医疗服务生产的规模经济研究

华中科技大学博士学位论文医疗服务生产的规模经济研究姓名：李显文申请学位级别：博士专业：社会医学与卫生事业管理指导教师：张亮;郭清2011-052345678StudyonEconomiesofScaleinMedicalServicesProductionDoctorCandidate:LIXianwenSupervisor:ZHANGLiang,GUOQing1.ResearchpurposeandsignificanceThisstudyaimstoanalyzeChina’sexpansionofhospitalsoverrecentyearsandtheeffectsofeconomiesofscaleofhospitals.Theoreticalandempiricalanalysisisemployedtoanalyzeofeconomiesofscaleintertiaryhospitalsanditsinfluencingfactors.Significanceofthestudy:Thestudyaimstobringinformationusefulforinformeddecisionmakingtopublichealthauthoritieswhoundertakeregionalhealthplanningandhospitalbuilding.Additionally,thisresearchaimstohelphospitalsbetterdeterminedevelopmentstrategytooptimizeoperations,andtakeadvantagesuccessfullyofeconomiesofscalebyminimizingwasteofresourcesasmuchaspossibletoreducehealthcarecosts.2.ContentsofResearcha.AnalysisofeconomiesofscaleintheproductionofMedicalservices:Afocusofthisresearchistoconstructaconceptualframeworkforeconomiesofscaleinhospitals--fromabuildingatheoreticalanalysisoftheproductionofmedicalservicestoincorporatingrealchallengesfacedatthedepartmentandhospital9level--inordertobetterunderstandthepossibilityforeconomiesofscaleanditscharacteristics.b.RelationshipofHospitalsizeandbeneficialresults:Analyzinghowdifferentsizehospitals(measuredbybeds)affectbusinessmodels,income,profitmargins,andefficiency.ComparinghospitalsofDEAefficientwithnon-DEAefficientbytheircharacteristics,analysisontherelationshipofhospitalsizewithbenefit.c.Economiesofscaleinthehospitalandtheimpactfactorsandtheappropriatescale:usingsampledatatodeterminethesizeofthesamplehospitals,measureimpactfactorsofeconomiesofscaleinhospitals,andderivethattheirappropriatesize.d.RegionalMedicalCenter:Usingresultsofeconomiesofscaleandresourceallocationtheory,performinganalysisandmakingrecommendationsontheregionalmedicalcentermodelofefficiency,accessibility,quality,costeffectiveness.3.MethodsandDataSourcesa.Studyobjects:individualsandinstitutionproducerofmedicalservices,esp.thetertiaryhospitals.b.Source:dataofZhejiang’s23GeneralHospitalsoftheirAnnualReportfrom2002to2007;specialsurveydataaboutthesehospitals;HealthstatisticsofnationalandofZhejiangProvince;publishedliterature.c.Methods:withliteratureresearchandinterviewstoinductthecausesofeconomiesofscaleandaffectingfactors.Bystatisticalanalysisonbusinessscalewithincome,volume,andefficiencytoinfertherelationshipbetween10scaleandbenefit.Accordingtotheeconomiesofscaletheory,usingdataenvelopmentanalysisandcostfunctionanalysis,aswellasvariousquantitativemethodsofanalysis,hospitalspecificeconomiesofscalecanbedetermined.Followingthis,regressionanalysisisusedtoinfertheinfluencefactorsofeconomiesofscaleandtheappropriatescaleofhospitals.4.ResearchResultsa.Medicalserviceeconomiesofscaleanalysis.Theresultssuggesteconomiesofscaleinmedicalservicecreatecostsavings,improvementsinefficiency,production,andmanagementaspectsacrossabroad-scale.Medicalservicescanachievecertaineconomyofscale,butthelevelofeffectivenessvariesfordifferentservices.Someservicessuchasinjection,nursing,andgeneraldiagnosis,treatment,pharmaceuticalservicesandothertechnicalservicesresultinweakeconomiesofscale(inefficiency).Hospitalsthatbenefitmostfromeconomiesofscaleareonesthatmakeuseoflarge,advancedmachinerysuchaslargemedicalimagingequipment,radiationtherapy,pharmacyservices,highpressuresterilization,etc.Byfocusingonsharinganddeliveringservicesprovidedbylargemachines,anddedicatingfewerresourcestotimeintensive,lowcostservices,strongereconomiesofscalecanbeachieved.Imaging,radiation,inspectionandlogisticsservices,aswellasspecialistdepartmentsshowrelativelystrongeconomiesofscale.Butdepartmentsofmanpoweranddailyconsumptionofwater,electric-basedclinicaldepartmentsshowweakeconomiesofscale.11Hospitaloperatingwithsomeextentofeconomiesofscale:Comparedwithotherenterprises,hospitalsdonotshowstrongeconomiesofscale.Itisnotverystrongandobviously,andonlyexistwithinlimitedarea;tosomeextent,itcanbeinducedbyinducedmedicaldemandandthediseconomiesofscalebecovered.b.HospitalsizeanditsrelationtoeconomicefficiencyThereisnoclearcorrelationbetweenthenumberofbedsatahospitalandtheeconomicefficiencyofahospital.Asatrend,whenhospitalsexpand,theyincreasemarketshare.However,atthesametime,theincreaseinhospitalscaleoftenresultsinanegativeimpactonthebalancebetweenrevenueandexpenditures.Thereisnoclearindicationthathospitalbedexpansionresultsinanincreaseineconomicefficiency.Expansionshowsthefollowingcharacteristics:largehospitalsgenerallyexpandatafasterratethansmallerclinicsandthusincreasemarketshare.Unfortunately,manyoftheadditionalbedsconstructedduringhospitalexpansionsdonotmeethealthdepartmentstandards,andthecostsassociatedwiththeexpansionofhospitalsresultindebtnotequaledbyincreaseinrevenues.Thisisparticularlysevereforlargehospitals.Therateofhospitalbedexpansioncanpredictedbylocalsocialandeconomicdevelopmentlevels,competitionlevels,andtheimpactofthebusinessdevelopmentneeds.c.Analysisofeconomiesofscaleofhospitalbasedonefficiency1.Thetertiaryhospitalsexhibitedeconomiesof