【作者】 刘丹；

【导师】 纪爱兵；

【作者基本信息】 河北大学 ， 社会医学与卫生事业管理， 2017， 硕士

【摘要】 【研究背景】近年来,随着人们生活环境不断发生变化,生活水平的不断提高,人们的医疗服务需求不断增加,虽然我们已经对医疗服务领域进行了大刀阔斧的改革,但是我们在医改的道路上尤其是如何对公立医院进行改革上还是“任重而道远”。当下如何进一步改革公立医院的管理体制,建立健全多投入、多产出机构的绩效评价机制,规范各级各类公立医疗卫生机构绩效评价工作,推动医疗卫生机构改进服务质量仍然迫在眉睫。为了更好的评价医院的服务效率和绩效水平我们急需一套切实可行的评价体系来评价医院这种多投入、多产出的机构。从目前的文献资料来看,常用的医院绩效评价方法主要有两种:参数法和非参数法。参数法以随机前沿分析法(SFA)为代表,但SFA需要构建函数模型且产出需为单一变量,而医院为多投入、多产出机构,相比之下以数据包络分析法(DEA)为代表的非参数法更适合对医院绩效进行评价,但是以往的研究都忽略了DEA模型在对各个变量进行加权求和时要求变量之间必须是相互独立的规定,所以经典DEA模型计算出的结果其实是不太科学和准确的。所以本研究针对经典DEA方法的弊端,研究出变量具有交互作用的DEA模型,并对其进行实证研究,对比分析两种模型的结果,从而验证新模型的可行性。【研究目的】(1)运用聚类分析、相关系数分析和变异系数分析筛选出合适的投入、产出指标,构建医院绩效评价指标体系。(2)在经典DEA模型的基础上,建立变量具有交互作用的DEA模型,并探讨新模型的性质定理和其优越性。(3)对比分析两模型对所选医院绩效评价的结果,得出变量具有交互作用DEA模型的科学性和可行性。【研究方法】(1)指标选择:用聚类分析、相关分析和变异系数分析法,筛选出合适的投入、产出指标。(2)模型选择:经典DEA模型、基于Choquet积分建立的变量具有交互作用的CH-CCR模型,并在新模型中加入交叉效率评价方法,来对评价对象的总体绩效进行优劣等级排序。(3)分析软件:用Max DEA和Lingo12软件,分别对两模型的数据进行分析。【研究结果】(1)经典DEA模型的研究结果由经典DEA模型的分析结果可知,在31所河北省大型综合三甲医院中,总体效率值为1的有14个,占了总的决策单元的45%,说明这14所医院的投入要素理论上已是最佳组合,所得产出结果也达到了最佳,规模报酬处于不变的状态。从17个非DEA有效DMU代表的医院的投入、产出指标的改进值和目标值可以看出,投入指标的改进值均为负数,说明这17家医院的各项投入都不同程度处于投入冗余状态,所以这些医院应该减少投入量,合理控制医院规模,提高资源利用率,争取以最少的投入获得最大的产出。(2)变量具有交互作用的DEA模型(CH-CCR模型)的研究结果此模型评价出的DEA有效的医院为23个比经典DEA模型的多了9个,DEA有效的决策单元也有所不同,CH-CCR模型计算出的DEA有效的医院在CCR模型的基础上多了DMU5、DMU7、DMU9、DMU12、DMU14、DMU16、DMU17、DMU24、DMU26、DMU31所代表的医院,但是DMU15所代表的医院虽然在CCR模型中有效但是用CH-CCR模型中却为DEA无效。不管是经典DEA模型还是CH-CCR模型计算出的DEA有效其实都为相对有效,而不是绝对的,由CH-CCR模型计算出的河北省31所大型综合三甲医院的最终绩效值均未达到1说明即使DEA有效的决策单元,也存在这改善空间。【研究结论】(1)模型结论本文首先对经典DEA模型(CCR、BCC)做了简要介绍,分析了DEA模型的数学原理和性质定理,为了克服经典DEA模型在分析多投入、多产出决策单元时所忽略的指标之间交互作用对评价结果准确性造成的影响。利用Choquet积分作为累加算子引进了一种新的数据包络分析(DEA)模型CH-CCR模型,介绍了CH-CCR模型产生原理和数学规划模型以及其所具有性质定理,并在CH-CCR模型中加入交叉效率,使得决策单元评价结果更符合实际状况,而且还能对决策单元的绩效等级进行优劣排序。(2)实例研究结论以河北省31所大型综合三甲医院为研究对象,根据这些医院2015年的数据资料分别用经典DEA方法和CH-CCR模型对这些医院的服务效率和绩效进行评价,发现两者评价结果存在差别,结合理论和实际发现CH-CCR模型所计算的结果更具现实意义和指导价值。经典DEA模型评价出的DEA有效的医院,用CH-CCR模型计算出的最终绩效值也不为1,因为DEA所评价出的结果是相对的而不是绝对的,即使相对效率为1的医院,医院的服务效率和绩效水平同样具有改善的空间。更多还原

