Bootstrapping Data Envelopment Analysis of Efficiency and Productivity of County Public Hospitals in Eastern, Central, and Western China after the Public Hospital Reform

China implemented the public hospital reform in 2012. This study utilized bootstrapping data envelopment analysis（DEA） to evaluate the technical efficiency（TE） and productivity of county public hospitals in Eastern, Central, and Western China after the 2012 public hospital reform. Data from 127 county public hospitals（39, 45, and 43 in Eastern, Central, and Western China, respectively） were collected during 2012–2015. Changes of TE and productivity over time were estimated by bootstrapping DEA and bootstrapping Malmquist. The disparities in TE and productivity among public hospitals in the three regions of China were compared by Kruskal–Wallis H test and Mann–Whitney U test. The average bias-corrected TE values for the four-year period were 0.6442, 0.5785, 0.6099, and 0.6094 in Eastern, Central, and Western China, and the entire country respectively, with average non-technical efficiency, low pure technical efficiency（PTE）, and high scale efficiency found. Productivity increased by 8.12%, 0.25%, 12.11%, and 11.58% in China and its three regions during 2012–2015, and such increase in productivity resulted from progressive technological changes by 16.42%, 6.32%, 21.08%, and 21.42%, respectively. The TE and PTE of the county hospitals significantly differed among the three regions of China. Eastern and Western China showed significantly higher TE and PTE than Central China. More than 60% of county public hospitals in China and its three areas operated at decreasing return scales. There was a considerable space for TE improvement in county hospitals in China and its three regions. During 2012–2015, the hospitals experienced progressive productivity; however, the PTE changed adversely. Moreover, Central China continuously achieved a significantly lower efficiency score than Eastern and Western China. Decision makers and administrators in China should identify the causes of the observed inefficiencies and take appropriate measures to increase the efficiency of county public hospitals in the three areas of China, especially in Central China.

Data Envelopment Analysis on Evaluating the Efficiency of Public Hospitals in Tianjin,China

Public hospitals are the most important components of health systems and account for a large proportion of health resources in China. However, few researches on the efficiency assessment of public hospitals have been conducted in Tianjin, China. On the basis of the data of annual health service report in 2013 from the Ministry of Health, we measured the relative efficiency of the tertiary general public hospitals in Tianjin and estimated the magnitudes of output increase and/or input reduction by using data envelopment analysis to improve hospital efficiency. The main findings of this study indicate that more than half of the sample hospitals operate at a technical and scale efficiency, and the prevalent scale inefficiency is increasing returns to scale. Moreover, it is a prominent issue that health resource constraint and resource waste coexist. Health policy-makers and hospital administrators would need to address these problems by taking comprehensive measures such as optimizing the allocation of health resources, implementing hierarchical diagnosis and treatment, as well as innovating medical-service operating mechanism of public hospital to improve the people's wellbeing.

Efficiency and Productivity of County-level Public Hospitals Based on the Data Envelopment Analysis Model and Malmquist Index in Anhui, China

Background： China began to implement the national medical and health system and public hospital reforms in 2009 and 2012, respectively. Anhui Province is one of the four pilot provinces, and the medical reform measures received wide attention nationwide. The effectiveness of the above reform needs to get attention. This study aimed to master the efficiency and productivity of county-level public hospitals based on the data envelopment analysis （DEA） model and Malmquist index in Anhui, China, and then provide improvement measures for the future hospital development. Methods： We chose 12 country-level hospitals based on geographical distribution and the economic development level inAnhui Province. Relevant data that were collected in the field and then sorted were provided by the administrative departments of the hospitals. DEA models were used to calculate the dynamic efficiency and Malmquist index factors for the 12 institutions. Results： During 2010-2015, the overall average relative service efficiency of 12 county-level public hospitals was 0.926, and the number of hospitals achieved an effective DEA for each year from 2010 to 2015 was 4, 6, 7, 7, 6, and 8, respectively, as measured using DEA. During this same period, the average overall production efficiency was 0.983, and the total productivity factor had declined. The overall production efficiency of five hospitals was 〉1, and the rest are 〈1 between 2010 and 2015. Conclusions： In 2010-2015, the relative service efficiency of 12 county-level public hospitals in Anhui Province showed a decreasing trend, and the service efficiency of each hospital changed. In the past 6 years, although some hospitals have been effective, the efficiency of the county-level public hospitals in Anhui Province has not improved significantly, and the total factor productivity has not been effectively improved. County-level public hospitals need to combine their own reality to find their own deficiencies.

