南京市分级诊疗实施效果数据包络法分析

Implementation effect analysis of DEA based hierarchical medical system in Nanjing

目的南京市分级诊疗是全国分级诊疗的重要组成部分。本研究对比南京市实施分级诊疗前后资源配置效果,为南京市分级诊疗发展提供思路。方法通过文献研究及数据包络分析法(data envelopment analysis,DEA),分析南京市11个区(玄武区、秦淮区、建邺区、鼓楼区、雨花台区、栖霞区、浦口区、江宁区、六合区、溧水区和高淳区)2011和2018年的医疗机构配置情况,比较分级诊疗实施前后的运行效率。结果2011年,南京市11个区卫生资源配置的综合效率、技术效率和规模效率均值分别为0.870、0.920和0.944,只有江宁区和溧水区2个区的医疗资源配置达到最优,综合效率、技术效率和规模效率均为1。2018年,南京市11个区卫生资源配置的综合效率、技术效率和规模效率的均值分别为0.877、0.942和0.942,达到医疗资源配置最优或者相对合理的的区增加至7个,分别为玄武区、秦淮区、鼓楼区、雨花台区、栖霞区、浦口区和六合区,该7个区各个效率指标均有提升。2018年南京市卫生资源配置为DEA无效的区多为床位数及卫生人员数存在过剩,如果这些区达到优化可以节省床位2697张,卫计人员4099名。在2015年加大对基层医院投入后,2018年的数据仍然存在投入冗余现象。结论8年来,南京市卫生资源配置效率逐渐提高并且资源配置逐渐均衡化,分级诊疗取得初步效果。但是在2015年加大对基层投入后,资源配置仍然存在投入冗余,说明基层医院产出不足即年诊疗人次以及出院人次不足,需招揽全科医生、加大宣传等提高基层医疗机构服务能力以提高南京市分级诊疗的效率。

OBJECTIVE Hierarchical medical system in Nanjing is an important part of hierarchical medical system throughout the country.This study compares the resource allocation effect before and after the implementation of hierarchical medical system in Nanjing,and provides ideas for the development of hierarchical medical system in Nanjing.METHODS Through literature research and data envelopment analysis(DEA),11 districts in Nanjing(Xuanwu District,Qinhuai District,Jianye District,Gulou District,Yuhuatai District,Qixia District,Pukou District,Jiangning District,Liuhe District)were analyzed District,Lishui District,and Gaochun District).The allocation of medical institutions in 2011 and 2018,comparing the operational efficiency before and after the implementation of hierarchical medical system.RESULTS In 2011,the average efficiency,technical efficiency and scale efficiency of health resource allocation in 11 districts in Nanjing were0.870,0.920 and 0.944,respectively.Only Jiangning District and Lishui District achieved optimal medical resource allocation,comprehensive efficiency,technical efficiency and scale efficiency were all 1.In 2018,the average efficiency,technical efficiency and scale efficiency of health resource allocation in 11 districts of Nanjing were 0.877,0.942 and 0.942 respectively,which reached the optimal or relatively reasonable medical resource allocation.The number of districts has increased to seven,namely Xuanwu District,Qinhuai District,Gulou District,Yuhuatai District,Qixia District,Pukou District,and Liuhe District,and the efficiency indicators of these seven districts have been improved.In 2018,the districts where Nanjing’s health resource allocation was invalid for DEA were mostly the number of beds and the number of health personnel.If these districts were optimized,2697 beds can be saved,and 4099 health personnel.After increasing investment in primary hospitals in 2015,there was still a phenomenon of investment redundancy in 2018 data.CONCLUSIONS In the past8 years,the efficiency of health resource allocation in Nanjing has gradually improved and the resource allocation has been gradually balanced,indicating that the graded diagnosis and treatment in Nanjing has achieved initial results.However,after increasing investment in grassroots in 2015,there is still investment redundancy,indicating that the output of grassroots hospitals is insufficient.It is necessary to recruit general practitioners and increase publicity to improve the service capabilities of grassroots medical institutions and Tmprove the efficiency of hierarchical medical system in Nanjing.