基于数据包络分析法和随机前沿分析法的重庆市市级公立医院运行效率及变化趋势研究  

Study on the operational efficiency and variation trend of municipal-level public hospitals in Chongqing based on DEA and SFA analyses

作　　者：郑万会[1,2] 龙畅[1,3] 孙虹[3] ZHENG Wan-hui;LONG Chang;SUN Hong(Xiangya School of Public Health, Central South University, Changsha 410011,China;The Ninth People’s Hospital of Chongqing, Chongqing 400700, China;Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅公共卫生学院,长沙410011 [2]重庆市第九人民医院,重庆400700 [3]中南大学湘雅医院,长沙410008

出　　处：《上海交通大学学报（医学版）》2016年第12期1789-1795,1803,共8页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家社会科学基金(14BGL112);重庆市教委高校人文社会科学研究规划项目(16SKGH019);重庆市北碚区科学技术委员会项目(2016-36);重庆市卫生经济学会招标课题(YWJK2016-9)~~

摘　　要：目的·了解新医改以来重庆市16家市级公立医院运行效率及变化趋势，为2017年重庆市全面推进城市公立医院改革提供量化依据。方法·利用2009—2015年16家公立医院的主要业务指标，采用数据包络分析法（DEA）的BC2模型计算综合效率、纯技术效率和规模效率的平均值和个案值，并分析投入冗余与产出亏空；采用随机前沿分析法（SFA）的柯布-道格拉斯模型测算生产效率和成本效率的平均值和个案值，采用最大似然法进行检验，并根据系数正负值大小判定其对总产出和总成本的影响。结果·DEA分析显示16家公立医院的平均综合效率、纯技术效率和规模效率值均为高效（0.852～0.991），但仅3家公立医院的上述3项指标达到最优（1.000），其余呈现不规则差异，且存在不同程度投入冗余与产出亏空；SFA分析显示16家公立医院的平均成本效率均为高效（0.889～1.000），但平均生产效率为中效到高效（0.665～0.782），各医院差异较大，且门（急）诊人次、实际占用总床日、百元固定资产医疗收入等3项指标对生产效率产出有负影响。结论·政府在对公立医院进行考评时，应重视效率测算及变化趋势，合理解决有限医疗资源配置中存在的问题，强化效率在量化投入中的作用。Objective · To explore the operational efficiency and the variation trend of 16 municipal-level public hospitals in Chongqing after the new healthcare reform and to provide quantitative evidence for overall advance of urban public hospital reform in 2017. Methods · Data of main business indicatorsfrom 16 public hospitals (2009-2015) were collected. The mean and sample values of overall efficiency, pure technical efficiency, and scale efficiency werecalculated with a BC2 model of the data envelopment analysis (DEA) and the input redundancy and output deficit were analyzed. The mean and sample valuesof productivity and cost effectiveness were calculated using the Cobb-Douglas production model of the stochastic frontier approach (SFA). The values wereverified with the maximum likelihood method. The effects of productivity and cost effectiveness on total output and total cost were determined according tocoefficients. Results · DEA analysis showed that average overall efficiency, pure technical efficiency, and scale efficiency were efficient in 16 public hospitals(0.852-0.991), but the optimal value (1.000) for above 3 indicators was only obtained in 3 public hospitals. There were irregular differences in the above 3indicators, as well as input redundancy and output deficit. SFA analysis showed that the average cost-effectiveness was efficient in 16 public hospitals (0.889-1.000), while the average productivity was moderate to efficient (0.665-0.782) with large differences among the hospitals. Some indicators negativelyinfluenced the productivity, including the number of outpatients and emergency patients, actual available bed days, and fixed assets medical income perhundred yuan. Conclusion · The government should pay more attention to efficiency estimation and variation trend, reasonably solve problems in allocatinglimited medical resources, and enhance the effect of efficiency in quantitative input when evaluating the public hospitals.

关 键 词：市级公立医院 运行效率 变化趋势 数据包络分析法 随机前沿分析法 

分 类 号：R197.32[医药卫生—卫生事业管理]