市场竞争对民营医院效率的影响

Impact of market competition on the efficiency of private hospitals

目的探索民营综合医院规模、医疗服务量的分布,分析其医疗市场情况及医疗效率,以期为优化四川省卫生资源配置提供参考。方法选取四川省18个市(州)二级以上民营综合医院2020年度相关数据,采用赫芬达尔-赫希曼指数(HHI指数)进行市场集中度分析从而反映医院市场竞争性;运用三阶段数据包络分析(DEA)模型剔除环境变量与随机误差后,进行医院效率分析;采用Tobit回归模型进行影响因素分析。结果各市(州)执业(助理)医师数、床位数、总诊疗人次的HHI指数均小于1000,属于低集中度市场;经过三阶段DEA分析,四川省二级以上民营综合医院的综合技术效率、纯技术效率和规模效率分别为0.534、0.661和0.806。执业(助理)医师数与规模效率呈负相关;床位数与纯技术效率呈负相关;总诊疗人次与综合技术效率、纯技术效率和规模效率呈正相关。结论省域内民营医院市场整体处于低集中度竞争阶段;不同地区、不同等级、不同类型医院效率有差异;资源配置市场竞争促进纯技术效率与规模效率的提升;市场份额竞争阻碍综合技术效率、纯技术效率和规模效率的提升。

Objective To investigate the distribution,service volume,and medical efficiency of private general hospitals in Sichuan Province to provide references for optimizing the allocation of health resources in Sichuan Province.Methods Using the 2020 data from private general hospitals above the second level in 18 cities and states in Sichuan Province,this study calculated the market concentration and competitiveness with the Herfindahl-Hirschman index(HHI).A three-stage data envelopment analysis(DEA)model was employed to eliminate environmental variables and random errors for hospital efficiency analysis.Influencing factors were conducted using a Tobit regression model.Results The HHI indices for the number of licensed(assistant)physicians,beds,and total consultations in each city and state were below 1000,indicating a low concentration market.The comprehensive technical efficiency,pure technical efficiency,and scale efficiency of private general hospitals above the second level in Sichuan Province were 0.534,0.661,and 0.806,respectively,after the three-stage DEA analysis.The number of practicing(assistant)physicians was negatively correlated with scale efficiency.the number of beds was negatively correlated with pure technical efficiency.The total number of consultations showed a positive correlation with overall technical efficiency,pure technical efficiency,and scale efficiency.Conclusion The provincial private hospital market exhibits low concentration competition.Differences in efficiency exist among various regions,grades,and hospital types.Market competition in resource allocation promotes the improvement of pure technological efficiency and scale efficiency.Market share competition hinders the improvement of comprehensive technical efficiency,pure technical efficiency,and scale efficiency.