基于DEA的基层医疗卫生机构效率评价研究及其思考
|
摘要
目的:对国内外基层医疗卫生机构及初级保健服务效率评价实证研究进行计量分析,系统了解其效率评价的研究进展、研究内容及研究趋势。方法:制定检索策略并依据研究目的选取文献,利用文献计量法对研究对象等进行分析和归纳。结果:研究对象以省市层面、乡镇卫生院、整体服务为主;应用模型以BCC(Banker-Charnes-Cooper)、CCR(Charnes-Cooper-Rhodes)为主;规模报酬设定的分布接近,部分研究未说明导向;数据主要来自公开资料或实地调研;指标确定主要依赖定性;投入指标主要为人财物方面,产出指标分为服务量、服务质量和资金收益。结论:尝试探索可行的服务质量指标,建议在评价指标和评价方法上更为严谨慎重。
Objectives:To conduct a quantitative analysis of the empirical research on the efficiency evaluation of primary healthcare institutions and primary healthcare at home and abroad,and systematically understand research progress,research contents and research trends.Methods:The search strategy was formulated and the literature was selected according to the purpose of the study.The research objects were analyzed and summarized by the bibliometric method.Results:The research subjects were mainly provincial and municipal level,township health center and overall services.BCC and CCR were the main models.Distribution of scale returns was close and some studies did not explain.Data mainly came from public data or field research.The indicators are mainly determined by qualitative and the input indicators are mainly human and financial aspects,and the output indicators are divided into service quantity,service quality and capital income.Conclusions:It is recommended to be more cautious in evaluation indicators and evaluation methods and to try to explore feasible service quality indicators.
Objectives:To conduct a quantitative analysis of the empirical research on the efficiency evaluation of primary healthcare institutions and primary healthcare at home and abroad,and systematically understand research progress,research contents and research trends.Methods:The search strategy was formulated and the literature was selected according to the purpose of the study.The research objects were analyzed and summarized by the bibliometric method.Results:The research subjects were mainly provincial and municipal level,township health center and overall services.BCC and CCR were the main models.Distribution of scale returns was close and some studies did not explain.Data mainly came from public data or field research.The indicators are mainly determined by qualitative and the input indicators are mainly human and financial aspects,and the output indicators are divided into service quantity,service quality and capital income.Conclusions:It is recommended to be more cautious in evaluation indicators and evaluation methods and to try to explore feasible service quality indicators.
引文
[1]World Health Organization.The World Health Report 2008-primary Health Care(Now More Than Ever)[R].Geneva,Switzerland:World Health Organization,2008.
[2]彭凯,段磊,叶婷,等.乡镇卫生院中医服务提供效率分析--以广东省某县级市为例[J].中国卫生资源,2016,19(6):512-516.
[3]王丽君,尹爱田.山东省乡镇卫生院中医医疗服务效率评价[J].中国卫生事业管理,2013,30(12):929-931,959.
[4]王文娟,蔡媛青,欧阳雁玲.三级医院与社区卫生服务中心合作效率研究:源于新结构经济学视角[J].广东社会科学,2017(5):198-205.
[5]饶卓识.河南省乡镇卫生院艾滋病防治效率的数据包络法评价[D].武汉:华中科技大学,2011.
[6]Giuffrida A.Productivity and efficiency changes in primary care:a malmquist index approach[J].Health Care Management Science,1999,2(1):11-26.
[7]Kontodimopoulos N,Niakas D,Moschovakis G,et al.The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece[J].Cost Effectiveness&Resource Allocation,2007,5(1):14.
[8]Caroline JA,Martin A,James A,et al.Using data envelopment analysis to measure the extent of technical efficiency of public health centres in ghana[J].BMC International Health and Human Rights,2008(8):11.
[9]Ruizrodriguez M,Rodriguezvillamizar LA,Herediapi I.Technical efficiency of women’s health prevention programs in bucaramanga,colombia:a four-stage analysis[J].BMC Health Services Research,2016,16(1):576.
[10]Beat Thürlimann.Assessment of physician performance for diabetes:a biascorrected data envelopment analysis model[J].Quality in Primary Care,2013,21(6):345.
[11]Rabetti T,Aparecida de Cássia.Evaluation of actions concerning systemic arterial hypertension in primary healthcare[J].Revista De Saúde Pública,2011,45(2):258-268.
[12]Linna M,Nordblad A,Koivu M.Technical and cost efficiency of oral health care provision in Finnish health centres[J].Social Science&Medicine,2003,56(2):343-353.
[13]张瑶,郭亚楠,张航,等.基于DEA-Tobit两阶段法的社区卫生服务中心技术效率评价与影响因素分析[J].中国卫生统计,2017,34(2):229-231.
[14]冯俊剑,刘智勇,籍文雪,等.基于DEA-Tobit模型的西部地区乡镇卫生院效率分析[J].中国医院管理,2016,36(5):29-31.
[15]明延飞.哈密地区乡镇卫生院运行效率及其影响因素分析[D].石河子:石河子大学,2015.
[16]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].中国农村卫生事业管理,2017,37(6):648-652.
[17]林海锋.河南省县级中医院适宜规模及其效率特征因素研究[D].武汉:华中科技大学,2016.
[18]李湘君,王中华.补偿机制改革对公立医院产出效率的影响--基于县级中医医院的实证研究[J].中国医院管理,2017,37(8):16-18.
[19]Pelone F,Kringos DS,Romaniello A,et al.Primary care efficiency measurement using data envelopment analysis:A systematic review[J].Journal of Medical Systems,2015,39(1):156.
[20]Ferreira C,Marques RC,Nicola P.On evaluating health centers groups in Lisbon and tagus Valley:efficiency,equity and quality[J].BMC Health Serv Res,2013,13(1):529.
