基于数据包络分析的各地区医疗机构效率评价
摘要
医疗机构在现代社会的作用是十分重要的。在人民生活水平提高的同时,人民对医疗机构提供的服务也提出了更高的要求。而我国所处发展阶段的现实与人民日益增长的对医疗机构的需求产生了很大的矛盾。一方面虽然国家的医疗投入逐年提高,但是仍不能满足人民对医疗服务的需求；另一方面,我国现阶段的医疗领域存在比较明显的效率低下现象,设备利用率低下、病床利用率低下等现象十分突出。因此单方面的增加卫生支出不是提高卫生服务的有效办法,如何提高医疗机构的效率对于提供更多更好的卫生服务有至关重要的意义。本文希望通过评价现有条件下医疗机构的效率,为医疗机构改善自身经营提供建议,从而帮助医疗机构在现有条件下提供更好的医疗服务。
本文首先对医疗机构效率进行了界定,分析了国际和国内对医疗机构效率的研究近况,然后将线性规划中的效率研究方法——数据包络分析法(Data Envelopment Analysis,简称DEA)引入到医疗机构效率评价中,介绍了DEA方法数学原理,分析了DEA方法的特点以及用于医疗机构效率评价时的优势。
本文详细介绍了DEA方法选择指标的综合性、重要性、可比性、简洁性等原则,并在此原则基础上结合以前学者的经验选择了诊疗人次、入院人次、健康检查人次、危重病人抢救成功人次、资产总额、执业医师人数、注册护士人数、其他管理人员人数8项投入、产出指标,运用BCC方法分析了2003-2008年我国各地区医疗机构效率状况,计算出各地区效率值,分析了2003-2008年各年效率均值、投入冗余均值和产出不足均值的变化情况,并结合数据给出了各地区改进的建议。运用独立两样本t检验分析了东部、中部、西部3个地域的效率状况,得出中部较东部、西部地区效率值偏低的结论。本文又通过对有效前沿面数据与其他数据的比较,分析了效率值为1的5个地区收入、支出、医疗机构规模配置情况,将这5个地区的收入、支出、医疗机构规模配置指标与其余地区的相应指标进行比较,得出了高效率地区收入支出比的特点.
Medical institutions have played an important role in the modern society. With the improvement of people's living standard, people show more concern about the medical institutions'services. But as China is a developing country, although the public finance investing in medical institutions have grew every year, it can not provides enough medical fund. On the other hand, there is a big medical inefficiency among the medical institutions, known as low equipment utilization and low bed utilization. So how to improve the medical institutions'efficiency to provide a better medical service based on existing condition is an important solution to the problem.
This paper had given a definition of medical institutions' efficiency, and then analyzed the background of researching medical institutions'efficiency. After that, this paper introduced Data Envelopment Analysis (DEA) for the analysis of medical institutions'efficiency, the author introduced the principal of DEA method, and the usage and development of DEA method. And the author analyzed the advantage of DEA method in measuring medical institution's efficiency.
This paper had analyzed the principals of choosing indexes in DEA method, like important, comprehensive, comparable and simple. Based on the principals and other former experiences, the author chose diagnosis person-time, in hospital person-time, health exam, successful rescue of critical patients, total asset, qualified doctors, qualified nurses, and other management staff. This paper used BCC method to assessing medical institutions'efficiency during 2003 to 2008 among difference provinces in China, tried to find the target value of all the input and output variables, and gives advices in difference provinces. The author used Independent-Sample T Test to test whether there is difference between east middle and west China, and found out that middle China was lower efficient than east and west China. This paper had tried to find out the peculiarity of high efficiency areas, and found the peculiar income and outcome relation among high efficiency areas.
