基于Bootstrap—DEA运行效率研究的湖北省县级公立医院

Operational efficiency of county level public hospitals in Hubei： a Bootstrap-data envelopment analysis

目的采用国际上普遍运用的Bootstrap—DEA方法，测算2014年湖北省37家县级公立医院的运行效率，弥补我国医院DEA效率评价理论和方法的不足，并为医院效率改进提出相应的政策及管理建议。方法基于前期研究基础，选择医院效率评价的投入产出指标体系，利用R软件描述投入产出指标的基本现状，结合FEAR软件包测算纠偏后的样本医院Bootstrap—DEA效率值，并对技术效率值结果进行标杆等实际应用分析。结果湖北省37家县级公立医院的卫生投入产出存在较大差异，其中实际床位数最大差幅为4．67倍。经Bootstrap．DEA方法修正后的效率值均低于纠偏前，平均修正后的相对效率值为0．7179，仅有20家（54．05％）县级公立医院的相对效率值处于平均水平以上。结论样本医院问的卫生资源配置还需进一步优化，医院还有较大的效率提升空间。政府除了提供政策支持外，还需引导医院创新管理机制，引入和开展标杆评比、跨医院学习等方法，持续改进医院的效率和绩效。

Objective To estimate the operational efficiency of 37 county level public general hospitals in Hubei province using the world popular method of Bootstrap-data envelopment analysis. The aim is to make up for the theory and methodology gaps on DEA research for hospitals in China, and to provide policy and management recommendations for their further improvement. Methods The input and output indicators of hospital efficiency evaluation were selected based on our previous research. R Software was used to describe the current input and output indicators, while FEAR package used to measure Bootstrap-DEA efficiency value of the sample hospitals with bias corrected, along with such applied analysis as efficiency benchmarking for the technical efficiency outcomes. Results There are great differences among the heahhcare input and output of these hospitals. In particular, the difference in the number of actual beds was 4. 67 times between the highest hospital and the lowest one. All of the bias corrected efficiency scores were lower than those before correction, and the average bias corrected score of the sample hospitals is 0. 717 9. Moreover,only 20 hospitals（ 54. 05% ）have their efficiency scores above the median level. Conclusions The heahhcare resources allocation of these hospitals needs to be further optimized. Hospitals still have big potential to improve their efficiency. Besides providing policy support, the government is advised to guide hospitals to innovate their management mechanisms, such as introducing and applying benchmarking, ranking, inter-hospital learning among others, so as to continuously improve their operational efficiency.