山东省县级中医院中医医疗服务效率评价及影响因素研究
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摘要
研究背景
中医药作为中华民族的瑰宝,蕴含着丰富的哲学思想和人文精神,是我国文化软实力的重要体现。长期以来,中医药和西医药互相补充、协调发展,共同担负着维护和增进人民健康的任务,这是我国医药卫生事业的重要特征和显著优势。中医药临床疗效确切、预防保健作用独特、治疗方式灵活、费用比较低廉,特别是随着健康观念变化和医学模式转变,中医药越来越显示出独特优势。
县级中医院是我国医疗服务机构的重要组成部分,是三级医疗卫生服务网络的龙头。应该发挥龙头的作用,提高基层的中医药服务能力从而满足城乡居民的要求。中医药的基础在农村,广大农民需要中医药,县级中医院是农村中医药医疗、预防、保健中心,承担农村中医药预防保健,基本医疗等任务。县级中医院作为农村中医药服务网络的主干力量,关系着农村传统医药的兴衰成败,对整个中医药事业举足轻重,影响深远。
但是县级中医院目前存在着政府财政支持不足、管理结构不够健全、人才梯队不合理的问题、中医医疗服务效率低下等问题。其中中医医疗服务效率低下是目前县级中医院面临的最严重的问题,目前对于医院医疗效率的研究主要集中在：某种因素对医疗服务效率的影响、医疗机构医疗服务效率评价、医院效率的影响因素研究等方面,但是研究中医院医疗服务效率,尤其是对县级中医院中医医疗服务效率的研究比较少,而且医院效率的影响因素主要集中在内部因素
基于以上的分析本研究提出四个研究问题,具体为：(1)县级中医院中医医疗服务的现状如何?(2)县级中医院中医医疗服务的效率怎样?(3)影响中医院中医医疗服务效率的因素是什么?(4)如何提高中医院的中医医疗服务效率?
研究目的
本研究的总体研究目标是通过分析山东省县级中医院中医医疗服务现状,分析中医医疗服务效率,按照管理环境理论构建本研究的影响因素评价指标体系,定量分析影响中医医疗服务效率的因素,提出提高中医医疗服务效率的政策建议。
具体的研究目标：
1.具体分析山东省中医院中医医疗服务现状。通过描述性分析发现山东省中医医疗服务现存的问题。
2.针对现存的问题,采用数据包络分析方法(DEA)分析山东省县级中医院中医医疗服务效率状况,重点包括各综合技术效率(Techinical Efficiency)、纯技术效率(Pure Techinical Efficiency)和规模效率(Scale Efficiency)进行分析。综合效率使用不变规模报酬(CRS)模型,利用可变规模报酬(VRS)模型具体分析纯技术效率和规模效率,并且对对非有效县级中医院医院在投入、产出方面存在的主要问题进行定量分析。
3.根据上述研究,针对山东省中医医疗服务效率的影响因素,利用文献研读、专家咨询和层次分析方法(AHP)确定影响因素的评价指标体系。
4.基于上述影响因素指标体系,运用Tobit回归方法对影响医院效率的因素进行回归分析,找出显著影响医院效率的指标,并分析各指标与效率高低的相关关系并对影响医院效率的因素进行系统的理论分析。
研究方法
本研究为横断面研究,样本医院为山东省101所县级公立中医院(以下称县级中医院)。研究资料来源于2010年山东省卫生厅中医药管理局开展的全省中医基本现状普查工作。
1、数据包络分析方法(DEA)
对于DEA模型的选取,应用不变规模报酬(CRS)模型和可变规模报酬(VRS)模型,CRS和VRS模型不需要首先设定医院的生产函数和无效率项的分布假设,而是使用数据包络分析的方法构建出最佳实践面,将决策单元同最佳的决策单元相比较,计算出每个单元的效率值。CRS模型测定的是医院的技术效率(Techinical Efficiency)也叫综合效率,即在给定的投入的情况下医院获取最大产出的能力,但是CRS模型无法说明无效率的原因是由于技术无效率还是规模无效率,因此需要利用VRS模型将技术效率进一步的分析为纯技术效率(Pure Techinical Efficiency)与规模效率(Scale Efficiency)。本文采用的以产出为导向的DEA模型即在投入一定的情况下,了解产出的效率情况。
变量的选取非常关键,能够影响模型的质量。所以我们利用了Pastor等人基于严密的数学论证和推导提出的DEA研究中较为有效的筛选变量方法,也称为Pastor方法。
2、影响因素指标体系构建方法
文献分析后初步确定了影响因素指标体系,通过两轮德尔菲法确定了影响因素指标体系,并且利用层次分析法(AHP)来确定影响因素指标体系的指标权重。
3、资料分析的方法
利用描述性统计分析对中医院中医医疗服务现状进行分析,找到现状中存在的问题,对投入产出指标进行描述和比较,并且对影响因素各个指标的基本特征进行描述。
利用Tobit回归对影响因素指标体系进行定量分析。
本论文分析过程主要分为三部分,第一部分对县级中医院的中医医疗服务现状进行描述性分析；第二部分利用数据包络分析方法从投入产出方面来计算县级中医院中医医疗服务效率及无效率医院的投影分析；第三部分利用Tobit回归对影响服务效率的因素进行分析。
研究结果
1、样本医院中医医疗服务开展情况
从现状分析可以看出山东省基本建立了中医药服务网络,山东省共有公立中医医院(中西医结合医院)123所,其中,省级2所,市级17所,县级中医院101所。全省初步建立了以县(市、区)级中医医院为龙头,乡镇卫生院、社区卫生服务中心中医科为主干,村卫生室、社区卫生服务站为依托的基层三级中医药服务网络,在疾病防治中发挥了独特的作用。据统计,县(市、区)级中医医院总诊疗人次数为1019万人次,占全省公立中医医院总数的65.88%。
中医方面卫生人力所占比例不高：山东省公立中医院人才队伍初具规模,全省县级中医院中编制人员总数为20746人,其中卫生技术人员21775人；执业医师为8492人,中医类别执业医师为3079人,占执业医师的比例为36.23%；执业助理医师为782人,其中中医类别执业医师为180人,所占比例为28.26%；注册护士为7372人,期中具有中医服务能力的护士为所占的比重为66.64%。
中医方面的卫生设备设施所占比重较小：山东省县级中医院医疗设备总值为68825911千元,其中中医特色诊疗设备总值为418661千元,占到医疗设备总值的0.61%。山东省县级中医院上报医用设备中,总量居前三位的是人工肾透析装置、危重病人监护系统、医学影像存档传输系统,数量分别为561套、464套、398套。
中医药服务所占比重偏低：全省县级中医医院承担了全省医院13.26%的门诊服务量和11.80%的住院服务量；中药饮片处方数和中成药处方数分别占总处方数的53.66%；山东省县级中医院总诊疗人次数为10192682人次,其中门诊人次数为9282207人次,中医专家门诊人次为1695189人次,占门诊人次的18.26%。山东省各县级中医院能够运用的中医疗法种数平均为14种,能够运用推拿疗法的县级中医院数量最多,占所有县级中医院的99.01%,其次为拔罐疗法,占98.02%。
中医类别经费所占卫生经费比例偏低：山东省县级中医院财政补助收入为204314千元,占县级中医院总收入的5.80%,中医治疗收入为305052千元,占医疗收入的18.31%。中药收入占药品收入的19.03%,中药费支出占药品支出的16.74%,而在中药费支出中,中成药费的支出占了44.87%,院内制剂仅占5.68%。
