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 in Anhui 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.
Background and purposeDrug costs is one of the main components of hospitalization expenditure for cerebral infarction inpatients. In China, the National Essential Medicine System (NEMS) was created to relieve the heavy drug-cost burden for patients. The objective of this study was to investigate essential drug-use status and its influencing factors among cerebral infarction inpatients in county-level hospitals of Anhui province, China.MethodsThree county-level hospitals were selected through a multi-stage cluster random sampling method. The hospitalization cost data of cerebral infarction inpatients in the three hospitals were extracted from the Anhui provincial information platform of the New Rural Cooperative Insurance System (NCMS), and whether the proportion of essential drug cost in the total drug cost reached the median value of 33.05% which was set as the evaluation index for essential drug-use status. Questionnaires for hospitals and physicians were designed and given to them to assess influencing factors.ResultsWe retrieved the cost data of 2,189 inpatients from the NCMS platform and investigated 51 corresponding physicians in total. The drug costs accounted for 52.6% of the total hospitalization cost, and essential drug costs alone accounted for 37.0% of the total drug costs. The essential drug-cost proportion was high among physicians with a higher recognition degree on NEMS, older age, lower final academic degree, longer work experience and lower professional title. Married physicians and those with tight organizational affiliation also prescribed more essential drugs.ConclusionsIncreasing the proportion of essential drugs was an effective way to reduce the disease burden for cerebral infarction patients. Perfecting the NEMS, increasing government investment, reinforcing education and propaganda, and formulating relevant incentive and restrictive mechanisms were all effective ways to promote and increase the number of essential drug prescriptions written by physicians.
BackgroundCounty-level public hospitals play an important role in China's medical tertiary health care network. Since a new round of medical reforms occurred in 2009, county-level public hospitals have conducted continuous exploration and reforms. To analyze the efficiency and productivity of 36 county-level public hospitals based three provinces in China.Methods.We randomly selected 12 county-level hospitals from each 3 provinces based on economic levels and regional differences in China, finally, a total of 36 county-level hospitals were chosen, and a self-made questionnaire was used to investigate hospital operations for collecting data from 2011 to 2015. 2011–2015 is the twelfth five-year period of China's national economic and social development. Four input indicators and three output indicators were selected. Data envelopment analysis and the Malmquist index methods were used to measure the efficiency and productivity by the key indicators for each region.Results.On average, four input indicators in three regions have continued to grow from 2011 to 2015. The output in the three regions is directly proportional to the upward trend in inputs. On average, the three output indicators of hospitals in the eastern region are higher than the central and western regions. The technical efficiency of county-level public hospitals in the central, eastern, and western regions of China were on an upward trend, and the number of the technical efficiency, the pure technical efficiency, and the scale efficiency values reaching 1 in the three regions was more than half, respectively. The average of total factor productivity change for 2011–2015 in the central, eastern, and western regions was 1.016, 0.997, and 0.930, respectively.Conclusions.The efficiency of the central Chinese region was mainly affected by pure technical efficiency; however, scale efficiency changed to affect the efficiency of the eastern and western hospitals in 2015. The increase in production efficiency in the central region was driven by the technical efficiency. In the future hospital management, management innovation needs to be strengthened. The decline in productivity in the eastern region was due to the decline in the technical efficiency. At present, the eastern region pays attention to management innovation, but it is necessary to be alert to the adverse consequences of the expansion of hospital scale. The decline in productivity in the western region was due to the decline in the technological efficiency and technical efficiency. The hospitals should strengthen hospital management and blind scale expansion. Financial subsidies in the western region have a significant role in promoting the development of hospitals. The internal management innovation of hospitals in the eastern region has a positive effect on the technical efficiency of hospitals. The medical reform measures in the central region have positively promoted the efficiency of hospitals.
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