基于Bootstrap-DEA模型的武汉市36所公立医院运行效率实证研究
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摘要
目的:运用Bootstrap-DEA法综合评价武汉市36所公立医院2017年度运行效率,探究两种维度下公立医院运行效率差异,并提出相关政策建议以促进武汉市公立医院运行效率提升。方法:基于文献研究及专家咨询构建公立医院运行效率评价的投入产出指标体系,通过现场调研及公立医院改革监测系统获取数据,运用MaxDEA软件中Bootstrap模块测算纠偏前后样本医院相对效率值。结果:武汉市不同公立医院间卫生资源分配差异较大。经Bootstrap修正后的样本医院效率值均小于修正前。纠偏后三级医院效率均值为0.7 892,低于二级医院的效率均值(0.8 058);综合医院效率均值为0.7 714,低于专科医院的效率均值(0.7 992)。结论:武汉市36所公立医院的运行效率尚未达到最优,公立医院技术效率的提升还需要多方努力。建议以医联体建设为契机加强二级医院的帮扶工作,同时强化专科医院专病专治以做好患者分流,减轻综合医院诊疗压力。
Objectives:To evaluate the operational efficiency of 36 public hospitals of Wuhan in the year 2017 by using Bootstrap data envelope analysis.The operational efficiency of 36 public hospitals in Wuhan is evaluated from the two dimensions:tertiary hospitals,secondary hospitals;general hospitals,specialist hospitals.The differences between the operational efficiency of public hospitals with two dimensions are explored.The key aim is to provide policy and management suggestions according to the analysis results.Methods:Based on literature research and expert consultation,the input-output index system of operating efficiency evaluation of public hospitals was constructed.Data were obtained through field survey and public hospital reform monitoring system.The MaxDEA software Bootstrap module was used to calculate the relative efficiency of sample hospitals before and after correction.Results:The distribution of health resources among different public hospitals in Wuhan is quite different.The efficiency of the sample hospital after Bootstrap correction was smaller than that before the correction.Among them,the average efficiency of tertiary hospitals is 0.7 892,lower than that of secondary hospitals.The average efficiency of general hospitals was 0.7 714,lower than that of specialized hospitals.Conclusions:The operating efficiency of 36 public hospitals in Wuhan has not yet reached the optimal level,and the improvement of technical efficiency of public hospitals still requires efforts from various aspects.It is suggested to strengthen the support work of secondary hospitals by taking the opportunity of the construction of medical treatment alliance,and highlight the special treatment of specialized hospitals to do a good job in patient diversion to relieve the pressure of general hospitals in diagnosis and treatment.
Objectives:To evaluate the operational efficiency of 36 public hospitals of Wuhan in the year 2017 by using Bootstrap data envelope analysis.The operational efficiency of 36 public hospitals in Wuhan is evaluated from the two dimensions:tertiary hospitals,secondary hospitals;general hospitals,specialist hospitals.The differences between the operational efficiency of public hospitals with two dimensions are explored.The key aim is to provide policy and management suggestions according to the analysis results.Methods:Based on literature research and expert consultation,the input-output index system of operating efficiency evaluation of public hospitals was constructed.Data were obtained through field survey and public hospital reform monitoring system.The MaxDEA software Bootstrap module was used to calculate the relative efficiency of sample hospitals before and after correction.Results:The distribution of health resources among different public hospitals in Wuhan is quite different.The efficiency of the sample hospital after Bootstrap correction was smaller than that before the correction.Among them,the average efficiency of tertiary hospitals is 0.7 892,lower than that of secondary hospitals.The average efficiency of general hospitals was 0.7 714,lower than that of specialized hospitals.Conclusions:The operating efficiency of 36 public hospitals in Wuhan has not yet reached the optimal level,and the improvement of technical efficiency of public hospitals still requires efforts from various aspects.It is suggested to strengthen the support work of secondary hospitals by taking the opportunity of the construction of medical treatment alliance,and highlight the special treatment of specialized hospitals to do a good job in patient diversion to relieve the pressure of general hospitals in diagnosis and treatment.
引文
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[6]余莉晨,刘新靓,毛宗福,等.基于Bootstrap-DEA的武汉市肾内科CRRT技术效率研究[J].中国医院管理,2017,37(7):34-37.
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[8]毛燕娜,王小万,冯芮华,等.基于数据包络分析的医院效率评价指标筛选研究[J].卫生经济研究,2015(8):15-19.
[9]董四平,左玉玲,陶红兵,等.中国医院效率DEA研究分类与投入产出指标分析[J].中国卫生政策研究,2014,7(10):40-45.
[10]Efron B.Bootstrap methods:another look at the jackknife[J].Annals Statistics,1979,7(1):1-26.
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[12]Simar L,Wilson PW.A general methodology for bootstrapping in nonparametric frontier models[J].Journal of Applied Statistics,2000,27(6):779-802.
[13]Simar L,Wilson PW.Sensitivity analysis of efficiency scores:how to bootstrap in nonparametric frontier models[J].Management Science,1998,44(1):49-61.
[14]成刚.数据包络分析方法与MaxDEA软件[M].北京:知识产权出版社,2014.
[15]Charnes A,Cooper WW,Rhodes E.Measuring the efficiency of decision making units[J].European Journal of Operational Research,1978,24(2):429-444.
[2]Cheng ZC,Cai M,Tao HB,et al.The efficiency and productivity measurement of rural township hospitals in China:a bootstrapping data envelopment analysis[J].BMJ Open,2016,6(11):78-82.
[3]刘新靓,董四平,黎浩.基于Bootstrap-DEA的湖北省县级公立医院运行效率研究[J].中华医院管理杂志,2017,33(6):420-422.
[4]景日泽,张鲁豫,章湖洋,等.北京市公立医院与民营医院效率比较研究:基于DEA模型[J].卫生经济研究,2018(6):22-25.
[5]陈岩,刘新靓,邓贵芳,等.基于BootstrapDEA的武汉市乡镇卫生院技术效率研究[J].中华医院管理杂志,2017,37(6):648-652.
[6]余莉晨,刘新靓,毛宗福,等.基于Bootstrap-DEA的武汉市肾内科CRRT技术效率研究[J].中国医院管理,2017,37(7):34-37.
[7]Li H,Dong SP,Liu T.Relative efficiency and productivity:a preliminary exploration of public hospitals in Beijing,China[J].BMC Health Services Research,2014,14(1):158-161.
[8]毛燕娜,王小万,冯芮华,等.基于数据包络分析的医院效率评价指标筛选研究[J].卫生经济研究,2015(8):15-19.
[9]董四平,左玉玲,陶红兵,等.中国医院效率DEA研究分类与投入产出指标分析[J].中国卫生政策研究,2014,7(10):40-45.
[10]Efron B.Bootstrap methods:another look at the jackknife[J].Annals Statistics,1979,7(1):1-26.
[11]陈峰,陆守曾,杨珉.Bootstrap估计及其应用[J].中国卫生统计,1997,14(5):5-7.
[12]Simar L,Wilson PW.A general methodology for bootstrapping in nonparametric frontier models[J].Journal of Applied Statistics,2000,27(6):779-802.
[13]Simar L,Wilson PW.Sensitivity analysis of efficiency scores:how to bootstrap in nonparametric frontier models[J].Management Science,1998,44(1):49-61.
[14]成刚.数据包络分析方法与MaxDEA软件[M].北京:知识产权出版社,2014.
[15]Charnes A,Cooper WW,Rhodes E.Measuring the efficiency of decision making units[J].European Journal of Operational Research,1978,24(2):429-444.
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