Determinants of efficiency growth of county-level public hospitals-evidence from Chongqing, China

The allocation and utilization efficiency of hospital beds in Sichuan Province, China

OBJECTIVE

To analyze the allocation and utilization efficiency of hospital beds in Sichuan Province, China, and to provide a scientific basis for improving the rational allocation and efficient utilization.

METHODS

The supply and demand balance method, health resource agglomeration degree (HRAD), bed efficiency index and bed utilization model were used to evaluate the allocation and utilization efficiency of hospital beds in Sichuan Province from 2017 to 2021.

RESULTS

The number of hospital beds per 1000 population in Sichuan Province increased from 4.97 in 2017 to 5.94 in 2021. The overall supply and demand ratio of hospital beds in Sichuan Province is between 0.85 and 1.01, and the supply and demand situation is a basically balanced situation. The HRAD of hospital beds in Ya'an, Aba, Ganzi and Liangshan is <1, indicating that the equity of hospital beds by geography in these regions is low. The difference between HRAD and population agglomeration degree (PAD) in 9 regions, including Deyang, Aba, Ganzi and Liangshan, is <0, indicating that there are insufficient hospital beds in these areas relative to the agglomerated population. The bed efficiency index of hospital beds in 17 regions, including Chengdu, Zigong, Aba and Ganzi, are all <1, which means that hospital beds are operating with low efficiency. The bed utilization model of Panzhihua is efficiency type, that of Zigong, Deyang and Ziyang is pressure bed type, and that of Nanchong and Ya'an is idle type.

CONCLUSION

The hospital bed allocation in Sichuan Province is relatively good, and the supply and demand situation is in a basically balanced situation. The hospital bed allocation in Aba, Ganzi and Liangshan is insufficient by geography and population. The overall operational efficiency of hospital beds is low, and there are more idle and pressure bed utilization models.

Effects of medical consortium policy on health services: an interrupted time-series analysis in Sanming, China

Objectives

China has implemented reforms to enhance the operational efficiency of three-level medical services through medical consortiums (MCs). This study evaluated the impact of MCs reform on health services in Sanming, China.

Methods

An interrupted time-series analysis (ITSA) was conducted to assess the impact of MCs on changes in health service levels and trends across the overall situation of MCs and different institutional types within MCs, including county hospitals and grassroots medical institutions. The evaluation focused on various indicators such as outpatient and emergency visits, inpatients, average length of stay, occupancy rate of hospital beds, and hospital bed turnover times. Monthly data were collected from April 2015 to June 2019 through reports on the Sanming Municipal Health Commission website and the Sanming public hospital management monitoring platform.

Results

After the intervention of MCs reform, a significant increase was observed in the total number of inpatients (β3 = 174.28, p < 0.05). However, no statistically significant change was observed in the total number of outpatient and emergency visits (β3 = 155.82, p = 0.91). Additionally, the implementation of MCs reform led to an amplification in service volumes provided by county hospitals, with significant increases in the number of outpatient and emergency visits (β3 = 1376.54, p < 0.05) and an upward trend in the number of inpatients (β3 = 98.87, p < 0.01). However, no significant changes were observed under the MCs policy for grassroots medical institutions regarding the number of outpatient and emergency visits (β3 = -1220.72, p = 0.22) and number of inpatients (β3 = 75.42, p = 0.09).

Conclusion

The Sanming MCs reform has achieved some progress in augmenting service volumes. Nevertheless, it has not led to an increase in service volumes at the grassroots medical institutions. There persists an insufficiency in the efficiency of services and a need for further improvement in primary healthcare. To address these concerns, it is imperative for county hospitals to offer targeted assistance that can enhance motivation among grassroots medical institutions. Besides the MCs should explore initiatives, including improved management of medical equipment, allocation of funding, and personnel resources.