2、中医医疗服务效率分析
本研究利用数据包络分析方法中的CRS模型和VRS模型,选取与中医医疗效率相关投入和产出指标分析山东省101家县级中医院中医医疗服务效率,研究结果表明：
(1)山东省县级中医院中医医疗服务效率总体分析：从总体上看综合效率有效的县级中医院为51所,综合效率平均值为50.50%。纯技术效率有效的县级医院为55所,纯技术效率有效比例为54.46%。规模效率平均值为96.40%,规模效率有效的医院为52所,规模效率有效比例为46.53%。规模报酬不变的为47所,规模报酬递减的医院为33所,规模报酬递增为21所。按效率得分分组,高分组为0.9分以上,中效率组为0.6-0.9,低效率组为0.6以下。各效率分值均为高分组中数量最多,技术效率中高分组为53家,均值为0.998,纯技术效率中,高分组为55家,均值为1.000,规模效率中高分组有74家,均值为0.989。而技术效率有效和纯技术效率有效的医院都很少,分别为4家和6家。
(2)按规模分组分析：按规模分组可以看出综合效率有效比例和纯技术效率有效比例最高的均为大规模,比例分别为88.80%和90.40%。而综合效率有效比例和纯技术效率有效比例最低的均为中规模组,比例分别为43.50%和44.40%。规模效率状态中,规模递减所占比重最多的组别为中规模组,比例为88.30%,而规模递减所占比重最少的组则是中小规模,比例为31.81%。
而且看出县级中医院的综合效率和纯技术效率随着规模的扩大呈现出先升然后再降低然后再大幅度上升的趋势。县级医院的中规模组的综合效率和纯技术效率最低,平均值分别为0.480和0.520,而大规模组的综合效率和纯技术效率都为最高,分别为0.888和0.901.而规模效率则表现比较平缓,规模效率最高的也为大规模组,平均分为0.983,最低也为中规模组,平均分为0.883。
规模收益不变的情况中,中小规模和中大规模的规模收益不变的比例较大,分别占到了45.50%和60%。而总体情况中50.50%的医院处在规模收益不变的情况。
规模收益递增的情况下看,中大规模和大规模都为0所医院,所占比例也都为0.00%,而小规模和中规模中规模收益的比例较高,分别为27.30%和27.80%。而总体情况看仅有12.87%的医院为规模递增状况。
从规模递减的情况看,中小规模和中规模的所占的比例最高,分别认为45.50%和38.90%。从总体上看36.63%的医院处于规模递减状态。
(3)按照市域分析：综合效率,纯技术效率和规模效率最高的城市为威海市,都为有效决策单位。而技术效率,纯技术效率最低的为枣庄市,分别为0.420、0.480,规模效率最低为滨州市仅为0.781。
(4)按地域分析：从表中可以看出东部的县级中医院为31所,中部为20所,而西部为50所,占总样本的49.50%,东部的县级中医院为31所。西部中医院的技术效率最低为0.583,中部的纯技术效率最高位0.769,东部的规模效率最高位0.941。从规模报酬来看,中部地区的仅为递减和不变,没有医院规模需要递增,而东部为递减8所,递增3所,不变为9所。
(5)非DEA有效决策单元的投入产出投影分析：非总体有效决策单元在所有投入指标均有不同程度的过剩与浪费。中医执业助理医师这个指标实际平均值为1.782人,但是目标值仅1.022人,过剩的比例为42.70%。中医特色诊疗设备总值实际平均值为414.52万元而目标值仅为78.2万元,过剩比例达到80.90%。所有的产出指标均未达到目标值,其中能够运用的中医疗法种数这个指标距离目标值还有28.966,差距比例为68.04%。
3、中医医疗服务效率影响因素分析
用Tobit回归分析方法对101家县级中医院的中医医疗服务效率的影响因素进行分析,分别从医院外部因素和医院的内部竞争因素两个方面进行分析：
(1)外部宏观因素分析：影响医院效率的主要的外部宏观因素主要是行政区域土地面积(平方公里)p值为0.013,在0.05的水平上有意义,影响系数为正向0.615和政策扶持力度这两个指标。在对三个效率的影响中,中医院的扶持力度这个指标和医院获得财政补助数占区域内医院财政补助比例这连两个指标的影响系数均为正值,因此说明中医院的扶持力度和医院获得的财政补助和中医院的中医医疗服务效率之间的正相关,且中医院的扶持力度和医院获得财政补助数占区域内医院财政补助比例两个指标在三个模型中均通过了显著性检验。这说明,政策的扶持力度能够促进中医院的的中医医疗服务效率
(2)外部微观因素：影响医院的外部的微观因素也就是竞争因素中我们可以看出医院卫生技术人员占区域内卫生技术人员数比例这个因素对三个效率值均有影响,而且均有统计学意义,并且回归系数为负值,这说明,卫生技术人员所占的区域内卫生技术人员比例越多,效率越低,人员越多,医院的压力越大,越容易开展更能盈利的西医诊疗方式。
(3)医院内部竞争因素分析：可以看出,多数的指标对效率的影响不显著,仅有中药收入占药品收入的比例、中药费的支出占药品支出的比例对综合效率和纯技术效率有影响,而所有的指标对规模效率的影响均不显著,这说明,药品收入和药品的支出影响中医医疗服务效率。
结论与政策建议
本研究从县级中医院的内部因素分析,发现县级中医院中医医疗服务存在很多的问题,首先,中医院虽然服务能力逐步提升,但是西化的比较严重。目前的的县级中医院中医医疗服务效率总体不高,并且县级中医院中规模经济与规模不经济的情况并存,同时还发现,医院中的中医方面的卫生技术人员和护理人员提供中医药服务的积极性不高,在医院内部的竞争因素中,发现中药药品收入占药品收入的比例和中药费支出占药费支出的比例这两个指标对效率的影响有统计学意义。
从外部因素分析可以看出,宏观的外部环境因素中,经济发展状况好的地区的县级中医院中医医疗服务效率越低,对中医药的扶持力度也能有效的提高县级中医院的服务效率,在微观的外部环境因素中可以看出卫生技术人员所占区域内卫生技术人员比例这个指标有意义,且影响为负向。
根据本研究的结论提出如下的政策建议：
医院内部因素措施：首先县级中医院应该做到以中医为重,努力提高中医在重大疾病中的参与性,提高中医院的服务质量和临床疗效,扩大指标范围；其次县级中医院应该加强县级中医院的中医医疗服务水平；再次提高中医方面的卫生技术人员和护理人员的提供中医服务的积极性。
医院的外部因素措施：首先国家的应该扩大对中医院的扶持力度,公立中医院是非营利性的医疗机构,是政府实行一定福利政策的公益事业的一部分,政府投入不足不利于公立中医院公益性的体现,也很难促进中医医疗服务的开展；其次国家应该从政策上扶持,除了财政投入外,更多的应该是政策上的扶持。
Background
Traditional Chinese medicine as a very important part of national wealth, contains extremely adequate philosophical thought and humanistic spirit, shows our Chinese cultural soft power on great extent.
