试论上海某10所医院管办分离及效益分析

目的:研究上海10所医院管办分离前后效益对比分析。方法:收集2004～2010年连续7年数据报表,以比率分析法和环比法进行数据分析。结果:投入产出及成本管理总值逐年持续增长,业务收支结余率年均增长0.43%;固定资产投入增长快速,年均增长率在20%以上;无形资产产出保持增长。门急诊次数、出院人数年均增长率分别为12.54%、12.47%;平均住院日、病死率逐年下降,诊疗费用、药占比逐年上涨,环比增长超过上海市人均生产总值。结论:加强资产运营效率,规范医院经营管理自主权,降低医院管理、医疗成本,提高医疗资源利用率,发挥社会效能。     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

关于DEA有效性理论的一点探索

给出经典的基于输入和输出的DEA模型,把基于DEA模型相结合的相对效率模型引入评价证券相对有效性,以风险作为输入,期望收益率作为输出,便可以用DEA模型评价每只证券相对有效性。     

An innovative mobile approach for patient safety services: The case of a Taiwan health care provider

As the importance of patient safety increases for hospital management, many health care providers have begun to use innovative mobile technology to make their procedures more accurate and efficient, and to reduce the risk of human error. This paper explores an innovative mobile approach for patient safety and health care services in a Taiwan hospital, where a web-based patient safety services (PSS) system was implemented to enhance the efficiency of diagnosis and patient safety. The functions and operating procedures of the PSS system are introduced. Furthermore, the contributions of the PSS system over a six-month period of clinical use are analyzed. Finally, the managerial implications of mobile PSS are discussed.     

Impact of Carbon Dioxide Emissions Reduction on the Austrian Economy

A linked econometric input–output (IO) model of the Austrian economy with an energy block is used in this study to assess the sectoral effects of carbon dioxide emissions reduction. The energy block and the other commodities are linked by a partitioned IO model. Energy demand is described using aggregate energy demand equations, by activities and subdemand systems of the translog type for different fuel types. The conversion of energy is modelled using an IO model of the energy sector. Measures for carbon dioxide reduction from detailed expert studies are introduced in the energy model and in the econometric model. The primary impacts are on energy demand, fuel shares and investment in new energy technologies. The simulation results of the partitioned IO model show different impacts on gross output, GDP and employment.     

Efficiency aggregation with enhanced Russell measures in data envelopment analysis

In aggregation for data envelopment analysis (DEA), a jointly determined aggregate measure of output and input efficiency is desired that is consistent with the individual decision making unit measures. An impasse has been reached in the current state of the literature, however, where only separate measures of input and output efficiency have resulted from attempts to aggregate technical efficiency with the radial measure models commonly employed in DEA. The latter measures are “incomplete” in that they omit the non-zero input and output slacks, and thus fail to account for all inefficiencies that the model can identify. The Russell measure eliminates the latter deficiency but is difficult to solve in standard formulations. A new approach has become available, however, which utilizes a ratio measure in place of the standard formulations. Referred to as an enhanced Russell graph measure (ERM), the resulting model is in the form of a fractional program. Hence, it can be transformed into an ordinary linear programming structure that can generate an optimal solution for the corresponding ERM model. As shown in this paper, an aggregate ERM can then be formed with all the properties considered to be desirable in an aggregate measure—including jointly determined input and output efficiency measures that represent separate estimates of input and output efficiency. Much of this paper is concerned with technical efficiency in both individual and system-wide efficiency measures. Weighting systems are introduced that extend to efficiency-based measures of cost, revenue, and profit, as well as derivatives such as rates of return over cost. The penultimate section shows how the solution to one model also generates optimal solutions to models with other objectives that include rates of return over cost and total profit. This is accomplished in the form of efficiency-adjusted versions of these commonly used measures of performance.     

Technical efficiency of Swedish employment offices

This paper studies technical efficiency for Swedish employment offices between 2004 and 2010. Efficiency is computed using a semi-dynamic DEA-framework. On the input side we include a measure of input quality and we also control for services that are carried out by private contractors. On the output side we are using both intermediate and final outputs. The motivation for using an intermediate output is to take into account the fact that employment offices might have strengthen the possibility for unemployed individuals that remain unemployed to get a job in the forthcoming year. The study identifies an average yearly inefficiency between 7 and 10 percent. It is also observed that the inefficiency is unevenly distributed. To make employment offices more efficient this uneven distribution needs to be considered, otherwise efforts to improve efficiency might instead result in increased inefficiency.     

