【摘要】：背景:醫(yī)療衛(wèi)生行業(yè)是與全民生產(chǎn)、生活息息相關(guān)的行業(yè)之一。我國對醫(yī)療衛(wèi)生領(lǐng)域高度重視,衛(wèi)生投入逐步提高,衛(wèi)生事業(yè)發(fā)展迅猛。近年來,中共中央、國務(wù)院印發(fā)的一系列政策文件明確指出,要提高醫(yī)院運(yùn)行效率、加強(qiáng)醫(yī)院精細(xì)化管理,建立現(xiàn)代醫(yī)院管理制度。上海市作為全國醫(yī)改的先行者,率先探索醫(yī)院“管辦分開、政事分開、政資分開”改革,借鑒現(xiàn)代化企業(yè)的管理制度,提升信息化程度,建立專業(yè)、精細(xì)、規(guī)范的現(xiàn)代醫(yī)院管理制度。科學(xué)、客觀地評價醫(yī)院運(yùn)行效率,分析其變化情況及影響因素,不僅能夠為醫(yī)院管理者改進(jìn)管理、制定發(fā)展戰(zhàn)略提供抓手,也能為政府管理部門合理配置醫(yī)療資源、制定衛(wèi)生政策提供參考依據(jù)。目的:本研究對上海市28家市級醫(yī)院2012-2015年的運(yùn)行現(xiàn)狀進(jìn)行分析,并運(yùn)用數(shù)據(jù)包絡(luò)分析法(DEA)中的C2R模型、BC2模型和Malmquist指數(shù)模型對上述醫(yī)院的運(yùn)行效率及效率變動情況進(jìn)行分析,為客觀評價醫(yī)院運(yùn)行效率、優(yōu)化管理方案提供參考。方法:本研究資料來源于2012-2015年上海申康醫(yī)院發(fā)展中心市級醫(yī)院績效簡報。研究對象為上海市28家市級醫(yī)院,其中包括綜合性醫(yī)院11家、�？漆t(yī)院17家。本研究廣泛收集查閱國內(nèi)外應(yīng)用DEA法評價醫(yī)院效率的理論方法、研究成果等文獻(xiàn)資料,在對重點文獻(xiàn)進(jìn)行分析的基礎(chǔ)上,歸納投入、產(chǎn)出指標(biāo),進(jìn)行頻次統(tǒng)計。在指標(biāo)的初步篩選基礎(chǔ)上進(jìn)行專家咨詢,結(jié)合聚類分析、相關(guān)性檢驗、變異系數(shù)等統(tǒng)計方法,確定研究使用的指標(biāo)體系。對構(gòu)建的指標(biāo)體系進(jìn)行描述統(tǒng)計,并采用DEA法中的C2R模型和BC2模型對樣本醫(yī)院的運(yùn)行效率進(jìn)行測算,并采用Malmquist指數(shù)模型分析生產(chǎn)率變動情況。本研究分析使用的軟件包括:Microsoft Office Acess 2013、SPSS 17.0、Max DEA6.17和DEAP 2.1。結(jié)果:根據(jù)文獻(xiàn)薈萃分析和專家咨詢結(jié)果,結(jié)合統(tǒng)計分析,最終構(gòu)建的指標(biāo)體系包括:職工總?cè)藬?shù)、實際開放床位數(shù)、業(yè)務(wù)支出、門急診均次費(fèi)用、出院均次費(fèi)用、門急診人次數(shù)、出院人次數(shù)、業(yè)務(wù)收入、門急診醫(yī)療費(fèi)用、住院醫(yī)療費(fèi)用、平均住院日。2012-2015年上海市28家市級醫(yī)院整體運(yùn)行狀況穩(wěn)中有進(jìn),表現(xiàn)良好。職工總?cè)藬?shù)、實際開放床位數(shù)和總資產(chǎn)均平穩(wěn)增長;門急診量穩(wěn)中有升,住院業(yè)務(wù)量增幅較大;費(fèi)用結(jié)構(gòu)更加優(yōu)化,與業(yè)務(wù)量增長趨勢基本相符,藥占比持續(xù)下降;服務(wù)效率高位運(yùn)行,平均住院日連續(xù)下降,病床周轉(zhuǎn)次數(shù)相應(yīng)加快,床位效率總體提升,醫(yī)院職工人均門急診人次、人均出院人數(shù)和人均住院手術(shù)人次均呈現(xiàn)上升趨勢,人力效率總體提升。本研究按照指標(biāo)組合,構(gòu)建了13個模型,根據(jù)模型區(qū)分度、穩(wěn)定性和指標(biāo)信息量,選擇兩個較優(yōu)的模型進(jìn)行效率評價。兩個模型計算的綜合效率值具有顯著相關(guān)性,提示采用這兩個模型進(jìn)行評價是合適的。利用兩個模型不同的區(qū)分度,得出2012-2015年DEA有效醫(yī)院的個數(shù)分別為5、4、6、5;DEA無效醫(yī)院的個數(shù)分別是12、7、9、10。在模型3體系下,28家醫(yī)院2012-2015年綜合效率均值分別為0.780、0.747、0.774、0.766;在模型11體系下,分別為0.941、0.943、0.940、0.941。評價結(jié)果體現(xiàn)了樣本醫(yī)院間相對效率的高低,也表明上海市28家市級醫(yī)院在2012-2015年間的總體運(yùn)行效率較高。Malmquist指數(shù)模型結(jié)果表明,2012-2015年28家市級醫(yī)院的全要素生產(chǎn)率呈增長狀態(tài),技術(shù)進(jìn)步對全要素生產(chǎn)率影響相對較大,技術(shù)效率略有下降,規(guī)模效率變化不大�；谝陨蠝y算、分析結(jié)果,建議上海市市級醫(yī)院在現(xiàn)有技術(shù)優(yōu)勢下,結(jié)合現(xiàn)行的院長績效考核、病種績效考核等量化管理模式,發(fā)揮自身優(yōu)勢和醫(yī)療特色,進(jìn)一步聚焦技術(shù)發(fā)展與科技創(chuàng)新,適應(yīng)衛(wèi)生經(jīng)濟(jì)領(lǐng)域改革新形勢,以專業(yè)化的管理人才、現(xiàn)代化的管理理念、精細(xì)化的管理方式提高管理水平,最終目的為實現(xiàn)控制成本支出,提高資源利用率,進(jìn)一步提高運(yùn)行效率,更好地提升服務(wù)能力和服務(wù)質(zhì)量。本研究結(jié)果可為醫(yī)院運(yùn)行效率的評價用于醫(yī)院精細(xì)化管理實踐提供一定的借鑒。
[Abstract]:BACKGROUND: The medical and health industry is one of the industries closely related to the production and life of the whole people. China attaches great importance to the field of medical and health care. Health investment has been gradually increased and health undertakings have developed rapidly. In recent years, a series of policy documents issued by the Central Committee of the Communist Party of China and the State Council have clearly pointed out that it is necessary to improve the efficiency of hospital operation and strengthen the fine management of hospitals. Shanghai, as a pioneer of the national medical reform, has taken the lead in exploring the reform of "separation of management and management, separation of government affairs and separation of government and capital". By drawing lessons from the management system of modern enterprises, Shanghai has upgraded the degree of informationization, established a professional, fine and standardized modern hospital management system. The analysis of its changes and influencing factors can not only help hospital managers to improve management and formulate development strategies, but also provide