[21]Ramírez-Valdivia MT,Maturana S,Salvo-Garrido S.A multiple stage approach for performance improvement of primary healthcare practice[J].Journal of Medical Systems,2011,35(5):1015-1028.
[22]Milliken O,Devlin RA,Barham V,et al.Comparative efficiency assessment of primary care service delivery models using data envelopment analysis[J].Can Public Policy,2011,37(1):85-109.
[23]Rouse A,Harrison J,Turner N.Cost and performance:Complements for improvement[J].Journal of Medical Systems,2011,35(5):1063.
[24]Pelone F,Kringos DS,Valerio L,et al.The measurement of relative efficiency of general practice and the implications for policy makers[J].Health Policy,2012,107(2-3):258-268.
[25]王文华,孔娜,尹爱田.基于均等化视角省域范围内乡镇卫生院效率分析:以山东省为例[J].中国卫生经济,2012,31(5):71-74.
[26]Dyson RG,Allen R,Camanho AS,et al.Pitfalls and protocols in DEA[J].European Journal of Operational Research,2001,132(2):245-259.
[27]Thanassoulis E,Boussofiane A,Dyson RG.Exploring output quality targets in the provision of perinatal care in England using data envelopment analysis[J].European Journal of Operational Research,1995,80(3):588-607.
[2]彭凯,段磊,叶婷,等.乡镇卫生院中医服务提供效率分析--以广东省某县级市为例[J].中国卫生资源,2016,19(6):512-516.
[3]王丽君,尹爱田.山东省乡镇卫生院中医医疗服务效率评价[J].中国卫生事业管理,2013,30(12):929-931,959.
[4]王文娟,蔡媛青,欧阳雁玲.三级医院与社区卫生服务中心合作效率研究:源于新结构经济学视角[J].广东社会科学,2017(5):198-205.
[5]饶卓识.河南省乡镇卫生院艾滋病防治效率的数据包络法评价[D].武汉:华中科技大学,2011.
[6]Giuffrida A.Productivity and efficiency changes in primary care:a malmquist index approach[J].Health Care Management Science,1999,2(1):11-26.
[7]Kontodimopoulos N,Niakas D,Moschovakis G,et al.The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece[J].Cost Effectiveness&Resource Allocation,2007,5(1):14.
[8]Caroline JA,Martin A,James A,et al.Using data envelopment analysis to measure the extent of technical efficiency of public health centres in ghana[J].BMC International Health and Human Rights,2008(8):11.
[9]Ruizrodriguez M,Rodriguezvillamizar LA,Herediapi I.Technical efficiency of women’s health prevention programs in bucaramanga,colombia:a four-stage analysis[J].BMC Health Services Research,2016,16(1):576.
[10]Beat Thürlimann.Assessment of physician performance for diabetes:a biascorrected data envelopment analysis model[J].Quality in Primary Care,2013,21(6):345.
[11]Rabetti T,Aparecida de Cássia.Evaluation of actions concerning systemic arterial hypertension in primary healthcare[J].Revista De Saúde Pública,2011,45(2):258-268.
[12]Linna M,Nordblad A,Koivu M.Technical and cost efficiency of oral health care provision in Finnish health centres[J].Social Science&Medicine,2003,56(2):343-353.
[13]张瑶,郭亚楠,张航,等.基于DEA-Tobit两阶段法的社区卫生服务中心技术效率评价与影响因素分析[J].中国卫生统计,2017,34(2):229-231.
[14]冯俊剑,刘智勇,籍文雪,等.基于DEA-Tobit模型的西部地区乡镇卫生院效率分析[J].中国医院管理,2016,36(5):29-31.
[15]明延飞.哈密地区乡镇卫生院运行效率及其影响因素分析[D].石河子:石河子大学,2015.
[16]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].中国农村卫生事业管理,2017,37(6):648-652.
[17]林海锋.河南省县级中医院适宜规模及其效率特征因素研究[D].武汉:华中科技大学,2016.
[18]李湘君,王中华.补偿机制改革对公立医院产出效率的影响--基于县级中医医院的实证研究[J].中国医院管理,2017,37(8):16-18.
[19]Pelone F,Kringos DS,Romaniello A,et al.Primary care efficiency measurement using data envelopment analysis:A systematic review[J].Journal of Medical Systems,2015,39(1):156.
[20]Ferreira C,Marques RC,Nicola P.On evaluating health centers groups in Lisbon and tagus Valley:efficiency,equity and quality[J].BMC Health Serv Res,2013,13(1):529.
[21]Ramírez-Valdivia MT,Maturana S,Salvo-Garrido S.A multiple stage approach for performance improvement of primary healthcare practice[J].Journal of Medical Systems,2011,35(5):1015-1028.
[22]Milliken O,Devlin RA,Barham V,et al.Comparative efficiency assessment of primary care service delivery models using data envelopment analysis[J].Can Public Policy,2011,37(1):85-109.
[23]Rouse A,Harrison J,Turner N.Cost and performance:Complements for improvement[J].Journal of Medical Systems,2011,35(5):1063.
[24]Pelone F,Kringos DS,Valerio L,et al.The measurement of relative efficiency of general practice and the implications for policy makers[J].Health Policy,2012,107(2-3):258-268.
[25]王文华,孔娜,尹爱田.基于均等化视角省域范围内乡镇卫生院效率分析:以山东省为例[J].中国卫生经济,2012,31(5):71-74.
[26]Dyson RG,Allen R,Camanho AS,et al.Pitfalls and protocols in DEA[J].European Journal of Operational Research,2001,132(2):245-259.
[27]Thanassoulis E,Boussofiane A,Dyson RG.Exploring output quality targets in the provision of perinatal care in England using data envelopment analysis[J].European Journal of Operational Research,1995,80(3):588-607.