中国医疗卫生事业效益分析之系列研究——2005-2009年全国妇产(科)医院效益分析

2005-2009年三大女性恶性肿瘤以年均188%的速度增长。研究全国妇科(科)医院若干投入、产出效益指标并分析,找出影响医院发展因此提出对策。妇产(科)医院投入与产出均呈高速发展,但应改善就医环境,提供良好工作环境,保护病人隐私,更大程度发挥妇产(科)医院的公益性和社会职能。     

A location-based comparison of health care services in four U.S. states with efficiency and equity

This paper examines the efficiency and equality in geographic accessibility provided by hospitals. We use the criteria efficiency, availability of the service, and equality. Quantitative measures are defined for all criteria, and are measured using a geographical information system. We then compare existing locations with optimal locations satisfying two objectives, one that minimizes hospital–patient distance, and another that captures as many patients as possible within a pre-specified time or distance. The results of our study indicate that the existing locations provide near-optimal geographic access to health care. Some potential for improvement is indicated.     

经济发展水平与科普资源投入产出效率的关系研究 ——基于三阶段DEA模型

双循环新发展格局对我国创新提出了更高的要求.创新发展一方面需要科技创新,另一方面也少不了科学普及,中央强调科学普及与科技创新同等地位.基于三阶段DEA模型,对2008—2015年31个省市、自治区科普投入产出效率进行研究,按照经济发展情况把全国划分为三个区域.研究发现:我国科普投入产出技术效率的上升和规模效率的波动影响...     

Analysis of Hospital Production: An Output Index Approach

In this study, we develop and implement an output index approach to the estimation of hospital cost functions that reflects the differentiated nature of hospital care. The approach combines the estimation of an output index within a flexible functional form. We find, in an application to California hospitals, evidence of scope economies across specialties within primary care, and diseconomies of scope within secondary and tertiary care. Minimum efficient scale is reached at larger levels of output than would be estimated by conventional techniques. These results indicate the importance of accounting for firm output heterogeneity when estimating cost functions. Copyright © 2014 John Wiley & Sons, Ltd.     

A grant rationing model for a health care system.

Most public health programs are created through a political process and the health administrator's resource allocation decision is influenced not only by the relative performance of the subunits but also by political considerations. This paper presents a goal programming model for rationing available grants to competing health care subunits on the basis of performance subject to resource and political constraints. Performance is defined in terms of output adjusted for non-compliance on the identified quality of care and administrative efficiency criteria. The quality and efficiency criteria are those specified by the Federal agency as amended by local funding authorities and subunit administrators through a Delphi process. The model has the advantage of flexibility and can be easily adapted to suit prevailing financial and political conditions. In particular, it can be used as a viable analytical tool in health care and other public service agencies where political considerations are important in resource allocation decisions.     

中国医疗卫生事业效益分析之系列研究——2000～2010年上海市医疗卫生机构效益分析

目的:研究中国最大城市之一的上海市医疗卫生行业投入与产出效益情况并找出影响因素并提出对策。方法:收集2000年-2010年相关数据,采用平均增长量、平均发展速度、平均增长速度计算出投入、产出指标值。结果:11年间上海市医疗卫生机构规模缩小。人员和病床规模扩大,但速度不及人口发展速度快,诊疗人数年均增长9.3%,医生人均每日担负诊疗人次年均增长速度达6.63%。人均住院费用年均增长6.04%,其中药费年均7.32%。结论:加大投入人力物力,合理医药改革,建立健全三级医疗体系,健全医疗保障制度,完善社会保障体系,保证医疗行业的公益性,充分发挥其社会职能。     

How to Regulate Heterogeneous Hospitals?

In many areas of health care financing, there is controversy over the sources of cost variability and about the respective roles of inefficiency versus legitimate heterogeneity. This paper proposes a payment system that creates incentives to increase hospital efficiency when hospitals are heterogeneous, without reducing the quality of care. We consider an extension of Shleifer's yardstick competition model and apply an econometric approach to identify and evaluate observable and unobservable sources of cost heterogeneity. Moral hazard can be seen as the result of two components: long‐term moral hazard (hospital management can be permanently inefficient) and transitory moral hazard. The latter is linked to the manager's transitory cost‐reducing effort. For instance, he or she can be more or less rigorous each year when bargaining prices for supplies delivered to the hospital by outside firms. The use of a three‐dimensional nested database makes it possible to identify transitory moral hazard and to estimate its effect on hospital cost variability. Econometric estimates are performed on a sample of 7,314 stays for acute myocardial infarction observed in 36 French public hospitals over the period 1994–1997. We obtain two alternative payment systems. The first takes all unobservable hospital heterogeneity into account, provided that it is time invariant, whereas the second ignores unobservable heterogeneity. Simulations show that substantial budget savings—at least 20%—can be expected from the implementation of such payment rules. The first method of payment has the great advantage of reimbursing high‐quality care. It leads to substantial potential savings because it provides incentives to reduce costs linked to transitory moral hazard, whose influence on cost variability is far from negligible. This payment rule could be extended to other areas of health care financing, such as Adjusted Average Per Capita Cost to calculate Medicare Managed Care reimbursements in the United States.     