reference for government departments to rationally allocate medical resources and formulate health policies. The C2R model, BC2 model and Malmquist index model in DEA were used to analyze the operational efficiency and efficiency changes of the above hospitals, providing reference for objective evaluation of hospital operational efficiency and optimization of management plan. The subjects were 28 municipal hospitals in Shanghai, including 11 general hospitals and 17 specialist hospitals. This study collected and consulted extensively the theoretical methods and research results of evaluating hospital efficiency by DEA at home and abroad. On the basis of analyzing the key literature, the input and output indicators were summarized and the frequency statistics were carried out. On the basis of preliminary screening, expert consultation is conducted, and the index system used in the study is determined by cluster analysis, correlation test, coefficient of variation and other statistical methods. The software used in this study included Microsoft Office Acess 2013, SPSS 17.0, Max DEA 6.17 and DEAP 2.1. Results: According to the results of literature analysis and expert consultation, combined with statistical analysis, the final index system was composed of the total number of employees, the actual number of open beds, business expenditure, the average number of outpatient and emergency services. From 2012 to 2015, 28 municipal hospitals in Shanghai were running steadily and well. The total number of staff and workers, the actual number of open beds and total assets increased steadily. The service efficiency is high, the average hospitalization days are continuously declining, the number of hospital bed turnover is accelerated accordingly, the bed efficiency is generally improved, the hospital staff per capita emergency and outpatient visits, per capita discharges and per capita hospitalization operations are increased. According to the index combination, thirteen models were constructed. According to the model discrimination, stability and index information, two better models were selected to evaluate the efficiency. The comprehensive efficiency values calculated by the two models were significantly correlated, suggesting that the two models were suitable for evaluation. The number of effective DEA hospitals in 2012-2015 is 5,4,6,5, and the number of ineffective DEA hospitals in 2012-2015 is 12,7,9,10. Under the model 3 system, the average comprehensive efficiency of 28 hospitals in 2012-2015 is 0.780,0.747,0.774,0.766, respectively; under the model 11 system, it is 0.941,0.943,0,0.941.941. The results show that the total factor productivity (TFP) of 28 municipal hospitals in Shanghai is increasing from 2012 to 2015, and the impact of technological progress on TFP is relatively large. Based on the above calculation and analysis results, it is suggested that Shanghai municipal hospitals should take advantage of their own advantages and medical characteristics to further focus on Technological Development and scientific and technological innovation to adapt to the health economy by combining the existing technological advantages with the existing quantitative management models such as president performance appraisal and disease type performance appraisal. The purpose of this study is to control the cost and expenditure, improve the utilization rate of resources, further improve the operational efficiency, and better enhance the service ability and quality. The results of this study can be used to evaluate the operational efficiency of hospitals. It can be used for reference in the fine management practice of hospitals.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 鄭萬會;龍暢;孫虹;;基于數(shù)據(jù)包絡(luò)分析法和隨機(jī)前沿分析法的重慶市市級公立醫(yī)院運(yùn)行效率及變化趨勢研究[J];上海交通大學(xué)學(xué)報(醫(yī)學(xué)版);2016年12期

