摘要
目的:分析中部某省县级综合医院医疗服务效率的发展轨迹差异并进行潜在分类,通过区别不同发展类别医院间的相关内外部指标特征以探讨影响医疗服务效率变化的可能因素,进而为改善医疗服务效率提供参考。方法:选取中部某省2013-2018年158家县级综合医院的卫生统计报表数据,构建超效率SBM-Undesirable-DEA模型测算样本医院的医疗服务效率。然后构建潜变量增长混合模型,将各样本医院的发展轨迹进行潜类别分类。最后对经模型分类后的潜类别间内外部指标进行组间差异分析。结果:2013-2018年间中部某省样本医院的医疗服务效率均值为0.61,总体处于较低水平。根据其发展特点将样本医院6年间的服务效率分为两类:低效率瓶颈期组(C1,54%)和中高效率稳定期组(C2,46%)。C1组的区域总人口数、医生护士总数、医院总资产和万元以上设备数等方面的均值均低于C2组。除了区域总人口数外其他指标在两潜类别组间的差异均有统计学意义(P<0.01)。结论:潜变量增长混合模型能够有效鉴别医院医疗服务效率发展轨迹的总体异质性和个体差异性。处于不同发展趋势阶段的县级综合医院具有不同的内外部环境特征,政府及医院为突破低效率瓶颈期需合理配置医疗卫生资源。
Objective: To analyze the development trajectories of medical service efficiency in county-level general hospitals in a province of central region and make latent classification, and to discuss possible factors of changes in medical service efficiency by distinguishing internal and external indexes of hospitals with different development types, so as to provide references for improving medical service efficiency. Methods: The data from health statistical reports of 158 county-level general hospitals in a province of central region from 2013 to 2018 were extracted, and the super-efficiency SBM-Undesirable-DEA model was constructed to measure the medical service efficiency of hospitals. Then the latent growth mixture modeling was constructed to make latent classification of development trajectories in sample hospitals. Finally, differences between the two latent classes in internal and external indexes were analyzed. Results: From 2013 to 2018, the mean value of medical service efficiency of hospitals in a province of central region was 0.61, which was generally at a low level. According to their development features, development trajectories of service efficiency in sample hospitals from 2013 to 2018 were divided into two classes including low efficiency bottleneck period group(C1, 54%) and medium high efficiency stable period group(C2, 46%). Mean values of regional population, total number of doctors and nurses, total assets of hospital and the number of equipment above 10000 yuan in C1 group were lower than those in C2 group.Except for the regional population,there were significant differences between the two groups in other indexes( P< 0.01). Conclusion: The latent growth mixture modeling can identify population heterogeneity and individual difference of development trajectories effectively. County-level general hospitals at different development trajectories have different internal and external environment features. In order to break through the bottleneck period of low efficiency,the government and hospitals should allocate medical and health resources reasonably.
作者
荆丽
余鸣人
龚易晓
徐娟
JING Li(School of Medicine and Health Management,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430030,China)
出处
《医学与社会》
北大核心
2022年第2期20-24,共5页
Medicine and Society
基金
国家自然科学基金资助项目,编号为71303084。
关键词
县级综合医院
医疗服务效率
潜变量增长混合模型
County-level General Hospital
Medical Service Efficiency
Latent Growth Mixture Modeling