中国医疗卫生事业效益分析之系列研究——2005-2009年全国传染病医院效益分析

目的:中国是肝炎大国,研究全国传染病医院投入与产出效益分析并找出影响因素并提出对策。方法:收集2005年-2009年统计数据,采用平均增长量、平均发展速度、平均增长速度计算出投入、产出指标值。结果:职工人数(包括医生数)、医疗仪器设备、房屋建筑面积(包括业务用房面积)等投入指标保持年均正增长速度。诊疗人次数、入院人数、病床工作日、病床周转次数等社会效益产出指标保持年均正增长速度,病床使用率提高16.4个百分点,出院者平均住院日每年缩短0.55日。净资产经济效益产出指标年均增长速度达32.47%,病毒性肝炎出院者人均医药费用年增长速度4.6%。结论:全国传染病医院属于朝阳事业,但应加大传染病预防的宣传力度,加强卫生管理,从源头消除传染源。加快完善新型农村合作医疗、城镇居民和职工医疗保险。     

Incorporating the Operating Environment Into a Nonparametric Measure of Technical Efficiency

The ability of a production unit to transform inputs into outputs is influenced by its technical efficiency and external operating environment. This paper introduces a nonparametric, linear programming, frontier procedure for obtaining a measure of managerial efficiency that controls for exogenous features of the operating environment. The approach also provides statistical tests of the effects of external conditions on the efficient use of each individual input (for an input oriented model) or for each individual output (for an output oriented model). The procedure is illustrated for a sample of nursing homes.     

基于DEA的先进制造技术无形效益评价研究

根据输入输出指标数据值进行数据包络分析(DEA)计算,对先进制造技术(AMT)投资方案的输入数据进行相对效率评价,避免单纯考虑输出指标的不确定性和不可度量性,做到无形效益价值输出指标的量化分析。将DEA中的C2R模型与BC2模型进行改变,结合对偶理论,提出AMT无形效益价值是一种新型影子价格的观点,分析AMT无形效益价值的相对有效性,对无效的方案提出了输入输出指标数据的改进方法。最后通过一个实例,验证了方法的可行性和实用性。     

Austria and the Single European Market

The economic consequences—global and on a sectoral level—of the full participation of Austria in the process of economic integration in Europe are assessed with the help of the INFORUM system of interlinked input–output models and the Austrian model in this family, i.e. AUSTRIA IV. The results of two scenarios up to the year 2000 are compared. One scenario is based on the assumption of the full participation of Austria in the process of European integration. The alternative scenario is based on the hypothesis that Austria has to remain in an outsider position. The analysis shows quite relevant positive consequences of full participation by Austria in the process of European integration. Because of compensating forces, the effects on a sectoral level are much more pronounced than those on the global level. The structural implications on output, employment, etc. are quite remarkable.     

Cross redundancy and sensitivity in DEA models

Data envelopment analysis (DEA) measures the efficiency of each decision making unit (DMU) by maximizing the ratio of virtual output to virtual input with the constraint that the ratio does not exceed one for each DMU. In the case that one output variable has a linear dependence (conic dependence, to be precise) with the other output variables, it can be hypothesized that the addition or deletion of such an output variable would not change the efficiency estimates. This is also the case for input variables. However, in the case that a certain set of input and output variables is linearly dependent, the effect of such a dependency on DEA is not clear. In this paper, we call such a dependency a cross redundancy and examine the effect of a cross redundancy on DEA. We prove that the addition or deletion of a cross-redundant variable does not affect the efficiency estimates yielded by the CCR or BCC models. Furthermore, we present a sensitivity analysis to examine the effect of an imperfect cross redundancy on DEA by using accounting data obtained from United States exchange-listed companies.