Analyzing the efficiency of Chinese primary healthcare institutions using the Malmquist-DEA approach: Evidence from urban and rural areas

Background

China has been increasing the investment in Primary Health Care Institutions (PHCIs) since the launch of the New Health Care System Reform in 2009. It is a crucial concern whether the PHCIs can meet residents' need both in urban and rural with the limited government finance, especially encountering the challenge of the COVID-19. This study aimed to reveal the trend of the primary health service efficiency in the past decade, compare the urban-rural differences, and explore relevant factors.

Methods

DEA and Malmquist models were applied to calculate the health service efficiency of PHCIs among 28 provinces in China, with the input variables including the number of institutions, number of beds, number of health technicians, and the outputs variables including the number of outpatients and emergency visits, number of discharged patients. And the Tobit model was used to analyze the factors on the efficiency in urban and rural. A sensitivity analysis for model validations was also carried out.

Results

The average technical efficiency (TE) of urban PHCIs fluctuated from 63.3% to 67.1%, which was lower than that in rural (75.8-82.2%) from 2009 to 2019. In terms of dynamic efficiency, the urban PHCIs performed better than the rural, and the trends in the total factor productivity change were associated with favorable technology advancement. The population density and dependency ratio were the key factors on TE in both of the urban and rural PHCIs, and these two factors were positively correlated to TE. In terms of TE, it was negatively correlated with the proportion of total health expenditure as a percentage of GDP in urban PHCIs, while in rural it was positively correlated with the urbanization rate and negatively correlated with GDP per capita. Besides, the tests of Mann-Whitney U, and Kruskal-Wallis H indicated the internal validity and robustness of the chosen DEA and Malmquist models.

Conclusions

It needs to reduce the health resource wastes and increase service provision in urban PHCIs. Meanwhile, it is necessary to strengthen medical technology and gaining greater efficiency in rural PHCIs by technology renovation.

Does perceived supervisor support reduce turnover intention? The mediating effects of work engagement among healthcare professionals

BACKGROUND: The study’s value is based on a complete understanding of the employee polychronicity–employee intention to leave the relationship in the health care sector. OBJECTIVE: This study examines (1) the role of job engagement in alleviating the relationship between employee polychronicity and intention to leave, and (2) the moderating impact of perceived supervisor support as a relationship. METHOD: This study employed a cross-cultural research design and collected data from nurses working in public sector hospitals. Through job engagement and perceived supervisor support (PSS), the effect of nurses’ polychronicity on turnover intention was examined using the PLS-SEM approach. RESULTS: The findings of this study demonstrate that employee polychronicity has an impact on employee turnover. Employee engagement appears to operate as a mediator in the association between employee polychronicity and intention to leave and a moderating effect of PSS. CONCLUSION: By emphasizing employee engagement as a mediator and moderating role, the perceived supervisor supports the association between polychronicity and intention to leave of nurses. This study offered a crisp perspective on the complexities of the links between polychronicity, engagement, perceived organizational support, and employees’ intention to leave.

Quality of Care in Public County Hospitals: A Cross-Sectional Study for Stroke, Pneumonia, and Heart Failure Care in Eastern China

There are very few studies about the quality of care (QoC) in Chinese county hospitals. Using 7, 6, and 6 standard operations from clinical pathways as the process indicators, we evaluated the quality of stroke, pneumonia, and heart failure care, respectively. We also conducted chi-squared tests to detect differences of quality between selected counties or hospitals. We extracted relevant information from medical records of 421 stroke cases, 329 pneumonia cases, and 341 heart failure cases, which were sampled from 6 county hospitals in 3 counties of eastern China. The average proportion of recommended care delivered included stroke, pneumonia, and heart failure patients at 55.36%, 41.64%, and 49.56%, respectively. Great variation of QoC was detected not only across selected counties but between comprehensive county hospitals and traditional Chinese medicine county hospitals. We deny the widely-accepted assumptions that poor QoC should be blamed on defectively-equipped facilities or medicine and overwhelmed care providers. Instead, we speculate the low qualifications of medical workers, failed clinical knowledge translation, incorrect diagnosis, and a lack of electronic systems could be the reasons behind poor QoC. It is high time for China to put QoC as the national health priority.

