医院规模规划的理论与方法研究

项目名称： 医院规模规划的理论与方法研究

项目编号： No.70873083

项目类型： 面上项目

立项/批准年度： 2009

项目学科： 无线电电子学、电信技术

项目作者： 马进

作者单位： 上海交通大学

项目金额： 18万元

中文摘要： 目前，我国普遍存在城市综合医院规模不断扩大的现象，研究表明，医院的规模在对医患关系、医院绩效、医院效率、经济效益等方面存在重要的影响，这使得我们不得不反思这种现象是否合理，卫生资源是否得到有效使用。本文首先系统的回顾了关于医院规模的理论和实践研究现状，目前的研究基本上都是基于成本最小化或者是医院经济效益最优的规模，但是这些假设与公立综合医院作为公益性的组织不相符，本文提出以福利最大化作为研究的基础，并采用数据包络分析和基于门诊流量的模型对医院的规模进行分析，这样的分析方法在测量医院效率的同时也兼顾了医院的医疗质量以及医院的管理成本，弥补了以往研究方法的不足，考虑问题更全面，使研究结果更真实有效。研究结论表明样本综合医院卫生资源利用效率不高，存在卫生资源利用浪费现象；规模效率呈现递减状态，而且随着医院规模增大，规模效率值越低；质量指标对技术效率存在显著影响；每床位管理成本、平均住院日、药品占收入比例、平均门诊费用对医院规模效率具有负效应。因此，需要精简机构，控制医院管理成本；缩短平均住院日，节约卫生资源；落实双向转诊制使病人流向更合理和加强宏观调控政策引导使卫生资源配置更合理。

中文关键词： 资源配置; 技术效率;规模效率;卫生资源调整

英文摘要： Currently, the general hospitals in big cities always expand their scale. Many studies have demonstrated that the hospital scale has important effect on the relationship between physician and paitents, hospital performance, efficiency and economic benefits. So we need consider if this kind of phenomenon is reasonable and if the health resource is used effiectly. This study reviewed the relative theory and practice about hospital scale, basicly; they all based minimum cost and maximum benefit. But this kind of hypothesis is not consistent with the nature of public hospital. So this research provided maximum welfare theory, and applies data envelopment analysis and model based on outpatient to explore the reasonable hospital scale. This method included not only the hospital efficiency but also quality and cost, it amended the shortagte of the prior methods, made the results more reasonable. The research results showed that there were inefficient hospitals in the sample; waste of the health resource; decreasing scale efficiency with the increasing hospital size; quality index had effect on technical efficiency; management cost per bed, average length of stay, the medecine ratio of total expenditure, outpatient cost had negative effect on hospital scale. It is suggested that simplify the organization to reduce management cost, short the average of stay to save health resource, apply dual referral system and macro-control to make patients and health resource more reasonable.

英文关键词： resource allocation; technical efficiency; scale efficiency;health resource adjustment