For a long time, traditional Chinese medicine and west medicine completed and largely developed each other, which contributing to protecting and improving people's health formed Public health and medicine industrial critical feature and excellent advantage. The clinical curative effect of traditional Chinese medicine is reliable, prevention and health care effects is unique, curative methods are flexible, and curing expense is relatively low. Especially, traditional Chinese medicine has showed dramatic advantage with the change of healthy version and medical pattern.
At the county level of the hospital that is an important component of medical service agencies in our country, plays an role of faucet in the medical service industry, and it should improve the capacity of basic traditional medical services to satisfy urban and rural residents'demand. The foundation of hospital at the county level is in rural areas. vast peasantry has enormous demand of traditional Chinese medicine, so that the county level of the hospital gradually became the center of rural health curing and prevention. And it's also responsible for primary rural medical care. At the county level of the hospital conducting as main power in rural traditional medical service, relates to the wax and wane of rural Chinese medical development, is vital to the whole traditional Chinese medical industry.
But the county level of the hospital exists many problems at present. Chinese medical services'efficiency is low, configuration Management is unreasonable, lack of governmental finance support and so on.
As for the research of hospital medical efficiency mainly concentrate on certain reason what influence medical service most and comments on medical association' service. However, few research on efficiency of traditional Chinese medical service. What's more, medical efficiency greatly influenced by it's inner factor.
This research come up with four questions:
(1) what's the present situation of the county hospital of traditional Chinese medicine health service?
(2) How's the efficiency of the county hospital of traditional Chinese medicine health service?
(3) What is the key factors that influence efficiency of traditional Chinese medicine health care services?
(4)How to improve the efficiency of hospital of traditional Chinese medicine medical service?
Objectives
The overall objective of this research is to analysis medical service efficiency of traditional Chinese medicine, through the analysis of Shandong Province County Chinese medicine hospital medical service present situation. And according to the environmental impact of the research on the theoretical construction of the evaluation index system of factors analysis, quantitative analysis of the influence factors of medical service efficiency of traditional Chinese medicine, improve medical service efficiency of Chinese policy recommendations.
The specific objectives of the study:
1. Specific analysis of the current situation of medical service of Shandong Provincial Traditional Chinese Medical Hospital
2. According to the problems in the current situation, using the method of data envelopment analysis of Shandong province101County Hospital of traditional Chinese medicine of traditional Chinese medical service efficiency, focuses on the analysis of the overall technical efficiency(TE), pure technical efficiency(PTE) and scale efficiency(SE) analysis. CRS model of comprehensive efficiency of use, using VRS model to analyze the pure technical efficiency and scale efficiency, and to make quantitative analysis on the main problems of non-effective County Hospital of Chinese medicine hospitals exist in the input and output.
3. According to the above research and the factors influencing Shandong Province Chinese medical service efficiency, determine the evaluation index system of impact factors by using the method of literature study, expert consultation and AHP.
4. Based on the index system of the influencing factors, we can use Tobit regression method to make a regression analysis, to find out influence factors of hospital efficiency of, and make a analysis on the correlation between the level of each index and efficiency to carry out systematic theoretical analysis of influence factors of hospital efficiency.
Methods
This research is a cross-sectional study design. The samples of research are hospitals for the county (city) of public TCM from Shandong province, in total101hospitals. In this study, data is from the Health Bureau of Shandong province and Shandong Provincial Administration of traditional Chinese medicine, which survey was the province's basic situation of Chinese census carried out in2010.That survey was a comprehensive survey.
1. The method of data envelopment analysis (DEA)
For the selection of DEA model, the study use CRS model and VRS model CRS and VRS model does not require the production function firstly set up the hospital and
ineffective distribution rate items, but can the method of data envelopment analysis to construct the best practice to compare the decision unit and the best decision unit, and calculate the efficiency value of each unit. CRS model can determine the technical efficiency of hospital (TE), also called the comprehensive efficiency,which have the ability to maximize output hospital in a given input conditions. But CRS model cannot explain inefficiency determined by pure technical inefficiency or scale inefficiency. So the study use VRS model to further analyze the technical efficiency into pure technical efficiency(PTE) and scale efficiency (SE). The DEA model used in this paper is output oriented which means to understand the efficiency output in certain circumstances.
Variable selection is so important that can affect the quality of the model. So we use pastor Et al. more effective screening method of variable DEA research which based on strict mathematical argumentation.
2. Construction methods of influence factors system
After studying of literature analysis, we can determin the factors index system,and determine the factors that influence the index system based on two Delphi method, and use the analytic hierarchy process (AHP) to determine the index weight of influence factors.
3. Methods of data analysis
By Using descriptive statistical analysis,the paper analyze the current status of traditional Chinese medicineof traditional in Chinese Medical Hospital, analyze the input-output index description and comparison, and analyze the basic features of the influence factors. By using Tobit regression, we can make a quantitative analysis on the influence factors.
In this paper, the analysis process is divided into three parts. The first part, we make a descriptive analysis about the Chinese medical service present situation in county hospital. The second part, we use data envelopment method to calculate the county hospital of Chinese medical service efficiency and void analysis projecton analysis through the aspect of input-output. The third part, we use Tobit regression to analyze the influential factors.
Results
1. basic situation of Chinese medicine services in medical institutions
There are123public TCM hospitals (Integrative medicine of Chinese and Western medicine, ICWM hospital) in Shandong Province, including2provincial,17municipal,101county (city, district) levels.
