重庆市县级公立医院成本效率及其影响因素分析

Analysis of the cost effectiveness in county-level public hospitals in Chongqing and relevant influencing factors

目的了解重庆市县级公立医院的成本效率及其影响因素。方法采集重庆市2012—2014年医疗机构主要指标汇编数据,采用随机前沿法(SFA)测算成本效率得分,利用Tobit回归模型进行成本效率的影响因素分析。结果 2012—2014年重庆市县级公立医院成本效率得分均值为0.841 6,并以0.49%的增长速度逐年上升。Tobit回归结果显示,医院所处区域、医院等级、是否医改试点单位和常住人口规模等4个外部因素显著影响县级公立医院成本效率;实际开放床位数、药占比、医技人员支出占比、职工年均出院人数、病床使用率、流动比率、百元药品与卫生材料业务收入和管理费率等8个内部因素显著影响县级公立医院成本效率。结论重庆市县级公立医院的成本效率仍存在一定的改善空间。多种因素影响县级公立医院成本效率,县级公立医院管理者和政策制定者应从相关影响因素入手,采取有效措施,提高县级公立医院的成本效率。

Objective To investigate the cost effectiveness in county-level public hospitals in Chongqing and relevant influencing factors. Methods D ata of main indexes of m edical institutions in Chongqing from 2012 to2014 were collected. The cost effectiveness was calculated with the Stochastic Frontier Approach（ SFA）. Factors influencing the cost effectiveness were analyzed with the Tobit regression model. Results The average score of cost effectiveness in county-level public hospitals in Chongqing was 0. 8416 and increased by 0. 49% annually.Tobit regression analysis revealed that cost effectiveness in county-level public hospitals was significantly influenced by four external factors, i. e. location, hospital level, reform pilot, and permanent resident population, and eight internal factors, i. e. number of beds, proportion of drug, proportion of m edical technicians expenditure, number of discharged patients perem ployee per year, utilization rate of beds, current ratio, incom e from drugs with prices less than 100 Yuan and hygiene m aterials, and rate of managem ent expenses. Conclusion The cost effectiveness in county-level public hospitals in Chongqing still needs im provem ent. Multiple factors influence the cost effectiveness in county-level public hospitals. Managers and policym akers of county-level public hospitals should take efficient m easures to im prove the cost effectiveness according to relevant influencing factors.