【Abstract】 【Background】In recent years,as people’s living environment and living standard changing constantly,people demand of more medical services.although we have the radical reform of the medical service field,but we still have a long way on the way of reform,especially on how to reform the public hospitals.Now how to further reform the management system of public hospitals,establish a sound performance evaluation mechanism of input and output mechanism,standardize the performance evaluation of public medical and health institutions at various levels and of work,promote medical institutions to improve the service quality is still looming.Therefore,in order to better evaluate the hospital service efficiency and performance level we need a set of practical and feasible evaluation system.From the point of the present literature,there are two main types of hospital performance evaluation methods: parametric and non-parametric method.The parametric method represented by stochastic frontier analysis(SFA),but SFA needs to build a function model for single output variable,but hospital is multiple input and multiple output mechanism,so the non-parametric method data envelopment analysis(DEA)is more suitable for hospital performance evaluation,In all the classical DEA models,the combination form of the multiple inputs(or outputs)is a linear weighted sum,it needs an assumption that there is no interaction among the contributions from individual information sources so that the joint contribution is just the simple sum of contributions from individual information sources.But in practice,the variables(input or output)are usually strongly correlated,there are interactions among variables.In general,the inherent interaction cannot be ignored in the efficiency evaluation..So aiming at the disadvantages of classical DEA method,this research studies the variable interactions with DEA model,and carries on the empirical research,analysis of the results of the two models,to verify the feasibility of the new model.【Research purposes】(1)Using the cluster analysis,the correlation analysis and coefficient of variation analysis select suitable input and output indicators,to construct the index system of hospital performance evaluation.(2)On the basis of classic DEA model,we build up a new DEA model with interaction variables,and then explore the nature of the new model theorem and its advantages 【Research methods】(1)Index selection: using cluster analysis,correlation analysis and coefficient of variation analysis,select the appropriate input and output index.(2)Model choice: classical DEA model,DEA model with interaction variables and cross efficiency evaluation,to evaluate and rank the overall performance of the decision making units.(3)Analysis software: MaxDEA and Lingo12 software 【Research result】(1)The results of the classical DEA modelThe classical DEA model analysis result shows that there are 14 decision making units overall efficiency value is 1,which accounts for 45%.Illustrating that the 14 hospitals inputs is best combination in theory,the output results are also achieved the best,scale reward is in a state of constant.From 17 non DEA efficient DMU on behalf of the input and output indicators of hospital can be seen to improve value and target value,input indicators,improvement of the negative,to illustrate the 17 hospitals at different level of investment in redundant state,so these hospitals should reduce inventory,reasonable control the scale of hospitals and improve resource utilization,for getting the most output with the least amount of inputs.(2)The results of CH-CCR modelThe number of effective DMUs of this model is nine more than the classical DEA model,The hospital represent by DMU5,DMU7,DMU9,DMU12,DMU14,DMU16,DMU17,DMU24,DMU26,DMU31 are also effective in CH-CCR model,but the hospital DMU15 is effective in CCR model not in CH-CCR model.The efficient results of classical DEA model and CH-CCR model are relatively effective,rather than absolute.The results of CH-CCR model shows even DEA efficient decision making units,also has the improvement space,【Conclusion】(1)Model conclusionIn order to overcome the classic DEA model based on the analysis of input and output decision-making unit index which ignored the interaction effects on the accuracy evaluation results.Choquet integral is used as additive operator introduced a new data envelopment analysis(DEA)model CH-CCR model,this paper introduces the principle of CH-CCR model and the mathematical programming model and its property theorem,and join cross efficiency in the new model,which makes the results more accord with the actual situation.(2)Case study conclusionthe efficient results of the 31 hospital are different with the two model.the CH-CCR model calculation result is more practical significance and guiding value.using the CH-CCR model calculate the ultimate performance of value is less than 1,because the results of the DEA evaluation out is relative rather than absolute,even the relative efficiency of 1 hospital,the hospital service efficiency and performance level also has room for improvement.更多还原