基于Bootstrap-Malmquist-DEA的公立三级综合医院全要素生产率测算与动态分解

Total factor productivity and its component changes in public tertiary general hospitals based on Bootstrap-Malmquist-DEA

目的:测算新医改以来我国公立三级综合医院全要素生产率及其变动情况。方法:采取系统分层典型抽样方法获取2012—2018年5个省份203家公立三级综合医院投入产出指标面板数据,应用Bootstrap-Malmquist-DEA方法计算样本医院的全要素生产率,并对其构成指数进行分解研究。结果:2012—2018年全要素生产率降低0.70%,技术效率降低6.76%,技术进步6.50%,纯技术效率降低4.80%,规模效率降低2.06%。结论:新医改以来我国公立三级综合医院全要素生产率存在轻微衰退,主要原因是纯技术效率和规模效率共同下降,技术进步是促进其提升的主要动因。建议公立医院加强内部精细化管理提升管理水平,依靠技术进步进一步缩短平均住院日;政府进一步加强公立医院规模控制,加大对经济欠发达省份医疗技术投入。

Objective:To measure the total factor productivity and its component changes within public tertiary general hospitals during the new round of Healthcare reform.Methods:Bootstrap-Malmquist-DEA to calculate the total factor productivity and its component changes with panel data of input&output indicators collected from 203 public tertiary general hospitals located in 5 different provinces in China using systematic multistage typical sampling method escalated on the period from 2012 to 2018.Results:Results found that the total factor productivity decreased by 0.70%,Technical Efficiency underwent a decrease of 6.76%,Technical Changes increased by 6.50%,and decreasing trend was spotted on Pure Technical Efficiency and Scale Efficiency with the proportions of 4.80%and 2.06%,respectively.Conclusions:During the new medical reform,the Chinese public tertiary general hospitals total factor productivity has declined slightly,mainly due to the decline of pure technical efficiency and scale efficiency,and technical progress is the main reason for the improvements so far made.It is suggested that public hospitals should strengthen the internal management to improve the management practice,and further shorten the average length of stay by relying on technical progress.The government should further the strengthening of the scale control of public hospitals and the increase funds invested in medical technology in underdeveloped provinces.