The personnel of TCM hospital in Shandong:The number of staff in Shandong TCM hospital is36433, including31075health and technical personnel;5713medical practitioners (assistant) of TCM, accounting for18.38%of the practicing (assistant) doctors; the education level of TCM service personnel was mainly undergraduate with the percentage of40.94, and the master's degree or above accounted for10.38%; the Personnel titles was mainly intermediate, accounted for43.26%, and the senior titles accounted for22.52%. The number of TCM service personnel in provincial general hospital (specialized hospital) was8455, including6241of Chinese medicine specialty and2214of Chinese pharmaceutical specialty, the number of practicing (assistant) doctors was74768, including6119TCM practicing (assistant) doctors, accounting for8.18%.
Medical service:13.26%outpatient services and11.80%of hospital services were held by the public TCM hospitals in Shandong Province. The patients in expert outpatient service accounted for23.59%of its total diagnostic person number in public TCM hospitals.
2. DEA (Data Envelopment Analysis) analysis of efficiency of TCM medical services
This study analyzed the TCM health service efficiency in101county level hospitals in Shandong province using CRS model and VRS model of DEA method, the indicators were from input and output indicators with correlation of TCM.
The results show that,
First, the overall efficiency of TCM medical service is not high in county level hospital.
From the data we can see that he overall efficiency of TCM medical service is not high, if in certain inputs, the target values of output had big gap, and if in certain outputs, the inputs would have waste. There were51comprehensive efficiency county level TCM hospitals and the average overall efficiency was50.50%.55county level hospitals had pure technical efficiency, and the proportion was54.46%. The Average scale efficiency was96.40%, and52hospitals had scale efficiency with the percentage of46.53%.
Second, the economies of scale existed in county level hospitals.
The medium-sized hospital whose actual beds was between151-200had the lowest efficiency, then the efficiency increased with the increase of bed, especially that the efficiency of more than500-bed hospital at the county level are all effective.
Third, from the point of returns to scale, the vast majority of the hospitals were in diminishing returns to scale, the returns to scale of large and medium-sized hospitals were not increasing.
Fourth, from the results of projection analysis of input and output index, the input indicators were more than the target value and the output indexes didn't reach the target, which meant that the hospital should improve the medical services of TCM from the quality, rather than the pursuit of scale expansion and the renewal of medical equipment.
3. The factor analysis of TCM medical service efficiencies
Through the analysis of influence factors on TCM medical service efficiencies in101TCM county level hospitals using tobit regression analysis, and from the external factors and the internal factor we can see:
The administrative land area (square kilometers) and policy support were the main external macro factors influencing the efficiency. In three models, the influence coefficient of support level and the percentage of financial aid were positive, so the support of the hospital and the hospital financial aid had positive correlation with the medical service efficiency of TCM hospitals, and the two indicators had passed the test of significance in the three models. This indicated that the support to the hospitals can promote the TCM hospitals' medical service efficiency.
From the external micro factors influencing hospitals and also the competitive factors we can see that the percentage of health technical personnel was influence factors on the three efficiency values, and all had statistical significance, and the regression coefficient was negative. This showed that the high the percentage of health technical personnel the lower the efficiency got, and the more the personnel got, the greater the pressure of the hospital, and the easier it was to develop a more profitable way of western medicine diagnosis and treatment.
And from the inner competition factors we can see that most of the indicators had no significant impact on efficiency, only the proportion of TCM drug income and TCM spending accounts for the proportion of drug expenditure had influence to the overall efficiency and pure technical efficiency, and all the indexes had not significance to the scale efficiency. This showed that competition factors were not the main factors that influence efficiency of medical services of traditional Chinese medicine, in other words, the good development of western medicine can't represent the TCM medical efficiency would certainly be affected.
Conclusion and policy implication
Lots of problems have found in county level traditional Chinese medicine hospitals of Chinese medical services from the hospital's internal factors analysis. First of all, the overall efficiency of county level traditional Chinese medicine hospital is not high. Secondly, economies of scale exist in county level traditional Chinese medicine hospitals. Thirdly, the Enthusiasm of Health professionals to provide Chinese medicine in county level traditional Chinese medicine hospitals is not high.
We can see from the analysis of the external environment firstly, the better economic development the lower medical services efficiency of county level traditional Chinese medicine hospital.
From the Tobit regression we can know that the impact of economic development indicators on traditional Chinese medicine service' efficiency is negative.Secondly, the support efforts of Chinese medicine can effectively improve the efficiency of Chinese medical services in county level traditional Chinese medicine hospital
We can also see from the tobit regression, the indicator of support efforts to Chinese medicine has the impact to the efficiency of Chinese medical services and the impact is positive, that means, the support of Chinese medicine can improve the efficiency of Chinese medical service in Chinese medicine hospital.
The recommendations Policy based on the conclusions of this study are following:
Measures for the hospital internal factors:Firstly, the county level traditional Chinese medicine hospital should strengthen its medical services' level As can be seen from the study, all inputs and outputs indicators of the Chinese medicine hospitals are reaching the target value, that means, Chinese medicine hospitals did not achieve the best outcomes under the existing scale of investment in the existing conditions. In the interview many officials in Chinese medicine department complaint that the TCM hospitals did not pay attention to traditional Chinese medicine departments, because of the poor economic benefit in Chinese medicine department. Secondly county level traditional Chinese medicine hospitals should be "Equal emphasis on traditional Chinese and western","Equal emphasis on traditional Chinese and western" is the country's health policy, hospitals should take this principle, improve the Chinese medicine's involvement in major diseases, improve service quality and clinical efficacy in Chinese medicine hospital, expand the indicators'range. To strengthen scientific research efforts in Chinese medicine, give full play to the advantages and expertise of Chinese medical technology to form their own core competitiveness in Chinese medicine hospital. Hospital of TCM should focus on their specialties.
Measures for the hospital external factors:Firstly, the government should expand the support efforts on the Chinese traditional medicine hospitals. Chinese medicine hospitals are a non-profit public medical institutions, is part of the Government to implement certain welfare policies, lack of government investment is not conducive to reflect the public TCM hospitals' welfare, and it is difficult to promote the development of the Chinese medicine services. Lack of government investment will inevitably lead to the hospitals'pursuit of the interests and have to survive from the drug treatment. Financial investment for Chinese medical services has a significant impact on the efficiency.
Secondly, the government should support from the policy. Except financial investment, policy support should be more, for example, the use of Chinese medicine services should be compensated and such as the Chinese medicine doctors in TCM hospitals should be given supports on the economy and the professional title. The westernization phenomenon in TCM hospitals also should be controlled, TCM hospitals should return to the "Chinese" characteristics. Developing a scientific evaluation system can control the phenomenon of westernization phenomenon in TCM hospitals.