A New Approach for Ranking Efficient Units in Data Envelopment Analysis and Application to a Sample of Vietnamese Agricultural Bank Branches

This paper proposes a new approach for ranking efficiency units in data envelopment analysis as a modification of the super-efficiency models developed by Tone [1]. The new approach based on slacks-based measure of efficiency (SBM) for dealing with objective function used to classify all of the decision-making units allows the ranking of all inefficient DMUs and overcomes the disadvantages of infeasibility. This method also is applied to rank super-efficient scores for the sample of 145 agricultural bank branches in Viet Nam during 2007-2010. We then compare the estimated results from the new SCI model and the exsisting SBM model by using some statistical tests.

Efficiency measurement of fertilizer-manufacturing organizations usingFuzzy data envelopment analysis

The aim of the paper is to benchmark the performance of the Indian fertilizermanufacturing organizations based on the ranking of efficiencies using a fuzzy data envelopment analysis(FDEA).FDEA has been used to find the relative efficiency and ranking of the fertilizer-manufacturing organizations.The last few years’data have been converted into the fuzzy inputs and outputs as minimum,mean,and maximum values,respectively.The performance of the fertilizer manufacturing organizations is based on the output maximization model of DEA.The frontier organizations set the benchmark for the lagging organizations for further improvement in the performance.This method can also be used to incorporate the data of the several years for multiple inputs and outputs instead of consideration of data of only one year.The proposed approach in this study may help organizations to improve its efficiency to fulfill its goal.

A point-wise minimization model for data envelopment analysis considering environmental variables

Environmental variables are widely recognized as a cause of differences in efficiency measurement.However,the existing literature on data envelopment analysis(DEA)in environmental factors ignores the impact of demand on output.To address this gap,we propose the Point-wise Minimization DEA model(PWMDEA),which considers contextual variables that affect demand and lead to differences in efficiency.The model obtains efficiency value by considering the minimum of virtual inputs and virtual demand.Then,efficiency is evaluated by minimizing the ratio of above minimum to virtual output.This one-step model avoids issues of multi-stage assumptions and requires less data,making it more applicable.Moreover,we demonstrate the accuracy of our new model by conducting simulations with given true efficiency values.The simulation results demonstrate that our model has the lowest ranking error when the output is affected by multiple inputs or when demand has a significant impact.In addition,we evaluate the efficiency of healthcare in 31 Chinese provinces by considering two environmental factors.The results suggest that provinces with lower financial investments or population loss received higher rankings from our proposed model.These findings provide plausible explanations and demonstrate the practical usefulness of our model.

The Correlation of Hospital Operational Efficiency and Average Length of Stay in China: A Study Based on Provincial Level Data

Objective: To measure the hospital operation efficiency, study the correlation between average length of stay and hospital operation efficiency, analyze the importance of shortening average length of stay to the improvement of the hospital operation efficiency and put forward relevant policy suggestion. Methods: Based on China provincial panel data from 2003 to 2012, the hospital operation efficiencies are calculated using Super Efficiency Data Envelopment Analysis model, and the correlation between average length of stay and hospital operation efficiency is tested using Spearman rank correlation coefficient test. Results: From 2003 to 2012, the average of national hospital operation efficiency was increasing slowly and the hospital operations were inefficient in most of the areas. The national hospital operation efficiency is negatively correlated to the average length of stay. Conclusion: Measures should be taken to set average length of stay in a scientific and reasonable way, improve social and economic benefits based on the improvement of efficiency.

