Study On Efficiency Evaluation And Influencing Factors Of Township Health Centers Under The Model Of County Medical Community

[Purpose]This study aims to quantitatively analyze the impact of county medical community construction on the function of primary health care institutions from the perspective of efficiency evaluation,and analyze the influencing factors of the efficiency of township health centers under the new medical service mode,in order to promote the construction of county medical community,and provide an empirical basis for achieving the goals and improving the service capabilities of primary health care institutions.[Methods]The data of this study are from 2010-2017 Township Health Center health statistics report 1-2,"Institutional Supplementary Questionnaire","Hubei Statistical Yearbook","Henan Statistical Yearbook" and field research and key informant interviews.In this study,a total of 37 township hospitals in 8 county medical community units were studied.Firstly,through literature selection,expert consultation and statistical analysis methods,the efficiency evaluation index system of township hospitals under the medical community model was determined.The Bootstrap-DEA and Bootstrap-Malmquist method measure the static efficiency value and dynamic efficiency of township hospitals in 2010-2017,and explains the reasons for the changes.Then,through literature reading,key informant interviews and expert consultation,the efficiency of township hospitals under the medical community model is determined.Internal and external factors,the random effect panel Tobit regression model is used to analyze the influence degree and direction of each factor.[Results](1)During 2010-2017,the average annual growth rate of personnel input,bed investment,and equipment input of sample township hospitals was 3.38%,6.27%,and 11.00%,respectively;The average annual growth rate of the number of patients in total,the number of discharged patients,and children aged 0-6 five outputs,the number of vaccinations in the national immunization program,the number of maternal health management at the end of the year,and the number of health management personnel aged over 65 at the end of the year were 7.63%,16.95%,-5.59%,5.09%,and 11.22%,respectively;The overall bed resource utilization rate of the sample township hospitals was less than 70%,and the average hospital stay was maintained between 7-8 days.(2)The average technical efficiency of sample township hospitals in 2010-2017 was calculated by Bootstrap-DEA method to be 0.5685,0.5775,0.6133,0.6234,0.6187,0.6273,0.6078,0.5838,respectively.The overall efficiency level was low,and showed the trend of weak decline after the growth.The pure technical efficiency of the same period showed a significant downward trend(0.7104,0.6861,0.6863,0.6807,0.6868,0.6783,0.6443,0.6113 in each year),and the scale efficiency increased year by year(0.8327,0.8907,0.9137,0.9320,0.9216,0.9342,0.9340,0.9160 in each year).The nonparametric test results show that the efficiency value after Bootstrap correction is significantly lower than the original efficiency of traditional DEA measurement(p<0.05).(3)Samples of township hospitals using the Bootstrap-Malmquist method have experienced continuous improvement in total factor productivity in 2010-2017(10.0%,1.6%,6.0%,1.7% year-on-year growth in 2010-2014)and deteriorating(In 2014-2017,it decreased by 5.5%,3.1%,and 8.2% year by year),but the overall improvement is still relatively good(over 20.5% in 2010-2017),and the technological progress is the main reason for the improvement of total factor productivity.(4)Analysis of the factors affecting the efficiency of township hospitals shows that under the significant level of 0.05,the significant influencing factors of technical efficiency of township hospitals are government financial subsidies(negative),the total number of key populations in the jurisdiction(positive),and bed use rate(positive)and number of undergraduate and above(negative);factors affecting pure technical efficiency include government financial subsidies(negative),time required to drive to the core hospital(positive),bed use rate(positive)And the number of undergraduate and above(negative);the factors affecting scale efficiency are per GDP(positive),whether to join the medical community(positive),and bed use rate(positive).[Conclusions](1)In 2010-2017,the sample medical resources input and health service output of township hospitals have increased to varying degrees.The township hospitals under the county medical community model maintained a stable development trend,but there are still problems of insufficient resource utilization.(2)From the perspective of static efficiency,the low technical efficiency of sample township hospitals is the main reason for the low overall technical efficiency level,suggesting that it is necessary to pay attention to the organization and management of township hospitals and the improvement of technical level;from the perspective of dynamic efficiency,2010-2017,the sample total productivity of township hospitals has improved,mainly due to the changes in technological progress,suggesting that the internal management level of institutions is lagging behind the speed of technological innovation,which is not conducive to the sustainable development of township hospitals.(3)From the perspective of influencing factors,the addition of medical community construction can significantly increase the scale efficiency obtained by the expansion of township hospitals,but the impact on technical efficiency and pure technical efficiency is not obvious.Increasing bed use rate can significantly improve technical efficiency,pure technical efficiency and scale efficiency of township hospitals.There is a need to strengthen the role of general practitioners,undergraduates and above in the provision of health services in township health centers.Economic growth can improve the scale efficiency of township hospitals.Government financial subsidies have not effectively promoted the transformation process of input and output due to the lack of objective needs assessment.It is consistent with the service function of township hospitals in the medical community,the increase of the total number of key populations in the jurisdiction can improve the technical efficiency of township hospitals.Township hospitals with remote geographical locations have higher requirements for institutional management and service efficiency.(4)In view of how to promote the operational efficiency of township hospitals under the medical community model,this study proposes the following policy recommendations: optimize the government’s financial input structure and strengthen supervision and evaluation of funds;institutionalize the operation and management of medical associations,and establish long integration effective interaction mechanism;innovate and standardize the talent management mechanism,strengthen the construction of grassroots talent team;implement the supporting medical insurance policy and reshape the incentive mechanism of the medical community.