Configurational Paths to Higher Efficiency in County Hospital: Evidence From Qualitative Comparative Analysis

ObjectivesChina has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.MethodsAn interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.ResultsAfter the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = −1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09).ConclusionThe Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Section: Discussionmentioning

confidence: 99%

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

Yang,

Chen,

et al. 2024

“…Although the central government has prioritized the least developed western region for central financial subsidies, the central developing region has been struggling with limited financial capacities ( 47 ). Rural county hospitals play a pivotal role in the Chinese healthcare system ( 48 ). They not only lead the three-tier healthcare delivery system for rural residents, but also serve as a liaising platform for tertiary hospitals (all metropolitan) to reach rural consumers ( 49 ).…”

Section: Discussionmentioning

confidence: 99%

Self-reported work-related accumulative fatigue of nurses: A cross-sectional study in public hospitals in China

Tang

Chen

Gong

et al. 2022

ObjectivesWork-related fatigue is a serious safety risk to nurses and their patients. This study aimed to assess self-reported work-related accumulative fatigue of nurses and its associated factors.MethodsA questionnaire survey of 2,918 clinical nurses conveniently sampled from 48 public hospitals across six provinces in China was conducted. The “Self-diagnosis Checklist for Assessment of Workers' Accumulated Fatigue” was adopted to assess the level of work-related accumulative fatigue of the study participants. Chi-square tests and ordinal regression analyses were performed to determine the sociodemographic characteristics associated with work-related accumulative fatigue.ResultsAbout one third of respondents reported low work-related accumulative fatigue, compared with 23.1% reporting high and 24.6% reporting very high levels of work-related accumulative fatigue. Higher levels of work-related accumulative fatigue were associated with female gender (AOR = 0.614 for male relative to female, p = 0.005), age between 30 and 40 years (AOR = 1.346 relative to >40 years, p = 0.034), 5–10 years of work experience (AOR = 1.277 relative to >10 years, p = 0.034), and bachelor or above degree qualifications (AOR = 0.806 for associate degree relative to bachelor or above degree, p = 0.007). Those who worked in rural county hospitals (AOR = 0.816 for metropolitan relative to rural county hospitals, p = 0.006) and resided in central China (AOR = 1.276 relative to western China, p = 0.004) had higher odds of reporting higher levels of work-related accumulative fatigue.ConclusionHigh levels of work-related accumulative fatigue are evident in nurses of public hospitals in China. The problem is more serious in the female nurses in their mid-career and those who worked in the central region and rural setting.

“…Jing et al (30) evaluated the technical efficiency of public and private hospitals in Beijing, China. After the reform of China's medical system, the public sector have been concerned about the efficiency of primary health services (31)(32)(33)(34), while ignoring the services of hospitals above the second level.…”

Section: Introductionmentioning

confidence: 99%

Measuring the efficiency of public hospitals: A multistage data envelopment analysis in Fujian Province, China

Sun

Ye²,

Zhang³

et al. 2023

ObjectiveThe present study aimed to evaluate the operational efficiency of public hospitals in Fujian Province and the factors responsible for the inefficiency of these hospitals and provide relevant suggestions for health policymakers in allocating service resources.MethodIn the first stage of the research, the variables affecting the efficiency of hospitals were extracted by qualitative and quantitative methods, including literature optimization, gray related analysis and gray clustering evaluation. In the second stage, the data envelopment analysis (DEA) method was used to evaluate the operational efficiency of 49 hospitals of different levels and types selected by sampling in 2020. Finally, a Tobit regression model with introduced institutional factors and background factors was established to study the main influencing factors of hospital inefficiency.ResultsIn the first stage, 10 input variables and 10 output variables necessary from the mangers' point of view were identified to test efficiency. In the second stage, the average comprehensive TE, PTE, and SE of 49 sample hospitals was 0.802, 0.888, and 0.902, respectively. 22.45% of these hospitals met the effective criteria, i.e., the overall effective rate was 22.45%. The low SE value of the hospital was the main reason hindering the improvement of the comprehensive efficiency value. The overall effective rate of secondary public hospitals (30.77%) was higher than that of tertiary public hospitals (19.44%), and the overall effective rate of public specialized hospitals (30%) was higher than that of general public hospitals (18.92%). Based on the third stage results, the bed occupancy rate (BOR) and the proportion of beds (POB) were major factors affecting the operation efficiency of grade III hospitals (p < 0.01). However, the operating efficiency of grade II hospitals was significantly affected by POB and regional per capita GDP(GDPPC) (p < 0.05). Moreover, the impact of BOR and GDPPC was positive, and POB was negatively correlated with hospital operation efficiency.ConclusionsThe study results indicated that the overall operation efficiency of public hospitals in Fujian Province is low. This study revealed that intervention should be strengthened from a policy and management perspective to improve the operation efficiency of public hospitals.