中医药作为中华民族的瑰宝,蕴含着丰富的哲学思想和人文精神,是我国文化软实力的重要体现。长期以来,中医药和西医药互相补充、协调发展,共同担负着维护和增进人民健康的任务,这是我国医药卫生事业的重要特征和显著优势。中医药临床疗效确切、预防保健作用独特、治疗方式灵活、费用比较低廉,特别是随着健康观念变化和医学模式转变,中医药越来越显示出独特优势。
县级中医院是我国医疗服务机构的重要组成部分,是三级医疗卫生服务网络的龙头。应该发挥龙头的作用,提高基层的中医药服务能力从而满足城乡居民的要求。中医药的基础在农村,广大农民需要中医药,县级中医院是农村中医药医疗、预防、保健中心,承担农村中医药预防保健,基本医疗等任务。县级中医院作为农村中医药服务网络的主干力量,关系着农村传统医药的兴衰成败,对整个中医药事业举足轻重,影响深远。
但是县级中医院目前存在着政府财政支持不足、管理结构不够健全、人才梯队不合理的问题、中医医疗服务效率低下等问题。其中中医医疗服务效率低下是目前县级中医院面临的最严重的问题,目前对于医院医疗效率的研究主要集中在：某种因素对医疗服务效率的影响、医疗机构医疗服务效率评价、医院效率的影响因素研究等方面,但是研究中医院医疗服务效率,尤其是对县级中医院中医医疗服务效率的研究比较少,而且医院效率的影响因素主要集中在内部因素
基于以上的分析本研究提出四个研究问题,具体为：(1)县级中医院中医医疗服务的现状如何?(2)县级中医院中医医疗服务的效率怎样?(3)影响中医院中医医疗服务效率的因素是什么?(4)如何提高中医院的中医医疗服务效率?
研究目的
本研究的总体研究目标是通过分析山东省县级中医院中医医疗服务现状,分析中医医疗服务效率,按照管理环境理论构建本研究的影响因素评价指标体系,定量分析影响中医医疗服务效率的因素,提出提高中医医疗服务效率的政策建议。
具体的研究目标：
1.具体分析山东省中医院中医医疗服务现状。通过描述性分析发现山东省中医医疗服务现存的问题。
2.针对现存的问题,采用数据包络分析方法(DEA)分析山东省县级中医院中医医疗服务效率状况,重点包括各综合技术效率(Techinical Efficiency)、纯技术效率(Pure Techinical Efficiency)和规模效率(Scale Efficiency)进行分析。综合效率使用不变规模报酬(CRS)模型,利用可变规模报酬(VRS)模型具体分析纯技术效率和规模效率,并且对对非有效县级中医院医院在投入、产出方面存在的主要问题进行定量分析。
3.根据上述研究,针对山东省中医医疗服务效率的影响因素,利用文献研读、专家咨询和层次分析方法(AHP)确定影响因素的评价指标体系。
4.基于上述影响因素指标体系,运用Tobit回归方法对影响医院效率的因素进行回归分析,找出显著影响医院效率的指标,并分析各指标与效率高低的相关关系并对影响医院效率的因素进行系统的理论分析。
研究方法
本研究为横断面研究,样本医院为山东省101所县级公立中医院(以下称县级中医院)。研究资料来源于2010年山东省卫生厅中医药管理局开展的全省中医基本现状普查工作。
1、数据包络分析方法(DEA)
对于DEA模型的选取,应用不变规模报酬(CRS)模型和可变规模报酬(VRS)模型,CRS和VRS模型不需要首先设定医院的生产函数和无效率项的分布假设,而是使用数据包络分析的方法构建出最佳实践面,将决策单元同最佳的决策单元相比较,计算出每个单元的效率值。CRS模型测定的是医院的技术效率(Techinical Efficiency)也叫综合效率,即在给定的投入的情况下医院获取最大产出的能力,但是CRS模型无法说明无效率的原因是由于技术无效率还是规模无效率,因此需要利用VRS模型将技术效率进一步的分析为纯技术效率(Pure Techinical Efficiency)与规模效率(Scale Efficiency)。本文采用的以产出为导向的DEA模型即在投入一定的情况下,了解产出的效率情况。
变量的选取非常关键,能够影响模型的质量。所以我们利用了Pastor等人基于严密的数学论证和推导提出的DEA研究中较为有效的筛选变量方法,也称为Pastor方法。
2、影响因素指标体系构建方法
文献分析后初步确定了影响因素指标体系,通过两轮德尔菲法确定了影响因素指标体系,并且利用层次分析法(AHP)来确定影响因素指标体系的指标权重。
3、资料分析的方法
利用描述性统计分析对中医院中医医疗服务现状进行分析,找到现状中存在的问题,对投入产出指标进行描述和比较,并且对影响因素各个指标的基本特征进行描述。
利用Tobit回归对影响因素指标体系进行定量分析。
本论文分析过程主要分为三部分,第一部分对县级中医院的中医医疗服务现状进行描述性分析；第二部分利用数据包络分析方法从投入产出方面来计算县级中医院中医医疗服务效率及无效率医院的投影分析；第三部分利用Tobit回归对影响服务效率的因素进行分析。
研究结果
1、样本医院中医医疗服务开展情况
从现状分析可以看出山东省基本建立了中医药服务网络,山东省共有公立中医医院(中西医结合医院)123所,其中,省级2所,市级17所,县级中医院101所。全省初步建立了以县(市、区)级中医医院为龙头,乡镇卫生院、社区卫生服务中心中医科为主干,村卫生室、社区卫生服务站为依托的基层三级中医药服务网络,在疾病防治中发挥了独特的作用。据统计,县(市、区)级中医医院总诊疗人次数为1019万人次,占全省公立中医医院总数的65.88%。
中医方面卫生人力所占比例不高：山东省公立中医院人才队伍初具规模,全省县级中医院中编制人员总数为20746人,其中卫生技术人员21775人；执业医师为8492人,中医类别执业医师为3079人,占执业医师的比例为36.23%；执业助理医师为782人,其中中医类别执业医师为180人,所占比例为28.26%；注册护士为7372人,期中具有中医服务能力的护士为所占的比重为66.64%。
中医方面的卫生设备设施所占比重较小：山东省县级中医院医疗设备总值为68825911千元,其中中医特色诊疗设备总值为418661千元,占到医疗设备总值的0.61%。山东省县级中医院上报医用设备中,总量居前三位的是人工肾透析装置、危重病人监护系统、医学影像存档传输系统,数量分别为561套、464套、398套。
中医药服务所占比重偏低：全省县级中医医院承担了全省医院13.26%的门诊服务量和11.80%的住院服务量；中药饮片处方数和中成药处方数分别占总处方数的53.66%；山东省县级中医院总诊疗人次数为10192682人次,其中门诊人次数为9282207人次,中医专家门诊人次为1695189人次,占门诊人次的18.26%。山东省各县级中医院能够运用的中医疗法种数平均为14种,能够运用推拿疗法的县级中医院数量最多,占所有县级中医院的99.01%,其次为拔罐疗法,占98.02%。
中医类别经费所占卫生经费比例偏低：山东省县级中医院财政补助收入为204314千元,占县级中医院总收入的5.80%,中医治疗收入为305052千元,占医疗收入的18.31%。中药收入占药品收入的19.03%,中药费支出占药品支出的16.74%,而在中药费支出中,中成药费的支出占了44.87%,院内制剂仅占5.68%。