2 駱熠;劉雙梅;黃仁彬;劉麗杭;王小萬;;湖南省地市級三級綜合醫(yī)院運(yùn)行效率及變動研究[J];中國醫(yī)院管理;2016年11期

3 龔倩怡;楊土保;游茂;李嫻君;孫越;;湖南省17家改革試點縣級公立醫(yī)院運(yùn)行效率DEA的評價[J];實用預(yù)防醫(yī)學(xué);2016年07期

4 陳麗紅;湯磊;倪衛(wèi)杰;;基于Malmquist指數(shù)的上海三級綜合醫(yī)院2003—2014年全要素生產(chǎn)率分析[J];上海交通大學(xué)學(xué)報(醫(yī)學(xué)版);2016年06期

5 楊宏偉;;TOPSIS法結(jié)合RSR法在綜合醫(yī)院工作效率方面的評價實證[J];中國醫(yī)院統(tǒng)計;2016年03期

6 崔政坤;吳明;;利用數(shù)據(jù)包絡(luò)分析法評價三級綜合醫(yī)院的效率[J];解放軍預(yù)防醫(yī)學(xué)雜志;2016年02期

7 高銘濤;劉雙梅;王誠麗;王小萬;;基于DEA模型的某三甲綜合醫(yī)院醫(yī)技科室運(yùn)行效率分析[J];現(xiàn)代經(jīng)濟(jì)信息;2016年07期

8 姚蘇娟;林雙宏;;基于數(shù)據(jù)包絡(luò)分析的武漢市市直和部、省屬公立醫(yī)院運(yùn)行效率評價[J];現(xiàn)代醫(yī)院;2016年03期

9 賈同英;袁蕙蕓;;基于數(shù)據(jù)包絡(luò)分析法的多院區(qū)醫(yī)院運(yùn)行效率研究[J];中國醫(yī)院管理;2016年03期

10 陳友東;孫昕;何秀芝;;基于DEA模型分析某軍隊醫(yī)院臨床科室運(yùn)行效率[J];解放軍醫(yī)院管理雜志;2016年02期

相關(guān)博士學(xué)位論文 前2條

1 趙寧;部分大型公立醫(yī)院經(jīng)濟(jì)運(yùn)行效率研究[D];華中科技大學(xué);2014年

2 郭曉日;我國公立醫(yī)院效率及其影響因素研究[D];山東大學(xué);2012年

，

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