Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study
Objective To evaluate the efficiency of county public hospitals in Shandong Province following China’s new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency.Design and setting This was a cross-sectional study on the efficiency and size of 68 cou...
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doaj-5e177e8acfa3483ba76acdea450bf6432021-03-13T09:30:28ZengBMJ Publishing GroupBMJ Open2044-60552020-06-0110610.1136/bmjopen-2019-035703Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional studyQian Li0Liqi Tian1Xiaolin Jing2Xianghua Chen3Jiangfeng Li4Huixin Chen51 The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China 1 The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China1 The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China1 The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China1 The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China2 Department of Social Medicine and Health Management, School of Medicine, Qingdao University, Qingdao, Shandong Province, ChinaObjective To evaluate the efficiency of county public hospitals in Shandong Province following China’s new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency.Design and setting This was a cross-sectional study on the efficiency and size of 68 county public hospitals in China in 2017.Outcome measures Data envelopment analysis was used to calculate the efficiency scores of hospitals and to analyse the slack values of inefficient hospitals. The actual number of open beds, doctors, nurses and total expenditure were selected as inputs, and the total number of annual visits, discharges and total income were selected as outputs. The Kruskal-Wallis H test was employed to compare the efficiency of hospitals with different bed sizes. The χ2 test was used to compare the returns to scale (RTS) of hospitals with different bed sizes.Results Twenty (29.41%) hospitals were efficient. There were 27 hospitals with increasing returns to scale, 23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale (DRS). The differences in technical efficiency (p=0.248, p>0.05) and pure technical efficiency (p=0.073, p>0.05) were not statistically significant. However, the differences in scale efficiency (p=0.047, p<0.05) and RTS (p<0.001) were statistically significant. Hospitals with DRS began to appear at 885 beds. All sample hospitals with more than 1100 beds were already saturated and some hospitals even had a negative scale effect.Conclusions The government and hospital managers should strictly control the bed size in hospitals and make hospitals resume operating in the interests of public welfare. Interventions that rationally allocate health resources and improve the efficiency of medical workers are conducive to solving redundant inputs and insufficient outputs.https://bmjopen.bmj.com/content/10/6/e035703.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Qian Li Liqi Tian Xiaolin Jing Xianghua Chen Jiangfeng Li Huixin Chen |
spellingShingle |
Qian Li Liqi Tian Xiaolin Jing Xianghua Chen Jiangfeng Li Huixin Chen Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study BMJ Open |
author_facet |
Qian Li Liqi Tian Xiaolin Jing Xianghua Chen Jiangfeng Li Huixin Chen |
author_sort |
Qian Li |
title |
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study |
title_short |
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study |
title_full |
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study |
title_fullStr |
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study |
title_full_unstemmed |
Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study |
title_sort |
efficiency and scale effect of county public hospitals in shandong province, china: a cross-sectional study |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2020-06-01 |
description |
Objective To evaluate the efficiency of county public hospitals in Shandong Province following China’s new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency.Design and setting This was a cross-sectional study on the efficiency and size of 68 county public hospitals in China in 2017.Outcome measures Data envelopment analysis was used to calculate the efficiency scores of hospitals and to analyse the slack values of inefficient hospitals. The actual number of open beds, doctors, nurses and total expenditure were selected as inputs, and the total number of annual visits, discharges and total income were selected as outputs. The Kruskal-Wallis H test was employed to compare the efficiency of hospitals with different bed sizes. The χ2 test was used to compare the returns to scale (RTS) of hospitals with different bed sizes.Results Twenty (29.41%) hospitals were efficient. There were 27 hospitals with increasing returns to scale, 23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale (DRS). The differences in technical efficiency (p=0.248, p>0.05) and pure technical efficiency (p=0.073, p>0.05) were not statistically significant. However, the differences in scale efficiency (p=0.047, p<0.05) and RTS (p<0.001) were statistically significant. Hospitals with DRS began to appear at 885 beds. All sample hospitals with more than 1100 beds were already saturated and some hospitals even had a negative scale effect.Conclusions The government and hospital managers should strictly control the bed size in hospitals and make hospitals resume operating in the interests of public welfare. Interventions that rationally allocate health resources and improve the efficiency of medical workers are conducive to solving redundant inputs and insufficient outputs. |
url |
https://bmjopen.bmj.com/content/10/6/e035703.full |
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