2、中医医疗服务效率分析
本研究利用数据包络分析方法中的CRS模型和VRS模型,选取与中医医疗效率相关投入和产出指标分析山东省101家县级中医院中医医疗服务效率,研究结果表明：
(1)山东省县级中医院中医医疗服务效率总体分析：从总体上看综合效率有效的县级中医院为51所,综合效率平均值为50.50%。纯技术效率有效的县级医院为55所,纯技术效率有效比例为54.46%。规模效率平均值为96.40%,规模效率有效的医院为52所,规模效率有效比例为46.53%。规模报酬不变的为47所,规模报酬递减的医院为33所,规模报酬递增为21所。按效率得分分组,高分组为0.9分以上,中效率组为0.6-0.9,低效率组为0.6以下。各效率分值均为高分组中数量最多,技术效率中高分组为53家,均值为0.998,纯技术效率中,高分组为55家,均值为1.000,规模效率中高分组有74家,均值为0.989。而技术效率有效和纯技术效率有效的医院都很少,分别为4家和6家。
(2)按规模分组分析：按规模分组可以看出综合效率有效比例和纯技术效率有效比例最高的均为大规模,比例分别为88.80%和90.40%。而综合效率有效比例和纯技术效率有效比例最低的均为中规模组,比例分别为43.50%和44.40%。规模效率状态中,规模递减所占比重最多的组别为中规模组,比例为88.30%,而规模递减所占比重最少的组则是中小规模,比例为31.81%。
而且看出县级中医院的综合效率和纯技术效率随着规模的扩大呈现出先升然后再降低然后再大幅度上升的趋势。县级医院的中规模组的综合效率和纯技术效率最低,平均值分别为0.480和0.520,而大规模组的综合效率和纯技术效率都为最高,分别为0.888和0.901.而规模效率则表现比较平缓,规模效率最高的也为大规模组,平均分为0.983,最低也为中规模组,平均分为0.883。
规模收益不变的情况中,中小规模和中大规模的规模收益不变的比例较大,分别占到了45.50%和60%。而总体情况中50.50%的医院处在规模收益不变的情况。
规模收益递增的情况下看,中大规模和大规模都为0所医院,所占比例也都为0.00%,而小规模和中规模中规模收益的比例较高,分别为27.30%和27.80%。而总体情况看仅有12.87%的医院为规模递增状况。
从规模递减的情况看,中小规模和中规模的所占的比例最高,分别认为45.50%和38.90%。从总体上看36.63%的医院处于规模递减状态。
(3)按照市域分析：综合效率,纯技术效率和规模效率最高的城市为威海市,都为有效决策单位。而技术效率,纯技术效率最低的为枣庄市,分别为0.420、0.480,规模效率最低为滨州市仅为0.781。
(4)按地域分析：从表中可以看出东部的县级中医院为31所,中部为20所,而西部为50所,占总样本的49.50%,东部的县级中医院为31所。西部中医院的技术效率最低为0.583,中部的纯技术效率最高位0.769,东部的规模效率最高位0.941。从规模报酬来看,中部地区的仅为递减和不变,没有医院规模需要递增,而东部为递减8所,递增3所,不变为9所。
(5)非DEA有效决策单元的投入产出投影分析：非总体有效决策单元在所有投入指标均有不同程度的过剩与浪费。中医执业助理医师这个指标实际平均值为1.782人,但是目标值仅1.022人,过剩的比例为42.70%。中医特色诊疗设备总值实际平均值为414.52万元而目标值仅为78.2万元,过剩比例达到80.90%。所有的产出指标均未达到目标值,其中能够运用的中医疗法种数这个指标距离目标值还有28.966,差距比例为68.04%。
3、中医医疗服务效率影响因素分析
用Tobit回归分析方法对101家县级中医院的中医医疗服务效率的影响因素进行分析,分别从医院外部因素和医院的内部竞争因素两个方面进行分析：
(1)外部宏观因素分析：影响医院效率的主要的外部宏观因素主要是行政区域土地面积(平方公里)p值为0.013,在0.05的水平上有意义,影响系数为正向0.615和政策扶持力度这两个指标。在对三个效率的影响中,中医院的扶持力度这个指标和医院获得财政补助数占区域内医院财政补助比例这连两个指标的影响系数均为正值,因此说明中医院的扶持力度和医院获得的财政补助和中医院的中医医疗服务效率之间的正相关,且中医院的扶持力度和医院获得财政补助数占区域内医院财政补助比例两个指标在三个模型中均通过了显著性检验。这说明,政策的扶持力度能够促进中医院的的中医医疗服务效率
(2)外部微观因素：影响医院的外部的微观因素也就是竞争因素中我们可以看出医院卫生技术人员占区域内卫生技术人员数比例这个因素对三个效率值均有影响,而且均有统计学意义,并且回归系数为负值,这说明,卫生技术人员所占的区域内卫生技术人员比例越多,效率越低,人员越多,医院的压力越大,越容易开展更能盈利的西医诊疗方式。
(3)医院内部竞争因素分析：可以看出,多数的指标对效率的影响不显著,仅有中药收入占药品收入的比例、中药费的支出占药品支出的比例对综合效率和纯技术效率有影响,而所有的指标对规模效率的影响均不显著,这说明,药品收入和药品的支出影响中医医疗服务效率。
结论与政策建议
本研究从县级中医院的内部因素分析,发现县级中医院中医医疗服务存在很多的问题,首先,中医院虽然服务能力逐步提升,但是西化的比较严重。目前的的县级中医院中医医疗服务效率总体不高,并且县级中医院中规模经济与规模不经济的情况并存,同时还发现,医院中的中医方面的卫生技术人员和护理人员提供中医药服务的积极性不高,在医院内部的竞争因素中,发现中药药品收入占药品收入的比例和中药费支出占药费支出的比例这两个指标对效率的影响有统计学意义。
从外部因素分析可以看出,宏观的外部环境因素中,经济发展状况好的地区的县级中医院中医医疗服务效率越低,对中医药的扶持力度也能有效的提高县级中医院的服务效率,在微观的外部环境因素中可以看出卫生技术人员所占区域内卫生技术人员比例这个指标有意义,且影响为负向。
根据本研究的结论提出如下的政策建议：
医院内部因素措施：首先县级中医院应该做到以中医为重,努力提高中医在重大疾病中的参与性,提高中医院的服务质量和临床疗效,扩大指标范围；其次县级中医院应该加强县级中医院的中医医疗服务水平；再次提高中医方面的卫生技术人员和护理人员的提供中医服务的积极性。
医院的外部因素措施：首先国家的应该扩大对中医院的扶持力度,公立中医院是非营利性的医疗机构,是政府实行一定福利政策的公益事业的一部分,政府投入不足不利于公立中医院公益性的体现,也很难促进中医医疗服务的开展；其次国家应该从政策上扶持,除了财政投入外,更多的应该是政策上的扶持。
Background
Traditional Chinese medicine as a very important part of national wealth, contains extremely adequate philosophical thought and humanistic spirit, shows our Chinese cultural soft power on great extent.