The Core of Healthcare Efficiency: A Comprehensive Bibliometric Review on Frontier Analysis of Hospitals

Parametric and non-parametric frontier applications are typical for measuring the efficiency and productivity of many healthcare units. Due to the current COVID-19 pandemic, hospital efficiency is the center of academic discussions and the most desired target for many public authorities under limited resources. Investigating the state of the art of such applications and methodologies in the healthcare sector, besides uncovering strategical managerial prospects, can expand the scientific knowledge on the fundamental differences among efficiency models, variables and applications, drag research attention to the most attractive and recurrent concepts, and broaden a discussion on the specific theoretical and empirical gaps still to be addressed in future research agendas. This work offers a systematic bibliometric review to explore this complex panorama. Hospital efficiency applications from 1996 to 2022 were investigated from the Web of Science base. We selected 65 from the 203 most prominent works based on the Core Publication methodology. We provide core and general classifications according to the clinical outcome, bibliographic coupling of concepts and keywords highlighting the most relevant perspectives and literature gaps, and a comprehensive discussion of the most attractive literature and insights for building a research agenda in the field.

Configurational Paths to Higher Efficiency in County Hospital: Evidence From Qualitative Comparative Analysis

Background

The efficient operation of county-level medical institutions is a significant guarantee in constructing Chinese rural tertiary care service networks. However, it is still unclear how to increase the efficiency of county hospitals under the interaction of multiple factors. In this study, 35 county general hospitals in China were selected to explore the configuration paths of county hospitals' high and poor efficiency status under the Environment-Structure-Behavior (ESB) framework and provide evidence-based recommendations for measures to enhance its efficiency.

Methods

Data envelopment analysis with the bootstrapping procedure was used to estimate the technical efficiency value of case hospitals. A fuzzy-set qualitative comparative analysis approach was carried out to explore the configuration of conditions to the efficiency status.

Results

Antecedent configurations affecting the efficiency status of county hospitals were identified based on the ESB analytical framework. Three high-efficiency configuration paths can be summarized as structural optimization, capacity enhancement, and government support. Another three types of paths, namely insufficient capacity, aggressive expansion, and poor decision-making, will lead to inefficient configurations.

Conclusion

Qualitative comparative analysis is necessary when exploring complex causality. The efficiency situation of county hospitals results from a combination of influencing factors instead of the effect of a single one. There is no solitary configuration for high efficiency that applies to all healthcare units. Any measures aimed at efficiency promotion should be discussed within the framework of a case-specific analysis.

Analysis of Factors Influencing Public Behavior Decision Making: Under Mass Incidents

Most mass incidents are created by economic or social concerns brought on by fast socioeconomic change and poor local government. The number of mass occurrences in China has significantly increased in recent years, putting the country’s steady growth and public behavior decision-making in harm. We examine the factors that influence public behavior decision-making in the following significant factors, contributing to the development of effective prevention and response strategies. The structural equation (SEM) approach is used to analyze the main determinants influencing public behavioral decisions in the aftermath of mass incidents using surveys of a large population. The finding shows that media plays a mediating role in the relationship between mass occurrences and influencing factors impacting public emotion. The direct and indirect effects of public behavior decision-making and its role increasingly social changes as things happen, government credibility, media plays mediating role in public emotional factors. All directly impact public behavior decision-making, while emotional factors have an indirect impact via media intermediaries. The escalation of public behavior decisions is seen as a result of structural transmission and the increase of dynamic as well as other factors.

