摘要
目的 探究紧密型县域医疗卫生共同体(以下简称县域医共体)中基层医疗机构的运行效率。方法 收集2018年1月—2023年12月A县县域医共体的40家基层医疗机构域监测数据和卫生健康财务年报数据,根据医共体建设推进状态可分为改革前(2018年1月—2020年12月)、改革后(2021年1月—2023年12月),并对各基层医疗机构按照区域邻近情况编号1~10,基于数据包络分析(data envelopment analysis,DEA)分析县域医共体改革前后基层医疗机构总投入和产出情况,运用DEA-Malmquist指数分析基层医疗机构的运行效率及变化趋势。结果 县域医共体改革前,基层医疗机构投入指标总编制床位数和年末专业技术人员数年均增长率分别为1.01%和6.40%,产出指标门诊人次数、出院人次数和各医疗机构总收入年均增长率分别为5.01%、-0.12%和7.21%,投入、产出的平均增长率分别为3.71%和4.03%,产出增长率大于投入增长率。县域医共体改革后,投入指标总编制床位数和年末专业技术人员数年均增长率分别为0.59%和-0.16%,产出指标门诊人次数、出院人次数和各医疗机构总收入年均增长率分别为3.16%、0.98%和0.29%,投入、产出的平均增长率分别为0.22%和1.48%,产出增长率大于投入增长率。DEA-Malmquist指数分析显示,2018—2023年,县域医共体中基层医疗机构技术效率、纯技术效率、规模效率均值均为1.003、1.002、1.001,技术进步率、全要素生产率均值均为1.009和1.011,基层医疗机构全要素生产率总体呈上升趋势,但其中4、7、9号区域基层医疗机构全要素生产率<1。结论 县域医共体基层医疗机构中技术效率、纯技术效率、规模效率变动相对稳定,全要素生产率总体呈上升趋势,且各基层医疗机构全要素生产率的提高主要取决于技术的进步,部分基层医疗机构在运行效率方面还有较大提升空间。
Objective To explore the operational efficiency of primary medical institutions in the county-level medical consortia.Methods Domain monitoring data and health financial annual report data of 40 primary medical institutions in the county A county-level medical consortia were collected from 2018 to 2023.Based on the progress of the medical consortia,it was divided into pre reform(January 2018 December 2020)and post reform(January 2021 December 2023).Primary medical institutions were numbered from 1 to 10 according to regional proximity.The data envelopment analysis(DEA)was used to analyze the total input and output of primary medical institutions before and after the reform of the county-level medical consortia,and the DEA-Malmquist index was used to analyze the operational efficiency and changing trends of primary medical institutions.Results Before the reform of the county-level medical consortia,the average annual growth rates of input indicators such as the total number of beds and professional and technical personnel at the end of the year were 1.01%and 6.40%,respectively,and the average annual growth rates of output indicators such as the number of outpatient visits,the number of discharged patients and the total income of each medical institution were 5.01%,-0.12%and 7.21%,respectively.The average growth rates of input and output were 3.71%and 4.03%,respectively,and the growth rate of output was higher than that of input.After the reform of county-level medical consortia,the average annual growth rates of total number of beds and professional and technical personnel at the end of the year were 0.59%and-0.16%,respectively,and the average annual growth rates of the number of outpatient visits,the number of discharged patients and the total income of each medical institution were 3.16%,0.98%and 0.29%,respectively,and the average growth rates of input and output was 0.22%and 1.48%,respectively,and the growth rate of output was higher than that of input.The DEA-Malmquist index analysis showed that from 2018 to 2023,the average values of technical efficiency,pure technical efficiency and scale efficiency of primary medical institutions in the county-level medical consortia were 1.003,1.002 and 1.001,respectively,and the average values of technological progress rate and total factor productivity were 1.009 and 1.011,respectively.The total factor productivity of primary medical institutions revealed an overall upward trend,but the change of total factor productivity of primary medical institutions in regions 4,7 and 9 was less than 1.Conclusion The changes of technical efficiency,pure technical efficiency,and scale efficiency in the county-level medical consortia are relatively stable,and the overall total factor productivity is on the rise,and the improvement of total factor productivity mainly depends on the progress of technology,and some primary medical institutions still have a large room for improvement in operational efficiency.
作者
李静
温启伟
孙蒙
LI Jing;WEN Qiwei;SUN Meng(Department of Medical Administration,Kaizhou District Health Commission,Chongqing City,Chongqing 500154,China;Department of Comprehensive,Jiulongshan Town Central Health Center,Kaizhou District,Chongqing City,Chongqing 500154,China;Department of Medical Affairs,the People's Hospital of Kaizhou District,Chongqing,Chongqing 500154,China)
出处
《中国卫生标准管理》
2025年第12期76-80,共5页
China Health Standard Management
基金
重庆市开州区科学技术局科技指导性项目(2023-Z-01-69)。