For a long time, traditional Chinese medicine and west medicine completed and largely developed each other, which contributing to protecting and improving people's health formed Public health and medicine industrial critical feature and excellent advantage. The clinical curative effect of traditional Chinese medicine is reliable, prevention and health care effects is unique, curative methods are flexible, and curing expense is relatively low. Especially, traditional Chinese medicine has showed dramatic advantage with the change of healthy version and medical pattern.
At the county level of the hospital that is an important component of medical service agencies in our country, plays an role of faucet in the medical service industry, and it should improve the capacity of basic traditional medical services to satisfy urban and rural residents'demand. The foundation of hospital at the county level is in rural areas. vast peasantry has enormous demand of traditional Chinese medicine, so that the county level of the hospital gradually became the center of rural health curing and prevention. And it's also responsible for primary rural medical care. At the county level of the hospital conducting as main power in rural traditional medical service, relates to the wax and wane of rural Chinese medical development, is vital to the whole traditional Chinese medical industry.
But the county level of the hospital exists many problems at present. Chinese medical services'efficiency is low, configuration Management is unreasonable, lack of governmental finance support and so on.
As for the research of hospital medical efficiency mainly concentrate on certain reason what influence medical service most and comments on medical association' service. However, few research on efficiency of traditional Chinese medical service. What's more, medical efficiency greatly influenced by it's inner factor.
This research come up with four questions:
(1) what's the present situation of the county hospital of traditional Chinese medicine health service?
(2) How's the efficiency of the county hospital of traditional Chinese medicine health service?
(3) What is the key factors that influence efficiency of traditional Chinese medicine health care services?
(4)How to improve the efficiency of hospital of traditional Chinese medicine medical service?
Objectives
The overall objective of this research is to analysis medical service efficiency of traditional Chinese medicine, through the analysis of Shandong Province County Chinese medicine hospital medical service present situation. And according to the environmental impact of the research on the theoretical construction of the evaluation index system of factors analysis, quantitative analysis of the influence factors of medical service efficiency of traditional Chinese medicine, improve medical service efficiency of Chinese policy recommendations.
The specific objectives of the study:
1. Specific analysis of the current situation of medical service of Shandong Provincial Traditional Chinese Medical Hospital
2. According to the problems in the current situation, using the method of data envelopment analysis of Shandong province101County Hospital of traditional Chinese medicine of traditional Chinese medical service efficiency, focuses on the analysis of the overall technical efficiency(TE), pure technical efficiency(PTE) and scale efficiency(SE) analysis. CRS model of comprehensive efficiency of use, using VRS model to analyze the pure technical efficiency and scale efficiency, and to make quantitative analysis on the main problems of non-effective County Hospital of Chinese medicine hospitals exist in the input and output.
3. According to the above research and the factors influencing Shandong Province Chinese medical service efficiency, determine the evaluation index system of impact factors by using the method of literature study, expert consultation and AHP.
4. Based on the index system of the influencing factors, we can use Tobit regression method to make a regression analysis, to find out influence factors of hospital efficiency of, and make a analysis on the correlation between the level of each index and efficiency to carry out systematic theoretical analysis of influence factors of hospital efficiency.
Methods
This research is a cross-sectional study design. The samples of research are hospitals for the county (city) of public TCM from Shandong province, in total101hospitals. In this study, data is from the Health Bureau of Shandong province and Shandong Provincial Administration of traditional Chinese medicine, which survey was the province's basic situation of Chinese census carried out in2010.That survey was a comprehensive survey.
1. The method of data envelopment analysis (DEA)
For the selection of DEA model, the study use CRS model and VRS model CRS and VRS model does not require the production function firstly set up the hospital and
ineffective distribution rate items, but can the method of data envelopment analysis to construct the best practice to compare the decision unit and the best decision unit, and calculate the efficiency value of each unit. CRS model can determine the technical efficiency of hospital (TE), also called the comprehensive efficiency,which have the ability to maximize output hospital in a given input conditions. But CRS model cannot explain inefficiency determined by pure technical inefficiency or scale inefficiency. So the study use VRS model to further analyze the technical efficiency into pure technical efficiency(PTE) and scale efficiency (SE). The DEA model used in this paper is output oriented which means to understand the efficiency output in certain circumstances.
Variable selection is so important that can affect the quality of the model. So we use pastor Et al. more effective screening method of variable DEA research which based on strict mathematical argumentation.
2. Construction methods of influence factors system
After studying of literature analysis, we can determin the factors index system,and determine the factors that influence the index system based on two Delphi method, and use the analytic hierarchy process (AHP) to determine the index weight of influence factors.
3. Methods of data analysis
By Using descriptive statistical analysis,the paper analyze the current status of traditional Chinese medicineof traditional in Chinese Medical Hospital, analyze the input-output index description and comparison, and analyze the basic features of the influence factors. By using Tobit regression, we can make a quantitative analysis on the influence factors.
In this paper, the analysis process is divided into three parts. The first part, we make a descriptive analysis about the Chinese medical service present situation in county hospital. The second part, we use data envelopment method to calculate the county hospital of Chinese medical service efficiency and void analysis projecton analysis through the aspect of input-output. The third part, we use Tobit regression to analyze the influential factors.
Results
1. basic situation of Chinese medicine services in medical institutions
There are123public TCM hospitals (Integrative medicine of Chinese and Western medicine, ICWM hospital) in Shandong Province, including2provincial,17municipal,101county (city, district) levels.