Does Polychronicity Undermine Procrastination Behavior Through ICTs? Insights From Multi-Level Modeling

Information and communication technologies (ICTs) are widely used in developing nations as a dynamic solution for socio-economic development. Pakistan has seen a rapid increase in the use of ICTs during the previous decade. The purpose of this study is to examine how polychronicity affects procrastination behavior when it is influenced by ICTs. According to this study, individuals are described as a dynamic and destructive kind of self-regulation failure in ICTs. Procrastination is a behavior that prevents emerging economies from growing from developing countries. We researched the group-level polychronicity influence of the individual behavior and the mechanism of procrastination from a team-level perspective of worker behavior. This study data collected 231 workers from 76 groups working in ICTs in Pakistan. The results revealed that the group polychronicity and the behavior of group members were positively linked by taking the work overload as a mediator. Moreover, group cohesiveness moderates the role between polychronicity and work overload diminishing the mediation procession between-group polychronicity and individual procrastination. The practical importance of this study is to understand the causes of procrastination, and how to decrease this obstacle to a fairer workplace. It also helps to decide the professional route that is most suited to personality characteristics.

The efficiency of provincial government health care expenditure after China's new health care reform

OBJECTIVE

We aim to estimate the total factor productivity and analyze factors related to the Chinese government's health care expenditure in each of its provinces after its implementation of new health care reform in the period after 2009.

MATERIALS AND METHODS

We use the Malmquist DEA model to measure efficiency and apply the Tobit regression to explore factors that influence the efficiency of government health care expenditure. Data are taken from the China statistics yearbook (2004-2020).

RESULTS

We find that the average TFP of China's 31 provincial health care expenditure was lower than 1 in the period 2009-2019. We note that the average TFP was much higher after new health care reform was implemented, and note this in the eastern, central and western regions. But per capita GDP, population density and new health care reform implementation are found to have a statistically significant impact on the technical efficiency of the provincial government's health care expenditure (P<0.05); meanwhile, region, education, urbanization and per capita provincial government health care expenditure are not found to have a statistically significant impact.

CONCLUSION

Although the implementation of the new medical reform has improved the efficiency of the government's health expenditure, it is remains low in 31 provinces in China. In addition, the government should consider per capita GDP, population density and other factors when coordinating the allocation of health care input.

SIGNIFICANCE

This study systematically analyzes the efficiency and influencing factors of the Chinese government's health expenditure after it introduced new health care reforms. The results show that China's new medical reform will help to improve the government's health expenditure. The Chinese government can continue to adhere to the new medical reform policy, and should pay attention to demographic and economic factors when implementing the policy.

Configuration Analysis of Influencing Factors of Technical Efficiency Based on DEA and fsQCA: Evidence from China's Medical and Health Institutions

Purpose

This paper aims to measure the technical efficiency of China’s medical and health institutions from 2012 to 2017 and outline the path to achieve high-quality development.

Methods

The DEA-Malmquist was used to evaluate the total factor productivity of medical and health institutions in 31 provinces. A fuzzy set Qualitative Comparative Analysis (fsQCA) was used for configuration analysis of determinants affecting technical efficiency.

Results

The average total factor productivity (TFP) of those institutions was 0.965, namely TFP declined averagely by 3.5% annually. The efficiency change and the technical change were 0.998 and 0.967, respectively. The realization paths of high technical efficiency are composed of high fatality rate and high financial allocation-led, high population density and high GDP-led. Low dependency ratio and low financial allocation-led, low fatality rate and low financial allocation-led are the main reasons for low technical efficiency.

Conclusion

Due to advanced medical technology and economic development, major cities like Beijing, Shanghai, and Guangdong have attracted a large number of high-level health personnel, achieving long-term and stable health business growth. Hubei, Anhui, and Sichuan also have made rapid development of health care through appropriate financial subsidies and policy supports. The technical changes in Qinghai, Yunnan, and Inner Mongolia are higher than the national average, but the operation and management level of the medical and health institutions is relatively weak. Henan, Jiangxi, and Heilongjiang have a prominent performance in the efficiency change, but the technical change is weaker than the national average.