基于波士顿矩阵分析法的区域医院科技创新效率研究

目的通过客观评价了解区域医院科技创新效率,推动医院医学学科建设,为医院争创国家区域医疗中心的建设目标提供助力。方法基于医院科技量值指标体系,选取深圳市67家三级医院作为研究对象,分析医院科技创新发展情况,利用波士顿矩阵分析法反映医院科技创新效率。结果深圳市医院间科技创新效率有较大差距:6家医院以相对低的科技投入产生了较高的科技产出,科技创新效率最好;13家医院以较高的科技投入产生了较高的科技产出,具有较好的科技创新效率,科技产出仍可再提升;1家医院科技投入高而科技产出较低,具有较低的科技创新效率,在科技产出方面仍有较大提升空间;47家医院科技投入较低且科技产出也较低,在科技投入及科技产出两个维度仍需发力。结论应依据城市经济高质量发展水平,加强医院科技创新投入水平,引导产出高质量医学科技成果,提升医院科技创新效率。

基于改进三阶段松弛测量-数据包络模型的火电上市公司碳排放效率评估研究

【目的】计算火电上市公司的碳排放效率,对比分析效率排名居后的原因及排名前列的驱动因素,根据差异性条件对火电公司进行分组,探讨造成效率差异的影响因素。【方法】基于非期望产出的改进三阶段松弛值测量(slackbasedmeasure, SBM)-数据包络分析(data envelopment analysis,DEA)模型评估中国火电上市公司2016—2022年全要素碳排放效率。【结果】火电上市公司的碳排放效率逐年递增,并在剔除外部环境影响后整体下降。增加政府环保补贴可能会引发火电公司资本、人员和煤炭过度投入;增加地区研发投入对公司资产、人员和煤耗量具有积极作用;区域经济水平的提高会促进企业资产优化配置和人员有效管理,但会导致发电煤耗量的浪费。【结论】中央实控、低煤耗率和有碳排放交易的火电上市公司技术差距率更高,整体碳排放效率水平更优。

基于DEA模型的多院区医院临床科室运行效率分析

目的:分析多院区医院临床科室运行效率,为完善多院区协同发展机制提供参考。方法:运用数据包络分析中的BCC模型和Malmquist生产率指数模型,分析多院区医院临床科室运行效率。结果:不同院区同一临床科室综合效率存在差异;效率相对较低的科室主要在于规模不合理或组织管理水平不高;分院区相关科室技术进步明显,而组织管理和规模经济短期受到影响。结论:多院区医院要发挥优势学科辐射带动作用,提升“非有效”科室的组织管理水平,探索适宜发展的规模;结合不同院区功能定位和科室发展特征,合理规划和布局各项医疗资源,推动医院高质量发展。

基于数据包络分析的中国污染地块治理绩效评价研究

中国高速的城市化进程产生了大量工业企业搬迁,造成众多污染地块需要治理。中国为治理污染地块耗资巨大,但缺乏相关的绩效评价。筛选了40个典型污染地块治理工程(涉及全国33个区县)进行绩效评价并探究了污染地块治理绩效的影响因素。结果表明:(1)山东省、河北省及湖南省中南部地区的污染地块治理绩效较高,重庆市、湖南省等华中地区及东南沿海地区零星有一些污染地块治理绩效相对较低。(2)地块尺度,资金投入不足、时间投入过短、人员投入过少是影响污染地块治理绩效的重要因素,期望产出方面也仍有很大提升空间,非期望产出方面需要进一步控制污染排放。(3)区县尺度,污染地块治理绩效主要与工业增加值占国内生产总值比例和年末总人口呈显著(p<0.05)正相关,说明经济和人口是主要影响因素。

