县级公立医院综合改革实施前后医院生产率变化的研究

Research on Hospital Productivity before and after the Implementation of County-Level Public Hospital Comprehensive Reform

目的:研究县级公立医院综合改革政策实施前后山东省县级公立医院生产率变化情况。方法:选取代表医院投入的人、财、物指标,代表医院产出的年门诊总量、年住院总量等产出指标,使用Deap 2.1软件,分析10个县级公立医院从2010—2013年4年间的全要素生产率变化、技术效率变化和规模效率变化。结果:在县级公立医院综合改革前后山东省县级医院全要素生产率变化不显著;试点期的技术效率平均值低于试点前(effch试点期=0.990,effch试点前=1.020,t=2.188,P=0.021);试点期的技术进步平均值要高于试点前(tech试点期=0.980,tech试点前=1.032,t=-2.075,P=0.029);试点期对试点医院和非试点医院的全要素生产率、技术效率和技术进步等比较无差异。结论:县级公立医院综合改革政策的核心措施取消药品加成,起到了切断医院的"以药补医"顽疾的作用,有效的促进了医院医疗技术的提高,对实现医生的医疗服务价值有重要意义。

Objective:To evaluate the productivity change status of county-level public hospitals in Shandong before and afterthe implementation of the comprehensive reform of county-level public hospitals.Methods:Human, finance and materials werechose to stand for hospital input. Production indexes like yearly outpatient amount and yearly inpatient amount were chose as hospitalproduction. DEAP 2.1 Software was used to analyze the whole factor productivity change, technical efficiency change and scale effi-ciency change of 10 county-level hospitals from 2010 to 2013.Results:There was no obvious change in the whole factor productivi-ty change in Shandong county-level hospitals before and after the implementation of the comprehensive reform of county-level publichospitals; the average value of technical efficiency during the pilot period was lower than that before the pilot(effch pilot period=0.990, effch before pilot=1.020, t=2.188, P=0.021); the average technical progress value during pilot period was higher than that be-fore the pilot(effch pilot period=0.980, effch before pilot=1.032, t=-2.075, P=0.029); the comparison of pilot period for whole factorproductivity, technical efficiency and technical progress in the pilot hospital and the non-pilot hospital had no difference.Conclusion:As the core measures of county-level public hospital comprehensive reform policy, canceling the drug addition played its roleof cutting off the hospital's illness of 'using drugs to support health care costs', which effectively promoted the hospital medicaltechnology improvement and had important significance for realizing medical service value.