CAJ | 학술논문

目的：：从静态与动态两个层次分析大型综合公立医院的效率特征及变动趋势。方法：采用数据包络分析的C2 R-DEA和BC2-DEA模型与Malmquist指数模型,利用50家大型公立医院2006—2012年的人员、设备、资产、医疗服务等投入—产出指标,构建适宜分析模型。结果：约10%~12%样本医院处在相对有效运行状态,其配置效率均值与规模效率均值分别为0．956与0．943,接近效率前沿,其效率表现相对较好；而纯技术效率均值、技术效率均值、成本效率均值与整体效率均值分别为0．796,0．784,0．714和0．714,与效率前沿差距较大,其效率表现相对较差。同时,样本医院处于规模报酬递减状态的医院由7．69%增加到26．31%,而处于规模报酬递增状态的医院由80．77%下降到58．34%；其技术进步与Malmquist生产率指数、技术效率指数、纯技术效率指数与规模效率指数的变化保持比较稳定的一致性,并呈现持续改善与稳步发展的趋势。结论：大型公立医院正面临着发展动力与激励机制的转换,不仅需要转变医院管理理念与发展模式,也需要构建有关结构、过程和结果的最佳效率评价标准,以促进包括政府职能在内的医院治理与发展模式的转变。
목적：：종정태여동태량개층차분석대형종합공립의원적효솔특정급변동추세。방법：채용수거포락분석적C2 R-DEA화BC2-DEA모형여Malmquist지수모형,이용50가대형공립의원2006—2012년적인원、설비、자산、의료복무등투입—산출지표,구건괄의분석모형。결과：약10%~12%양본의원처재상대유효운행상태,기배치효솔균치여규모효솔균치분별위0．956여0．943,접근효솔전연,기효솔표현상대교호；이순기술효솔균치、기술효솔균치、성본효솔균치여정체효솔균치분별위0．796,0．784,0．714화0．714,여효솔전연차거교대,기효솔표현상대교차。동시,양본의원처우규모보수체감상태적의원유7．69%증가도26．31%,이처우규모보수체증상태적의원유80．77%하강도58．34%；기기술진보여Malmquist생산솔지수、기술효솔지수、순기술효솔지수여규모효솔지수적변화보지비교은정적일치성,병정현지속개선여은보발전적추세。결론：대형공립의원정면림착발전동력여격려궤제적전환,불부수요전변의원관리이념여발전모식,야수요구건유관결구、과정화결과적최가효솔평개표준,이촉진포괄정부직능재내적의원치리여발전모식적전변。
Objective: To analyze the efficiency characteristics and trend of tertiary general public hospitals from both static and dynamic perspectives. Methods: After collecting data of personnel, equipment, assets, health services and other inputs-output indicators from 50 tertiary public hospitals from 2006 to 2012 , this paper uses C2 R-DEA and BC2-DEA models, as well as Malmquist Index model to build suitable analysis model. Results:About 10%~12% of the sample hospitals are in a relatively effective operational state, and the mean values of allocation effi-ciency and scale efficiency are 0. 956 and 0. 943, respectively, which are close to the efficient frontier. The mean values of pure technical efficiency, technical efficiency, cost efficiency and overall efficiency are 0. 796, 0. 784, 0. 714 and 0. 714, respectively, which are relatively poor compared with the efficiency frontier. Moreover, the number of hospitals that are in the state of diminishing returns to scale increased from 7 . 69% to 26 . 31%, while the number of hospitals that are in the state of increasing returns to scale decreased from 80. 77% to 58. 34%. The changes in techno-logical progress, Malmquist productivity index, technical efficiency index, pure technical efficiency index and scale effi-ciency index remained a relatively stable consistency, and showed continuous improvement and steady development trend. Conclusion:Tertiary general public hospitals are facing the transformation of driving force for development and incentive mechanisms. This needs not only to change the management concept and development mode of the hospitals, but also to build evaluation standards of optimum efficiency that are relevant to the structure, process and outcome, in order to pro-mote the transformation of hospital governance and development model that includes the functions of government.