本文首先对医疗机构效率进行了界定,分析了国际和国内对医疗机构效率的研究近况,然后将线性规划中的效率研究方法——数据包络分析法(Data Envelopment Analysis,简称DEA)引入到医疗机构效率评价中,介绍了DEA方法数学原理,分析了DEA方法的特点以及用于医疗机构效率评价时的优势。
本文详细介绍了DEA方法选择指标的综合性、重要性、可比性、简洁性等原则,并在此原则基础上结合以前学者的经验选择了诊疗人次、入院人次、健康检查人次、危重病人抢救成功人次、资产总额、执业医师人数、注册护士人数、其他管理人员人数8项投入、产出指标,运用BCC方法分析了2003-2008年我国各地区医疗机构效率状况,计算出各地区效率值,分析了2003-2008年各年效率均值、投入冗余均值和产出不足均值的变化情况,并结合数据给出了各地区改进的建议。运用独立两样本t检验分析了东部、中部、西部3个地域的效率状况,得出中部较东部、西部地区效率值偏低的结论。本文又通过对有效前沿面数据与其他数据的比较,分析了效率值为1的5个地区收入、支出、医疗机构规模配置情况,将这5个地区的收入、支出、医疗机构规模配置指标与其余地区的相应指标进行比较,得出了高效率地区收入支出比的特点.
Medical institutions have played an important role in the modern society. With the improvement of people's living standard, people show more concern about the medical institutions'services. But as China is a developing country, although the public finance investing in medical institutions have grew every year, it can not provides enough medical fund. On the other hand, there is a big medical inefficiency among the medical institutions, known as low equipment utilization and low bed utilization. So how to improve the medical institutions'efficiency to provide a better medical service based on existing condition is an important solution to the problem.
This paper had given a definition of medical institutions' efficiency, and then analyzed the background of researching medical institutions'efficiency. After that, this paper introduced Data Envelopment Analysis (DEA) for the analysis of medical institutions'efficiency, the author introduced the principal of DEA method, and the usage and development of DEA method. And the author analyzed the advantage of DEA method in measuring medical institution's efficiency.
This paper had analyzed the principals of choosing indexes in DEA method, like important, comprehensive, comparable and simple. Based on the principals and other former experiences, the author chose diagnosis person-time, in hospital person-time, health exam, successful rescue of critical patients, total asset, qualified doctors, qualified nurses, and other management staff. This paper used BCC method to assessing medical institutions'efficiency during 2003 to 2008 among difference provinces in China, tried to find the target value of all the input and output variables, and gives advices in difference provinces. The author used Independent-Sample T Test to test whether there is difference between east middle and west China, and found out that middle China was lower efficient than east and west China. This paper had tried to find out the peculiarity of high efficiency areas, and found the peculiar income and outcome relation among high efficiency areas.
引文
1 王绍光,中国公共卫生的危机与转机,2003
[1]Alessandro Schiavone, Technical Efficiency of Italian Public Hospitals [J], Bank of Italy, Occasional Paper No.29,2009
[2]A. Charnes, W. W.Cooper,et al, Invariant multiplicative efficiency and piecewise cobb-douglass envelopment[J], Operations Research letters,1983,2(3):38-49.
