广西紧密型县域医共体试点地区乡镇卫生院运行效率研究——基于Bootstrap-DEA和Tobit模型

Study on the Operational Efficiency of Township Health Centers in the Pilot Areas of Compact County-level Medical Community in Guangxi——Based on Bootstrap-DEA and Tobit Model

目的:分析近年来广西紧密型县域医共体试点地区乡镇卫生院的运行效率及其影响因素,提出对策建议。方法:运用Bootstrap-DEA模型测算2015—2020年试点地区乡镇卫生院静态、动态运行效率,借助Tobit模型检验各因素对效率的影响。结果:2015—2020年试点地区乡镇卫生院综合效率、纯技术效率、规模效率均小于0.9,未达到有效状态;6年间全要素生产率小于1,处于退步状态;医护比、全科医生数占比、医师日均担负诊疗人次、人均GDP、重点人群数量对综合效率有正向影响,出院者平均住院日、门急诊病人人均费用对综合效率有负向影响。结论:紧密型医共体试点地区乡镇卫生院运行效率退步,原因主要在于技术进步指数下降,建议完善乡镇卫生院管理制度,提升管理与医疗技术水平,强化医共体信息平台建设,提升乡镇卫生院运行效率。

Objective To analyze the operational efficiency of township health centers and its influencing factors in the pilot areas of compact county-level medical community in Guangxi in recent years,and to put forward relevant countermeasures and suggestions.Methods The Bootstrap-DEA model and Bootstrap-Malmquist model were used to measure the static and dynamic operational efficiency of township health centers in the pilot areas from 2015 to 2020.The Tobit model was used to examine the impact of various factors on the efficiency.Results From 2015 to 2020,the comprehensive efficiency,pure technical efficiency,and scale efficiency of township health centers in the pilot areas were all below 0.9,which did not reach an effective state.The overall productivity remained less than 1 during the 6-year period,which was in a state of regression.The ratio of doctor and nurse,proportion of general practitioners,average daily patient visits per physician,per capita GDP,and the number of key populations had a positive impact on the comprehensive efficiency.The average length of hospital stay for discharged patients,and average cost per outpatient and emergency patients had a negative impact on the comprehensive efficiency.Conclusion The operational efficiency of township health centers in the pilot areas of compact county-level medical community has declined.The reason for the regression is mainly due to the decrease in the index of technological progress.It is recommended to improve the management system of township health centers,enhance the level of management and medical technology,and strengthen the construction of information platform for medical community,in order to improve the operational efficiency of township health centers.