【作者】 梁建凤；

【导师】 沈毅；

【作者基本信息】 浙江大学 ， 流行病与卫生统计学， 2006， 硕士

【摘要】 研究背景: 公立医院绩效评估考核研究,已逐渐从尝试阶段向成熟阶段、从表层应用向深层应用推进。然而由于卫生系统长期计划指导以及卫生服务的特殊性,尚未形成较为公认的医院绩效评估体系。近年来,特别是WHO《2000年世界卫生报告》中关于卫生系统绩效框架的提出,提高卫生系统的绩效是很多国家和政府关心的重要问题之一。卫生行政部门由于很少根据医院的绩效进行赏罚,缺乏制约医院行为的有利措施,公立医院往往存在如效率低下、资源浪费、人才流失和对消费者的反应性差等问题。对医院来讲,既要面对医院改制转型的改革,又要适应卫生服务体制和医疗保障制度的改革。医院是卫生系统的主体,也是卫生系统主要功能的承担者。如何客观公正考核医院的医院绩效,是卫生决策者和医院管理者一直致力于解决的问题。评价医院工作绩效可以了解医院面临的机遇和挑战,从而提高医院的工作效率,增强医院综合竞争力。 研究目的: 一、借鉴平衡记分卡法(BSC)绩效管理理论从医疗服务效率管理类指标、财务类指标、医院发展类指标和满意度指标四方面建立医院绩效考核指标体系。结合投入、结构、过程和结果等方面,经二轮专家咨询建立基于医院内外考核和医院等级评审相结合的医院绩效评价指标体系。 二、应用基于医院多种投入,多种产出的数据包络分析方法(DEA)获得对浙江省2004年二级以上医院总体技术效率的估计,单纯技术效率和医院规模效率的测量。并为非DEA有效的医院判断规模报酬状况,评价医院绩效状况,为医院发展提供参考依据。 三、应用TOBIT回归分析评价医院效率与医院绩效评价指标体系中医疗业务管更多还原

【Abstract】 Background:Study on the hospital performance evaluation system in China has gradually come into a mature era since the year 2000 when WHO first released the health system performance evaluation framework. Hospital as a main component of the national health system, takes many responsibilities of the medical care and health promotion especially when it has to face challenges from the hospital classification intonon-profit hospital and profit hospital, china’s entry into WTO, medical care opening market in China. However hospital in traditional healthcare system typically known as low efficiency in medical services and huge waste in health resources has become on the target since the reforming and opening up in health policies in China recently, thus hospital performance evaluation and monitoring have been a critical task to those health policy makers and hospital managers. Objective:The study on public non-profit hospital performance is to construct a performance evaluation index system based on four aspects: medical care management, hospital economy, hospital development, hospital responsiveness introduced from business Balanced-Scored Card (BSC) performance management concept. The study also analyses the hospital performance in ZHEJIANG province in terms of the efficiency index from Data Envelopment Analysis (DEA) and the relationship between efficiency index and the former newly-developed performance index system by TOBIT regression. Finally a policy suggestion on further modifying to current hospital performance index system is put forward to enhance the hospital efficiency integrating the BSC concept so as to improve hospital core competition. Research method:Delphi method: a professional panel, including 20 professionals in hospital teaching or hospital manager has been selected based on their practices knowledge and fame in hospital management. The hospital performance evaluation index system including Four aspects service quality and effectiveness, financial condition, study/creative ability, hospital development and hospital responsiveness has been discussed in two rounds of expert consultation to form agreement.Econometric methods: Data Envelopment Analysis (DEA) is used to measure the hospital performance status in ZEHJIANG province with four input indices: hospital bed number, hospital staff number, permanent assets in total value, medical care expense;four output indices: outpatient and emergency visits, inpatient visits, yearly bed day occupation, medical care revenue. The operation is accomplished on the program software DEAP2.1 established by Tim Coelli, a professor from departmentof econometrics University of New England of Australia. TOBIT regression analysis, combined with the DEA measurement, is further applied to evaluate the performance index system. Research results:1. The performance evaluation index system based on service quality and effectiveness, financial condition, study/creative ability and hospital responsiveness according to two rounds of expert consultation has come into being aiming at adapting to the reforming health service system in China.2. the result from DEA analysis show that only sixteen(10.96%) of 146 hospitals in class 2 were identified technically efficient of Constant Return to Scale (CRS) while the figure is eighteen (34.62%) of 52 hospitals in class 3;eighty-four (57.53%) hospitals of 146 hospitals in class 2 were measured in the status of the Increasing Return to Scale (IRS) and 48 (28.77%) of them were in terms of Decreasing Return to Scale (DRS) while the correspondence are only thirteen (25%) (IRS) and eighteen (34.62%) (DRS) of 52 hospitals in class 3 respectively.3. the results Through DEA analysis and TOBIT regression show that The performance evaluation index system on service quality and effectiveness, financial condition has acceptable characteristics of stability, reliability and availability with the simulation on hospitals in the ZHEJIANG province, the hospital performance index system including the selected 26 indicators based on weighted shows satisfactory reference indices of yearly workload per person, bed efficiency, average inpatient staying period, success rate in saving dying patient and recovery rate on service quality and effectiveness and yearly professional revenue per person, yearly expense per person, balance rate and debt rate on financial status in decision-making, however it has some obvious defects and obstacles in application on hospitals in class 3.Conclusion:The results suggest hospital performance index system is effective but should be further modified. The BSC concept should be adopted in hospital performance management focusing on improving operation efficiency to enhance the core force forhospital competition.更多还原