[3]Antonio Afonso,Sonia Fernandes, Assessing Hospital Efficiency:Non-parametric Evidence for, Portugal[J], SEG-UTL Economics Working Paper No.07/2008/DE/UECE,2008
[4]Antonio Afonso and Sonia Fernandes, Assessing and Explaining the Relative Efficiency of Local Government [J], Journal of Socio-Economics, Vol.37, No.5, pp.1946-1979,2008
[5]Antonio Afonso and Miguel St. Aubyn, Relative Efficiency of Health Provision:A DEA Approach with Non-Discretionary Inputs [J], ISEG-UTL Economics Working Paper No.33/2006/DE/UECE,2006
[6]Antonio Afonso and Miguel St. Aubyn, Non-parametric Approaches to Education and Health Expenditure Efficiency in OECD Countries [J], ISEG-UTL Economics Working Paper No. 1/2004/DE/CISEP/UECE,2004
[7]Bernd Helmig and Irvine Lapsley, On the Efficiency of Public, Welfare and Private Hospitals in Germany Over Time-A Sectoral DEA-Study [J], Health Services Management Research, Vol.14, pp. 263-274,2001
[8]Chilingerian J. A. et al, Managing Physician Efficiency and Effectiveness in Providing Hospital Service[J], Health Service Management,1990,3 (1):3～15
[9]Chris Tofallis,ombining Two Approaches to Efficiency Measurement [J], Journal of the Operational Research Society, Vol. 52, No.11, pp.1225-1231,2001
[10]Dr. Bernd Helmig, Prof. Dr. Irvine Lapsley, On the Efficiency of Public, Welfare and Private Hospitals in Germany Over Time-A Sectoral DEA-Study[J], Health Serve Management Res, Nov14, 263-274,2001
[11]Grosskopf S. et al. Measuring Hospital Performance:A Non parametric Approach [J], Journal of Health Economics,1987,6 (2) 89-107
[12]James F. Nolan, Adrian T. Moore and Geoffrey Segal, Putting out the Trash:Measuring Municipal Service Efficiency in U. S. Cities [D], University of Saskatchewan-College of Agriculture,2003
[13]Jarmo Vakkuri, Research Techniques and Their Use in Managing Non-profit Organisations-An Illustration of DEA Analysis in NPO Environments[J], Financial Accountability & Management, Vol.19, pp.243-263,2003
[14]Jian Wang, Zhong Zhao, Amir Mahmood, Relative Efficiency, Scale Effect, and Scope Effect of Public Hospitals[J], Institute for the Study of Labor, No.2520,2006
[15]Jonas Mansson, How Can We Use the Result from a DEA Analysis? Identification of Firm-Relevant Reference Units [J], Journal of Applied Economics, Vol.6, No.1, pp.157-175,2003
[16]Laurens Cherchye and Thierry Post, Methodological Advances in Dea[J], ERIM Report Series Reference, No. ERS-2001-53-F&A, 2010
[17]M. J. Farrell, The Measurement of Productive Efficiency[J], Journal of the Royal Statistical Society[J], Series A (General),1957, Vol.120,253-290
[18]Magnus A. Bjorkgren and Brant E. Fries, Applying RUG-Ⅲ for reimbursement of nursing facility care[J], International Journal of Healthcare Technology and Management,2006, Volume 7,82-99
[19]Mickael Lothgren and Magnus Tambour, Bootstrapping DEA-Based Efficiency Measures and Malmquist Productivity Indices: A Study of Swedish Eye-Care Service Provision [J], Stockholm School of Economics, WPS 78,2008
[20]Matthias Rene Staat and Maik Hammerschmidt, Product Performance Evaluation-A Super-Efficiency Model, International Journal of Business Performance Management, Vol.7, No.3,2005
[21]Oliver Tiemann and Schreyoegg Jonas, Effects of Ownership on Hospital Efficiency in Germany[J], BuR Business Research Journal, Vol.2, No.2,2009
[22]R. D. Banker, A. Charnes and W. W. Cooper, Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis[J], Management Science,1984, Vol.30No.9,1078-1092
[23]Said Gattoufi, Muhittin Oral and Arnold Reisman, A Taxonomy for Data Envelopment Analysis [J], Socio-Economic Planning Sciences, Vol.38, No.2-3, pp.115-232,,2004
[24]Santiago Herrera and Gaobo Pang, Efficiency of Public Spending in Developing Countries:An Efficiency Frontier Approach [J], World Bank Policy Research Working Paper No.3645,2005
[25]Thomas R. Sexton, Alan M. Leiken, Arlene H. Nolan, Shari Liss, Andrew Hogan and Richard H. Silkman, Evaluating Managerial Efficiency of Veterans Administration Medical Centers Using Data Envelopment Analysis[J], Medical Care,1989, Vol.27 No.12, 1175-1188
[26]Valdmanis B. G. et al, Ownership and Technical Efficiency of Hospital [J], Medical Care,1990 vol 28 (6),552～561
[27]Vincenzo Rebba, Dino Rizzi, Measuring Hospital Efficiency through Data EnvelopmentAnalysis when Policy-makers'Preferences Matter[J], University Ca' Foscari of Venice, Dept. of Economics Research Paper Series No.13/06,2006
[28]Yasar A. Ozcan, Roice D. Luke and Cengiz Haksever, Ownership and Organizational Performance:A Comparison of Technical Efficiency across Hospital Types [J], Medical Care,1992, Vol.30, No.9, 781-794
[29]Yasar A. Ozcan, Michael J McCue and Ahmad A Okasha, Measuring the technical efficiency of psychiatric hospitals[J], Journal of Medical Systems,1996, Vol20,141-150
[30]Louis Rubino,魏东海,美国医院战略选择的内外环境制约与绩效评估[J],中国医院管理,2001,21(3)：59-60
[31]陈志兴、沈晓初、王萍、王炼、邓建申,评价医院经济效益的力点[J],中华医院管理杂志》1994年12期
[32]郭磊.综合变量DEA方法及其应用研究[D],大连理工大学.2005.
