Impact of slack resources on healthcare costs in tertiary and secondary hospitals: a panel data study of public hospitals in Beijing from 2015 to 2019

Abstract

ObjectiveThis study aims to explore the relationship between slack resources and cost consumption index in tertiary and secondary hospitals and to provide targeted healthcare resource utilisation recommendations for tertiary and secondary hospital managers.DesignThis is a panel data study of 51 public hospitals in Beijing from 2015 to 2019.SettingTertiary and secondary public hospitals in Beijing. Data envelope analysis was used to calculate the slack resources. Regression models were used to explore the relationship between slack resources and healthcare costs.ParticipantsA total of 255 observations were collected from 33 tertiary hospitals and 18 secondary hospitals.Outcome measuresSlack resources and healthcare costs in tertiary and secondary public hospitals in Beijing from 2015 to 2019. Linear or curve relationship between slack resources and healthcare costs in tertiary and secondary hospitals.ResultsThe cost of healthcare in tertiary hospitals has always been higher than in secondary hospitals, and the slack resources in secondary hospitals have always been worse than in tertiary hospitals. For tertiary hospitals, the cubic coefficient of slack resources is significant (β=−12.914, p<0.01) and the R2of cubic regression is increased compared with linear and quadratic regression models, so there is a transposed S-shaped relationship between slack resources and cost consumption index. For secondary hospitals, only the first-order coefficient of slack resources in the linear regression was significant (β=0.179, p<0.05), so slack resources in secondary hospitals were positively related to the cost consumption index.ConclusionsThis study shows that slack resources’ impact on healthcare costs differs in tertiary and secondary public hospitals. For tertiary hospitals, slack should be kept within a reasonable range to control excessive growth in healthcare costs. In secondary hospitals, keeping too many slack resources is not ideal, so managers should adopt strategies to improve competitiveness and service transformation.

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“…In addition, a study has confirmed that tertiary hospitals "siphon" mainly target secondary hospitals rather than primary hospitals [ 27 ]. Tertiary hospitals have been in a favorable position in the competition, while primary hospitals have been supported by national policies, and secondary hospitals are in a " sandwich " predicament [ 28 ]. Secondary hospitals are squeezed by tertiary and primary hospitals in the competition, and are generally in an awkward position with an unfilled workload and unclear positioning, thus leading to no significant change in the flow of patients to secondary hospitals.…”