appropriate strategies on how to improve the efficiency of health resource allocation based their particular characteristics. As second-level hospitals are an important part of Shanghai health care system, researches on how to improve the efficiency of these hospitals are of great significance.Considering 20 second-level hospitals in Shanghai as the analysis pool, we assessed their operating efficiency and its risk factors from the year 1999 to 2009, by using both economical and statistical methods. Based on the analysis, we further discussed suggestions on how to enhance their operating efficiency, which could be considered as a reference for hospital managers as well as policy-makers to make well-informed decisions. Results show that, the average increasing rate of gross income and expenditures of these hospitals are 12.94% and 13.09%, respectively. By conducting the Data Development Analysis (DEA), we observed that the operating efficiency of these hospitals which was measured by Malmquist Index (MPI) increased from the year 2003 to 2006, but fell after 2006. Linear regression models display that the technical efficiency of these hospitals were significantly influenced by the proportion of financial subsidy accounting for the expenditure, the proportion of specialized equipment accounting for capital asserts, debt rate of assets, utilization rate of hospital beds, average workload per staff, average bed-days per patient, and the number of hospital staff. Based on above results, we carefully provide suggestions as follows: first, a number of second-level public hospitals in Shanghai should promote their debt rate of assets, utilization rate of hospital beds and average workload per staff, while reduce average bed-days per patient, given that the quality of the health care are not compromised; second, the sound management and adjustment of input resources according to the dynamic change of market are prerequisite in enhancing the operating efficiency of these hospitals; third, public hospitals in this level should clarify aims and objectives in their development, and open the market by providing services different from hospitals in other levels.