[33]孔超,浦东新区卫生资源配置研究[D],复旦大学,2009
[34]李建发、张曾莲,基于财务视角的政府绩效报告的构建[J],会计研究,2009.6,11-17
[35]李美娟、陈国宏,数据包络分析法(DEA)的研究与应用[J],中国工程科学,2003,5,88—94
[36]刘萌,改进后的综合DEA模型及其灵敏度分析[D],上海交通大学,2007
[37]林皓、金祥荣,政府投入与我国医院效率的变化[J],经济学家,2007.2,77-83[9]邱亭林、石光不同产权制度下医院效率比较研究[J],中国医院管理,2006,12,19-20
[38]林皓,美国政府管制与医疗市场效率[J],国外医学卫生经济分册,2006,23,136-139
[39]任祝景,两阶段DEA模型及其在商业银行经营效率中的应用[D],上海交通大学,2008
[40]申一帆、胡善联、黄炯烈、熊远大、方一波、宋朗明,1980年_2001年广州市医疗资源配置和利用效率分析[J],中华医院管理杂志,2004.6第20卷第6期,361-365
[41]史健、魏权龄,DEA方法在卫生经济学中的应用[J],数学的时间与认识,2004,34,59-65
[42]苏舒,基于DEA的我国房地产上市公司绩效研究[D],重庆大学,2007
[43]苏月霞,对我国商业银行技术效率和规模效率的DEA分析[D],苏州大学,2005
[44]孙振球、王乐三,医学综合评价方法及其应用[M],化学工业出版社,2006
[45]王媛,基于malmquist_DEA指数的城市基础设施投资效率评价[D],天津大学,2005
[46]魏权龄,数据包络分析[M],北京：科学出版社,2004
[47]魏权龄,李宏余,决策单元的变更对DEA有效性的影响[J],北京航空航天大学学报,1991,1：85-97
[48]徐爱军,医院绩效的测量方法研究[J],医药管理论坛,2008年第9期,25-30
[49]杨春梅,基于DEA的环保投入效率研究[D],暨南大学,2007
[50]虞佩燕,基于DEA的区域人力资本投资效益综合评价[D],重庆大学,2007
[51]张光鹏,数据包络分析在中医院配置效率研究中的应用[J],中华医院管理杂志,2005,5,336-338
[52]张玉萍,基于DEA的大连城市人居环境可持续发展能力评价[D],辽宁师范大学,2007
[53]朱乔,陈遥,一种预测方法[J],数理统计与管理,1991,6：28-33
[54]左娅佳、毕兆荣,医院病床利用的DEA分析[J],中国医院管理,2002年第22卷第12期,27-27
[1]Alessandro Schiavone, Technical Efficiency of Italian Public Hospitals [J], Bank of Italy, Occasional Paper No.29,2009
[2]A. Charnes, W. W.Cooper,et al, Invariant multiplicative efficiency and piecewise cobb-douglass envelopment[J], Operations Research letters,1983,2(3):38-49.