The personnel of TCM hospital in Shandong:The number of staff in Shandong TCM hospital is36433, including31075health and technical personnel;5713medical practitioners (assistant) of TCM, accounting for18.38%of the practicing (assistant) doctors; the education level of TCM service personnel was mainly undergraduate with the percentage of40.94, and the master's degree or above accounted for10.38%; the Personnel titles was mainly intermediate, accounted for43.26%, and the senior titles accounted for22.52%. The number of TCM service personnel in provincial general hospital (specialized hospital) was8455, including6241of Chinese medicine specialty and2214of Chinese pharmaceutical specialty, the number of practicing (assistant) doctors was74768, including6119TCM practicing (assistant) doctors, accounting for8.18%.
Medical service:13.26%outpatient services and11.80%of hospital services were held by the public TCM hospitals in Shandong Province. The patients in expert outpatient service accounted for23.59%of its total diagnostic person number in public TCM hospitals.
2. DEA (Data Envelopment Analysis) analysis of efficiency of TCM medical services
This study analyzed the TCM health service efficiency in101county level hospitals in Shandong province using CRS model and VRS model of DEA method, the indicators were from input and output indicators with correlation of TCM.
The results show that,
First, the overall efficiency of TCM medical service is not high in county level hospital.
From the data we can see that he overall efficiency of TCM medical service is not high, if in certain inputs, the target values of output had big gap, and if in certain outputs, the inputs would have waste. There were51comprehensive efficiency county level TCM hospitals and the average overall efficiency was50.50%.55county level hospitals had pure technical efficiency, and the proportion was54.46%. The Average scale efficiency was96.40%, and52hospitals had scale efficiency with the percentage of46.53%.
Second, the economies of scale existed in county level hospitals.
The medium-sized hospital whose actual beds was between151-200had the lowest efficiency, then the efficiency increased with the increase of bed, especially that the efficiency of more than500-bed hospital at the county level are all effective.
Third, from the point of returns to scale, the vast majority of the hospitals were in diminishing returns to scale, the returns to scale of large and medium-sized hospitals were not increasing.
Fourth, from the results of projection analysis of input and output index, the input indicators were more than the target value and the output indexes didn't reach the target, which meant that the hospital should improve the medical services of TCM from the quality, rather than the pursuit of scale expansion and the renewal of medical equipment.
3. The factor analysis of TCM medical service efficiencies
Through the analysis of influence factors on TCM medical service efficiencies in101TCM county level hospitals using tobit regression analysis, and from the external factors and the internal factor we can see:
The administrative land area (square kilometers) and policy support were the main external macro factors influencing the efficiency. In three models, the influence coefficient of support level and the percentage of financial aid were positive, so the support of the hospital and the hospital financial aid had positive correlation with the medical service efficiency of TCM hospitals, and the two indicators had passed the test of significance in the three models. This indicated that the support to the hospitals can promote the TCM hospitals' medical service efficiency.
From the external micro factors influencing hospitals and also the competitive factors we can see that the percentage of health technical personnel was influence factors on the three efficiency values, and all had statistical significance, and the regression coefficient was negative. This showed that the high the percentage of health technical personnel the lower the efficiency got, and the more the personnel got, the greater the pressure of the hospital, and the easier it was to develop a more profitable way of western medicine diagnosis and treatment.
And from the inner competition factors we can see that most of the indicators had no significant impact on efficiency, only the proportion of TCM drug income and TCM spending accounts for the proportion of drug expenditure had influence to the overall efficiency and pure technical efficiency, and all the indexes had not significance to the scale efficiency. This showed that competition factors were not the main factors that influence efficiency of medical services of traditional Chinese medicine, in other words, the good development of western medicine can't represent the TCM medical efficiency would certainly be affected.
Conclusion and policy implication
Lots of problems have found in county level traditional Chinese medicine hospitals of Chinese medical services from the hospital's internal factors analysis. First of all, the overall efficiency of county level traditional Chinese medicine hospital is not high. Secondly, economies of scale exist in county level traditional Chinese medicine hospitals. Thirdly, the Enthusiasm of Health professionals to provide Chinese medicine in county level traditional Chinese medicine hospitals is not high.
We can see from the analysis of the external environment firstly, the better economic development the lower medical services efficiency of county level traditional Chinese medicine hospital.
From the Tobit regression we can know that the impact of economic development indicators on traditional Chinese medicine service' efficiency is negative.Secondly, the support efforts of Chinese medicine can effectively improve the efficiency of Chinese medical services in county level traditional Chinese medicine hospital
We can also see from the tobit regression, the indicator of support efforts to Chinese medicine has the impact to the efficiency of Chinese medical services and the impact is positive, that means, the support of Chinese medicine can improve the efficiency of Chinese medical service in Chinese medicine hospital.
The recommendations Policy based on the conclusions of this study are following:
Measures for the hospital internal factors:Firstly, the county level traditional Chinese medicine hospital should strengthen its medical services' level As can be seen from the study, all inputs and outputs indicators of the Chinese medicine hospitals are reaching the target value, that means, Chinese medicine hospitals did not achieve the best outcomes under the existing scale of investment in the existing conditions. In the interview many officials in Chinese medicine department complaint that the TCM hospitals did not pay attention to traditional Chinese medicine departments, because of the poor economic benefit in Chinese medicine department. Secondly county level traditional Chinese medicine hospitals should be "Equal emphasis on traditional Chinese and western","Equal emphasis on traditional Chinese and western" is the country's health policy, hospitals should take this principle, improve the Chinese medicine's involvement in major diseases, improve service quality and clinical efficacy in Chinese medicine hospital, expand the indicators'range. To strengthen scientific research efforts in Chinese medicine, give full play to the advantages and expertise of Chinese medical technology to form their own core competitiveness in Chinese medicine hospital. Hospital of TCM should focus on their specialties.
Measures for the hospital external factors:Firstly, the government should expand the support efforts on the Chinese traditional medicine hospitals. Chinese medicine hospitals are a non-profit public medical institutions, is part of the Government to implement certain welfare policies, lack of government investment is not conducive to reflect the public TCM hospitals' welfare, and it is difficult to promote the development of the Chinese medicine services. Lack of government investment will inevitably lead to the hospitals'pursuit of the interests and have to survive from the drug treatment. Financial investment for Chinese medical services has a significant impact on the efficiency.
Secondly, the government should support from the policy. Except financial investment, policy support should be more, for example, the use of Chinese medicine services should be compensated and such as the Chinese medicine doctors in TCM hospitals should be given supports on the economy and the professional title. The westernization phenomenon in TCM hospitals also should be controlled, TCM hospitals should return to the "Chinese" characteristics. Developing a scientific evaluation system can control the phenomenon of westernization phenomenon in TCM hospitals.
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