浙江省三级公立医院综合技术效率及影响因素——基于DEA和Tobit回归分析

The comprehensive technical efficiency and determinants of tertiary public hospitals in Zhejiang province: DEA and Tobit-based analysis

目的:测算浙江省三级公立医院综合技术效率,探讨其影响因素,并提出相应的政策建议。方法:采用数据包络分析方法测算医院综合技术效率,并以测算出的综合技术效率为因变量,相关指标为自变量,利用Tobit回归方法探讨其影响因素。结果:浙江省三级公立医院综合技术效率平均值为0.949,纯技术效率平均值为0.963,规模效率平均值为0.985。28.26%的医院DEA有效,29.35%的医院规模收益不变。综合效率与床位周转率、人均工作量呈正相关,与医疗业务成本比呈负相关。结论:研究对象的总体技术效率水平较高,床位周转率、医生人均工作量影响医院整体技术效率;面临规模过度扩张风险,西医与中医医院的规模效益差异较大。建议:严格控制大型医院规模扩张,西医与中医医院要采取差异化政策;实现粗放式发展向内涵式发展转变;推进质量管理和精细化管理,实现可持续发展。

Objective：To measure the comprehensive technical efficiency of tertiary public hospitals and explore its determinants,so as to uncover health policy implications.Methods：The data envelopment analysis was adopted to measure the comprehensive technical efficiency,and Tobit regression was utilized to explore its determinants.The dependent variable used was the comprehensive technical efficiency,while the independent variables were factors which referred to physician workloads,bed turnover rates,and so on.Results：The average comprehensive technical efficiency,pure technical efficiency and scale efficiency were 0.949,0.963 and 0.985 respectively.Only approximately 28.26％ hospitals were identified as technically efficient,while 29.35％ were in the status of fixed to scale.The comprehensive technical efficiency had a positive correlation with workload per person and bed turnover rates.Conclusion：The comprehensive efficiency of the study object is relatively high,the bed rotation rate and physician workload per capital impact the comprehensive efficiency of hospitals.Public hospitals face a risk of scale overexpansion; traditional Chinese medicine hospitals and western medicine hospitals reveal vastly different economies of scale.Future health policies should strictly control the scale of large hospitals,employ different policies for western medicine and traditional Chinese medicine hospitals,facilitate extensive developmental changes to connotative developments,and boost quality management and specialized management so as realize sustainable development.