基于基本医疗服务包设计的公立医院实际和标准运营效率比较研究

Study on the Actual and Standardized Operational Efficiency of Public Hospitals Based on Designing of Essential Medical Service Package

目的设计基本医疗服务包,进行公立医院实际与标准运营效率比较,探索公立医院公益性。方法综合指数法设计基本医疗服务包,DEA测量实际和标准运营效率。结果11个样本县基本医疗服务包平均分摊系数为64%,病种费用占医院平均收入的50%以上,有着很好的代表性。实际与标准运行效率比较分析发现,11家医院中,大部分医院实际平均运行效率处于规模报酬递减和固定阶段,标准平均运行效率医院则走向规模报酬递增和固定阶段。结论以基本医疗服务包设计理念为契点,结合基本公共卫生服务包的实施,促进卫生系统宏观综合改革;控制县级公立医院单体和复合体规模,提高公立医院运营效率。

Objective To design the essential medical service package,compare the actual and standardized operational efficiency for exploring the public welfare of public hospital.Methods General index method was used for essential medical service package,and DEA was employed for the analysis of actual and standardized operational efficiency.Results Essential medical service package has some representative due to its expenditure accounting for at least 50%total expenditure with average 64%proportion.Within 11 hospitals,for average actual efficiency,most of the hospital was in the diminishing and fix stage of returns to scale;otherwise for standardized efficiency,most of the hospital was in the incremental and fix stage of returns to scale.Conclusion It is suggested to further improve the health system reform as the designing of essential medical service according to the essential public health service package,and to improve the operational efficiency with the control size of monomers and complexes of public hospital.