[3]Antonio Afonso,Sonia Fernandes, Assessing Hospital Efficiency:Non-parametric Evidence for, Portugal[J], SEG-UTL Economics Working Paper No.07/2008/DE/UECE,2008
[4]Antonio Afonso and Sonia Fernandes, Assessing and Explaining the Relative Efficiency of Local Government [J], Journal of Socio-Economics, Vol.37, No.5, pp.1946-1979,2008
[5]Antonio Afonso and Miguel St. Aubyn, Relative Efficiency of Health Provision:A DEA Approach with Non-Discretionary Inputs [J], ISEG-UTL Economics Working Paper No.33/2006/DE/UECE,2006
[6]Antonio Afonso and Miguel St. Aubyn, Non-parametric Approaches to Education and Health Expenditure Efficiency in OECD Countries [J], ISEG-UTL Economics Working Paper No. 1/2004/DE/CISEP/UECE,2004
[7]Bernd Helmig and Irvine Lapsley, On the Efficiency of Public, Welfare and Private Hospitals in Germany Over Time-A Sectoral DEA-Study [J], Health Services Management Research, Vol.14, pp. 263-274,2001
[8]Chilingerian J. A. et al, Managing Physician Efficiency and Effectiveness in Providing Hospital Service[J], Health Service Management,1990,3 (1):3～15
[9]Chris Tofallis,ombining Two Approaches to Efficiency Measurement [J], Journal of the Operational Research Society, Vol. 52, No.11, pp.1225-1231,2001
[10]Dr. Bernd Helmig, Prof. Dr. Irvine Lapsley, On the Efficiency of Public, Welfare and Private Hospitals in Germany Over Time-A Sectoral DEA-Study[J], Health Serve Management Res, Nov14, 263-274,2001
[11]Grosskopf S. et al. Measuring Hospital Performance:A Non parametric Approach [J], Journal of Health Economics,1987,6 (2) 89-107
[12]James F. Nolan, Adrian T. Moore and Geoffrey Segal, Putting out the Trash:Measuring Municipal Service Efficiency in U. S. Cities [D], University of Saskatchewan-College of Agriculture,2003
[13]Jarmo Vakkuri, Research Techniques and Their Use in Managing Non-profit Organisations-An Illustration of DEA Analysis in NPO Environments[J], Financial Accountability & Management, Vol.19, pp.243-263,2003
[14]Jian Wang, Zhong Zhao, Amir Mahmood, Relative Efficiency, Scale Effect, and Scope Effect of Public Hospitals[J], Institute for the Study of Labor, No.2520,2006
[15]Jonas Mansson, How Can We Use the Result from a DEA Analysis? Identification of Firm-Relevant Reference Units [J], Journal of Applied Economics, Vol.6, No.1, pp.157-175,2003
[16]Laurens Cherchye and Thierry Post, Methodological Advances in Dea[J], ERIM Report Series Reference, No. ERS-2001-53-F&A, 2010
[17]M. J. Farrell, The Measurement of Productive Efficiency[J], Journal of the Royal Statistical Society[J], Series A (General),1957, Vol.120,253-290
[18]Magnus A. Bjorkgren and Brant E. Fries, Applying RUG-Ⅲ for reimbursement of nursing facility care[J], International Journal of Healthcare Technology and Management,2006, Volume 7,82-99
