中国基层医疗卫生机构运行效率及影响因素研究

Operation Efficiency and Influencing Factors of Primary Healthcare Institutions in China

背景基层医疗卫生机构是我国卫生服务体系的网底,承担着基本医疗和基本公共卫生服务的职责,在改善居民健康状况、降低医药费用等方面起着重要作用,目前国内关于全国性基层医疗卫生机构效率的研究较为缺乏。目的分析我国基层医疗卫生机构运行效率,探讨基层医疗卫生机构效率的影响因素。方法数据来源于2016年11月-2017年5月"基层医疗服务能力和质量的综合评价"项目,收集322家基层医疗卫生机构的外部特征、内部管理与技术因素、投入-产出指标等资料。采用数据包络分析计算基层医疗卫生机构的效率值,采用多元线性回归分析基层医疗卫生机构效率的影响因素,提出针对性的建议。结果 322家基层医疗卫生机构平均规模效率、纯技术效率、综合技术效率值分别为(0.79±0.23)、(0.52±0.25)、(0.42±0.26)。多元线性回归分析结果显示,地域、财政补助方式、辖区6岁以下儿童人数为基层医疗卫生机构规模效率的影响因素,地域、是否开设外科、是否使用电子病历、绩效工资主要的影响因素是否包括国家公共卫生服务达标率是基层医疗卫生机构纯技术效率的影响因素,地域、辖区6岁以下儿童人数、是否开设外科为基层医疗卫生机构综合效率的影响因素(P<0.05)。结论财政补贴应逐渐向按服务单元付费的购买模式转变,开设临床外科可能对基层医疗卫生机构效率不利,薪酬制度的改革可提升基层医疗卫生机构效率。

Background Primary healthcare institutions belong to primary healthcare system of China’s healthcare system,which assume the responsibilities for delivering essential medical care and public health services and play an important role in improving residents’ health status and reducing medical costs.At present,there is a lack of research on the efficiency of domestic primary healthcare institutions at the national level.Objective This paper analyzed the operational efficiency and influencing factors of primary healthcare institutions in China.Methods Data about administrative features,internal management and technical factors,and input-output indicators of 322 primary healthcare institutions participated in the project of "Comprehensive Evaluation of Service Capacity and Quality of Primary Healthcare Institutions" implemented from November 2016 to May 2017 were collected.Data envelopment analysis was used to quantify the operational efficiency value of these institutions.Multiple linear regression analysis was performed to analyze the influencing factors of the efficiency.And based on this,targeted facilitation strategies were put forward.Results The average scale efficiency,pure technical efficiency and overall technical efficiency of the 322 primary healthcare institutions were(0.79±0.23),(0.52±0.25),(0.42±0.26),respectively.Multiple linear regression analysis showed that factors influencing the scale efficiency of the institutions were regional location,financial subsidy mode,and number of children under 6 years of age in the service area(P<0.05).Regional location,whether setting up a surgery department,whether using an electronic medical record system,and whether using the rate of reaching the national public health performance standards as a reference parameter for calculating the performance-related pay were associated with the pure technical efficiency of the institutions(P<0.05).Regional location,and number of children under 6 years of age in the service area,whether setting up a surgery department were associated with the overall technical efficiency of the institutions(P<0.05).Conclusion The current mode of financial subsidy is suggested to gradually change to the government purchasing-based mode according to specific services.Setting up a surgery department may produce negative influence on the scale efficiency,but payment reform may improve the efficiency of primary healthcare institutions.