A Comparative Study On The Efficiency Of Public And Private Hospitals In Xiamen Based On DEA-Tobit Model

ObjectiveWith the advancement of the medical and health system reform and the introduction of various related policies,the state has put forward higher requirements for the rational allocation of existing medical and health resources and the effective improvement of the efficiency of medical and health service institutions.How to accurately evaluate hospital efficiency and find out the influencing factors of hospital efficiency is an urgent problem to be solved.This study takes Xiamen tertiary hospital as an example to analyze the efficiency of public and private ownership hospitals,analyze the influencing factors of hospital efficiency and the differences between different ownership hospitals,and provide decision-making basis for the formulation of hospital reform related policies.MethodsCollecting health statistics and financial data of 13 tertiary hospitals(including 12 tertiary public hospitals and 1 tertiary private hospital)in Xiamen from 2015 to 2017;using descriptive analysis to describe the hospital's input,output and financial status Analyze the current situation of resource allocation in sample hospitals;use the BCC model,CCR model and Malmquist index model in the data envelopment analysis method(DEA)to study the overall efficiency and efficiency of the hospital;use SWOT analysis for public and private hospitals The analysis of the opportunities and risks,advantages and disadvantages in the internal and external environment,and the analysis of the financial operation status of Chang Gung Memorial Hospital by DuPont analysis and comparison with the results of public hospitals;the hospital efficiency value obtained by DEA analysis as the dependent variable,The indicators of diagnosis and treatment,average hospitalization days,number of open beds and total number of employees were independent variables.The Tobit regression method was used to analyze the factors affecting hospital efficiency,and the correlation between external environment and internal organizational variables and hospital efficiency was discussed.Resu tsThe analysis of the resource allocation of Xiamen hospitals found that the average number of open beds,average number of employees and total expenditures of the 13 hospitals in 2015-2017 was on the rise,and the growth of total expenditure was the most significant(up 23.51%).In terms of output,the sample hospital also showed a trend of increasing year by year in three years.Among them,the number of emergency visits was small,and the total income rose most significantly(up 22.77%).In terms of efficiency,the average efficiency of public hospitals in three years was average.The overall level is 0.969,0.975,0.961,but the scale efficiency and pure technical efficiency of some hospitals are still low.The minimum scale efficiency and pure technical efficiency are 0.894 and 0.871 respectively.The comprehensive efficiency values of private hospitals for three years are respectively 0.945;1.000,0.934,there are certain fluctuations;SWOT analysis shows that the main advantages of public hospitals are financial support,policy inclination and their own good historical accumulation.The disadvantages are mainly reflected in the unclear property rights,weak competition awareness and high cost;The advantages of private hospitals are mainly concentrated in the management system and operating power In terms of footwork,the imperfection of policies and the lack of talents are its main disadvantages and threats.In the financial management level,Chang Gung Memorial Hospital's net assets return rate,total return on assets and business return rate all increased during the three years,showing good results.The development momentum,but compared with public hospitals,Chang Gung Hospital is lower than the average level of return on equity and return on total assets of public hospitals in terms of return on net assets(4.93%)and return on total assets(3.24%).The results of Tobit regression analysis showed that the number of patients treated and the number of open beds had a significant positive effect on hospital efficiency.The average hospitalization days and the total number of employees had an inhibitory effect on hospital efficiency.ConclusionThe overall efficiency level of Xiamen hospitals is relatively high,but some hospitals still have problems of excessive scale expansion and insufficient output.There is a certain room for improvement in terms of technical efficiency and scale efficiency.The overall efficiency of public hospitals is higher than that of private hospitals.Hospital efficiency is at a medium-to-high level in all hospitals;private hospitals face development opportunities in the new era,and also show a rapid development trend,but still face challenges and threats from all aspects;Chang Gung Hospital has a good operating level and always maintains With a steady upward trend,and the return on net assets is rising year by year,it shows good financial management ability,but it is still insufficient compared with public hospitals;hospital efficiency has a significant correlation with hospital input-output indicators,and hospitals are expanding in scale.At the same time,strengthening its own management and improving its technical level can improve the overall efficiency of the hospital.It is recommended that public hospitals strengthen their technical level while expanding their own scale and strengthen their medical services.Private hospitals should pay attention to the heterogeneous competition with public hospitals while developing their own specialties and services.