[19]Mickael Lothgren and Magnus Tambour, Bootstrapping DEA-Based Efficiency Measures and Malmquist Productivity Indices: A Study of Swedish Eye-Care Service Provision [J], Stockholm School of Economics, WPS 78,2008
[20]Matthias Rene Staat and Maik Hammerschmidt, Product Performance Evaluation-A Super-Efficiency Model, International Journal of Business Performance Management, Vol.7, No.3,2005
[21]Oliver Tiemann and Schreyoegg Jonas, Effects of Ownership on Hospital Efficiency in Germany[J], BuR Business Research Journal, Vol.2, No.2,2009
[22]R. D. Banker, A. Charnes and W. W. Cooper, Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis[J], Management Science,1984, Vol.30No.9,1078-1092
[23]Said Gattoufi, Muhittin Oral and Arnold Reisman, A Taxonomy for Data Envelopment Analysis [J], Socio-Economic Planning Sciences, Vol.38, No.2-3, pp.115-232,,2004
[24]Santiago Herrera and Gaobo Pang, Efficiency of Public Spending in Developing Countries:An Efficiency Frontier Approach [J], World Bank Policy Research Working Paper No.3645,2005
[25]Thomas R. Sexton, Alan M. Leiken, Arlene H. Nolan, Shari Liss, Andrew Hogan and Richard H. Silkman, Evaluating Managerial Efficiency of Veterans Administration Medical Centers Using Data Envelopment Analysis[J], Medical Care,1989, Vol.27 No.12, 1175-1188
[26]Valdmanis B. G. et al, Ownership and Technical Efficiency of Hospital [J], Medical Care,1990 vol 28 (6),552～561
[27]Vincenzo Rebba, Dino Rizzi, Measuring Hospital Efficiency through Data EnvelopmentAnalysis when Policy-makers'Preferences Matter[J], University Ca' Foscari of Venice, Dept. of Economics Research Paper Series No.13/06,2006
[28]Yasar A. Ozcan, Roice D. Luke and Cengiz Haksever, Ownership and Organizational Performance:A Comparison of Technical Efficiency across Hospital Types [J], Medical Care,1992, Vol.30, No.9, 781-794
[29]Yasar A. Ozcan, Michael J McCue and Ahmad A Okasha, Measuring the technical efficiency of psychiatric hospitals[J], Journal of Medical Systems,1996, Vol20,141-150
[30]Louis Rubino,魏东海,美国医院战略选择的内外环境制约与绩效评估[J],中国医院管理,2001,21(3)：59-60
[31]陈志兴、沈晓初、王萍、王炼、邓建申,评价医院经济效益的力点[J],中华医院管理杂志》1994年12期
[32]郭磊.综合变量DEA方法及其应用研究[D],大连理工大学.2005.
[33]孔超,浦东新区卫生资源配置研究[D],复旦大学,2009
[34]李建发、张曾莲,基于财务视角的政府绩效报告的构建[J],会计研究,2009.6,11-17
[35]李美娟、陈国宏,数据包络分析法(DEA)的研究与应用[J],中国工程科学,2003,5,88—94
[36]刘萌,改进后的综合DEA模型及其灵敏度分析[D],上海交通大学,2007
[37]林皓、金祥荣,政府投入与我国医院效率的变化[J],经济学家,2007.2,77-83[9]邱亭林、石光不同产权制度下医院效率比较研究[J],中国医院管理,2006,12,19-20
[38]林皓,美国政府管制与医疗市场效率[J],国外医学卫生经济分册,2006,23,136-139
[39]任祝景,两阶段DEA模型及其在商业银行经营效率中的应用[D],上海交通大学,2008
[40]申一帆、胡善联、黄炯烈、熊远大、方一波、宋朗明,1980年_2001年广州市医疗资源配置和利用效率分析[J],中华医院管理杂志,2004.6第20卷第6期,361-365
[41]史健、魏权龄,DEA方法在卫生经济学中的应用[J],数学的时间与认识,2004,34,59-65
[42]苏舒,基于DEA的我国房地产上市公司绩效研究[D],重庆大学,2007
[43]苏月霞,对我国商业银行技术效率和规模效率的DEA分析[D],苏州大学,2005
[44]孙振球、王乐三,医学综合评价方法及其应用[M],化学工业出版社,2006
[45]王媛,基于malmquist_DEA指数的城市基础设施投资效率评价[D],天津大学,2005
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