基于DEA的三级公立医院手术科室效率研究

目的中国公立医院进入高质量发展的新时代,各医院手术数量不断攀升,管理部门亟需引进一套科学评价手术科室资源效率的工具,促使医院充分利用现有手术资源。方法数据包络分析法(data envelopment analysis,DEA)对投入产出效率进行评价。以中国首批高质量发展试点单位北京市某三甲医院为例,投入量为手术科室的医护人数、床位数量、专用设备原值,产出量为经过CMI校正的手术量和出院人数。结果通过DEA模型分析,发现该医院只有K7、K9两个科室实现DEA有效,K1、K2纯技术效率过低,说明未充分利用现有手术资源。从规模效益上看,K3、K6处于递减状态,K7、K9不变,其余科室递增。通过Malmquist指数对技术效率和规模效率进行动态评价,结果显示,除新冠疫情影响期间外,其余期间均处于全要素增长率递增状态。文章也计算了各投入产出的松弛变量,精确得出应调整的生产资料投入值和产出工作量的数值。结论案例医院各手术科室效率参差不齐,决策层应对未充分利用手术资源的科室给予指导;对实现DEA有效的科室,在手术资源分配上给予适当倾斜。

Comparative Study of Three Commonly Used Methods for Hospital Efficiency Analysis in Beijing Tertiary Public Hospitals, China

Background： Tertiary hospitals serve as the medical service center within the region and play an important role in the medical and health service system. They are also the key targets of public hospital reform in the new era in China. Through the reform of health system, the public hospital efficiency has changed remarkably. Therefore, this study aimed to provide some advice for efficiency assessment of public hospitals in China by comparing and analyzing the consistency of results obtained by three commonly used methods for examining hospital efficiency, that is, ratio analysis （RA）, stochastic frontier analysis （SFA）, and data envelopment analysis （DEA）. Methods： The theoretical basis, operational processes, and the application status of RA, SFA, and DEA were learned through literature analysis. Then, the empirical analysis was conducted based on measured data from 51 tertiary public hospitals in Beijing from 2009 to 2011. Results： The average values of hospital efficiency calculated by SFA with index screening and principal component analysis （PCA） results and those calculated by DEA with index screening results were relatively stable. The efficiency of specialized hospitals was higher than that of general hospitals and that of traditional Chinese medicine hospitals. The results obtained by SFA with index screening results and the results obtained by S FA with PCA results showed a relatively high correlation （r-value in 2009, 2010, and 2011 were 0.869, 0.753, and 0.842, respectively, P 〈 0.01）. The correlation between results obtained by DEA with index screening results and PCA results and results obtained by other methods showed statistical significance, but the correlation between results obtained by DEA with index screening results and PCA results was lower than that between results obtained by SFA with index screening results and PCA results. Conclusions： RA is not suitable for multi-index evaluation of hospital efficiency. In the given conditions, SFA is a stable efficiency analysis method. In the evaluation of hospital efficiency, DEA combined with PCA should be adopted with caution due to its poor stability.

基于DEA-Malmquist指数模型的我国中医医院服务效率评价研究

目的评价2017—2023年全国30个省(区、市)中医医院的服务效率,为促进中医医院高质量发展提供参考。方法运用数据包络分析法中的BCC模型和Malmquist指数模型测算全国中医医院服务效率的静态和动态变化,利用时间序列预测法预测2022—2023年的指标变化并进行动态评价。结果2021年全国中医医院的综合效率均值为0.852,50%的省(区、市)处于DEA无效状态,2017—2021年全国中医医院的总体服务效率呈现下降态势,全要素生产率指数均值为0.958,平均下降4.2%,东、中、西部地区的指数均值分别为0.978、0.946和0.951,3大地区均出现不同程度的下降,经预测分析后的2017—2023年整体效率变化趋势不大。结论全国中医医院的总体服务效率处于较低水平,且区域发展差异明显,其中技术进步指数是一项重要影响因素。各省(区、市)应合理控制中医医院的发展规模,不断推动技术进步,提高资源利用率,逐步缩小地区差异,进而提升中医医院的服务效率。

