基于数据包络分析的山东省三级公立综合医院运营效率与规模报酬分析

Operational efficiency and returns to scale in public tertiary general hospitals in Shandong province using data envelopment analysis approach

目的探索山东省三级公立综合医院投入产出现状、不同床位规模下医院运行效率以及规模报酬情况。方法基于2017年山东省137家三级公立综合医院的投入产出数据,选取在职职工数和实有床位数作为投入指标,门急诊人次和出院人次作为产出指标,运用数据包络分析(data envelopment analysis,DEA)方法计算该省三级公立综合医院的技术效率、纯技术效率和规模效率,并在不同床位规模下进行对比分析。结果 137家三级公立综合医院2017年的技术效率平均值为0.666,纯技术效率和规模效率中位数分别0.817、0.919,其中非DEA有效的医院132家,占比96.4%,处于规模报酬递增、不变和递减状态的医院分别有90、11和36家,占比分别为65.7%、8.0%和26.3%。不同床位规模下的医院效率值及规模报酬状态差异均有统计学意义(P<0.001),床位规模为1 001~2 000张时规模效率值最大。结论该省三级公立综合医院运营效率整体不高,非DEA有效医院占比较大,多数医院处于规模报酬递增状态,医院的实有床位数适宜规模在1 001~2 000张。

Objective To explore the present situation of the efficiency about public tertiary general hospitals in Shandong province, measure and compare the efficiency and the state of returns to scale of hospitals under different bed scales. Methods Based on the input and output data of 137 public tertiary general hospitals in Shandong province in2017, two input indicators(the number of employees and the number of actual beds) and two output indicators(the total number of outpatients and emergent patients, and the number of discharges) were selected. The technical efficiency, pure technical efficiency and scale efficiency of sample hospitals were calculated by using data envelopment analysis, and a comparative analysis was carried out under different bed scales. Results Of the 137 public tertiary general hospitals,the mean of technical efficiency value was 0.666, the medians of pure technical efficiency value and scale efficiency value in2017 were 0.817 and 0.919, respectively. In the 137 sample hospitals, there were 132 hospitals(96.4%) in ineffective status;there were 90 hospitals(65.7%) exhibiting increasing returns to scale, 11 hospitals(8.0%) exhibiting constant returns to scale, and 36 hospitals(26.3%) exhibiting decreasing returns to scale. There were significant differences in hospital efficiency and returns to scale under different bed sizes(P<0.001), and the scale efficiency was the highest when the bed size was 1 001-2 000. Conclusions The overall operating efficiency of the public tertiary general hospitals in the province was not high yet. Most hospitals were in ineffective status and most of them were in the state of increasing returns to scale. The optimal scale of actual beds is between 1 001 and 2 000 beds from the perspective of scale efficiency.