基于两阶段中立型交叉效率和Shannon熵的公交服务效益评价:利益相关者视角

为了获得高区分度、更准确的公交服务效益评价结果,提出了一种基于两阶段中立型交叉效率和Shannon熵集结模型的组合评价方法。基于网络数据包络分析模型得到两阶段中立型交叉效率模型中的自评结果,在此基础上测算出互评结果,利用Shannon熵集结模型将自评与互评结果集结得出最终交叉效率值。从公交企业、公众和政府三方利益相关者的角度构建了公交服务效益评价指标体系,对2011~2016年间“长三角”地区案例进行研究。结果表明:大多数公交企业的运营状况均不佳,但综合效益总体上在缓慢提升;服务过程评价结果显著优于生产过程评价结果;小型规模公交企业综合效益最高,其次是中型规模企业,而大型规模企业最低;政府大量的补贴和公交企业过量的资源投入会对效益产生负面影响。

基于DEA-Tobit模型的华东地区公共体育服务效率研究

公共体育服务是政府为满足公民体育需求所提供的一种体育服务措施,而效率评价是衡量其发展的重要手段。科学的公共体育服务效率评价,能够客观清晰地反映公共体育服务发展情况。构建DEA模型对2016—2018年我国华东地区六省一市的公共体育服务效率评价指标进行测算分析,并运用Tobit模型进行实证检验,探究可能对公共体育服务效率带来影响的外部因素。结果显示:(1)华东地区2016—2018年公共体育服务综合效率值为0.931,纯技术效率值为0.992,规模效率值为0.937,规模报酬呈现递减趋势;(2)地区经济发展水平、人口密度和体育管理人员规模与公共体育服务效率呈正相关,与受教育水平呈负相关。根据研究结果分析华东地区公共体育服务效率问题与差距,提出以下对策建议:减少区域短板,促进协同发展;调整资源配置,提升供给质量;健全监督机制,完善管理体系。

广西民营医院运行效率及影响因素研究

目的分析广西二级及以上民营医院运行效率及其影响因素,为优化广西医疗卫生资源配置并推动广西民营医院高质量发展提供参考建议。方法通过问卷调查收集民营医院运行数据,分别采用DEA法和Tobit回归模型测算效率、探究影响因素。结果专科民营医院及综合民营医院综合效率均值、纯技术效率均值、规模效率均值分别为0.612和0.646、0.799和0.770、0.748和0.820。14个地市中仅有崇左市为DEA有效。非DEA有效医院投入冗余主要为万元以上设备总价值及实际开放床位数,设备及床位资源利用率有待提高;门急诊人次数产出不足率均值>100%,是民营医院产出不足的主要方面。是否为医保定点与专科、综合民营医院效率均成负向关系;患者次均诊疗费用、住院费用及人均GDP与专科、综合民营医院效率均成负向关系;人口密度与专科、综合民营医院分别成负向、正向关系;药占比及平均床位使用率与综合民营医院成正向关系。结论民营医院效率存在区域差异且环境因素对医院效率影响显著,规模扩张时应充分考虑外部因素的差异性,强化其战略布局及优化配置。专科民营医院与综合民营医院效率低下且原因各异,应精准施策以提升效率。医疗费用过高不利于患者的就医选择和医院发展,应提高服务效率及控费效果。

基于DEA-Malmquist指数的江苏省三级甲等公立中医医院运行效率研究

目的:研究2018—2020年江苏省三级甲等公立中医医院(三甲公立中医院)运行效率状况,为改善中医院医疗服务效率提供参考。方法:基于2018—2020年江苏省卫生资源与医疗服务调查内部资料,运用DEA-Malmquist指数法分析2018—2020年江苏省三甲公立中医院全要素生产率。结果:2018—2020年,江苏省三甲公立中医院综合效率均值为0.965,纯技术效率均值为0.986,规模效率均值为0.977;2018—2020年江苏省三甲公立中医院全要素生产率变化指数上升27.80%,技术效率变化指数上升2.60%,技术变化指数上升23.80%,纯技术效率变化指数上升1.90%,规模效率变化指数上升0.60%。结论:样本期内江苏省三甲公立中医院运行效率呈下降趋势;区域间三甲公立中医院全要素生产效率存在差异,而技术进步是推动全要素生产率提高的关键因素。须激活三甲公立中医院发展新动力,推动全要素生产效率提升。