Operation Efficiency and Influencing Factors of Primary Healthcare Institutions in China

Abstract

Abstract: Background　Primary healthcare institutions belong to primary healthcare system of China's healthcare system，which assume the responsibilities for delivering essential medical care and public health services and play an important role in improving residents' health status and reducing medical costs.At present，there is a lack of research on the efficiency of domestic primary healthcare institutions at the national level.Objective　This paper analyzed the operational efficiency and influencing factors of primary healthcare institutions in China.Methods　Data about administrative features，internal management and technical factors，and input-output indicators of 322 primary healthcare institutions participated in the project of "Comprehensive Evaluation of Service Capacity and Quality of Primary Healthcare Institutions" implemented from November 2016 to May 2017 were collected.Data envelopment analysis was used to quantify the operational efficiency value of these institutions.Multiple linear regression analysis was performed to analyze the influencing factors of the efficiency.And based on this，targeted facilitation strategies were put forward.Results　The average scale efficiency，pure technical efficiency and overall technical efficiency of the 322 primary healthcare institutions were（0.79±0.23），（0.52±0.25），（0.42±0.26），respectively.Multiple linear regression analysis showed that factors influencing the scale efficiency of the institutions were regional location，financial subsidy mode，and number of children under 6 years of age in the service area（P<0.05）．Regional location，whether setting up a surgery department，whether using an electronic medical record system，and whether using the rate of reaching the national public health performance standards as a reference parameter for calculating the performance-related pay were associated with the pure technical efficiency of the institutions（P<0.05）．Regional location，and number of children under 6 years of age in the service area，whether setting up a surgery department were associated with the overall technical efficiency of the institutions（P<0.05）．Conclusion　The current mode of financial subsidy is suggested to gradually change to the government purchasing-based mode according to specific services.Setting up a surgery department may produce negative influence on the scale efficiency，but payment reform may improve the efficiency of primary healthcare institutions.

Key words: Primary healthcare institutions, Efficiency, Data envelopment analysis, Root cause analysis

摘要： 背景　基层医疗卫生机构是我国卫生服务体系的网底，承担着基本医疗和基本公共卫生服务的职责，在改善居民健康状况、降低医药费用等方面起着重要作用，目前国内关于全国性基层医疗卫生机构效率的研究较为缺乏。目的　分析我国基层医疗卫生机构运行效率，探讨基层医疗卫生机构效率的影响因素。方法　数据来源于2016年11月—2017年5月“基层医疗服务能力和质量的综合评价”项目，收集322家基层医疗卫生机构的外部特征、内部管理与技术因素、投入-产出指标等资料。采用数据包络分析计算基层医疗卫生机构的效率值，采用多元线性回归分析基层医疗卫生机构效率的影响因素，提出针对性的建议。结果　322家基层医疗卫生机构平均规模效率、纯技术效率、综合技术效率值分别为（0.79±0.23）、（0.52±0.25）、（0.42±0.26）。多元线性回归分析结果显示，地域、财政补助方式、辖区6岁以下儿童人数为基层医疗卫生机构规模效率的影响因素，地域、是否开设外科、是否使用电子病历、绩效工资主要的影响因素是否包括国家公共卫生服务达标率是基层医疗卫生机构纯技术效率的影响因素，地域、辖区6岁以下儿童人数、是否开设外科为基层医疗卫生机构综合效率的影响因素（P<0.05）。结论　财政补贴应逐渐向按服务单元付费的购买模式转变，开设临床外科可能对基层医疗卫生机构效率不利，薪酬制度的改革可提升基层医疗卫生机构效率。

关键词: 基层医疗卫生机构, 效率, 数据包络分析, 影响因素分析

HUANG He,HU Linlin,LIU Yuanli. Operation Efficiency and Influencing Factors of Primary Healthcare Institutions in China　[J]. Chinese General Practice, 2019, 22(19): 2280-2285.
黄河,胡琳琳,刘远立. 中国基层医疗卫生机构运行效率及影响因素研究[J]. 中国全科医学, 2019, 22(19): 2280-2285.

References

［1］武宁，程明羕，闫丽娜，等．中国全科医生培养发展报告（2018）［J］．中国全科医学，2018，21（10）：1135-1142.DOI：10.3969/j.issn.1007-9572.2018.10.001.
WU N，CHENG M Y，YAN L N，et al．Training development report of GPs（2018）［J］．Chinese General Practice，2018，21（10）：1135-1142.DOI：10.3969/j.issn.1007-9572.2018.10.001.
［2］刘利群．推进家庭医生签约服务加强分级诊疗制度建设［J］．中国全科医学，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
LIU L Q．Promoting contracted services of family doctors to strengthen the construction of hierarchical medical system［J］．Chinese General Practice，2018，21（1）：1-4．DOI：10.3969/j.issn.1007-9572.2018.01.001.
［3］万广圣.我国基层医疗卫生机构运行效率的地区比较分析［J］．中国农村卫生事业管理，2016，36（12）：1500-1503．DOI：CNKI：SUN：ZNWS.0.2016-12-002.
WAN G S.Regional comparative analysis of operational efficiency of primary medical and health institutions in China［J］．Chinese Rural Health Service Administration，2016，36（12）：1500-1503．DOI：CNKI：SUN：ZNWS.0.2016-12-002.
［4］SU M，ZHANG Q L，LU J P，et al．Protocol for a nationwide survey of primary health care in China：the China PEACE（patient-centered evaluative assessment of cardiac events）MPP（million persons project）primary health care survey［J］．BMJ Open，2017，7（8）：13．DOI：10.1136/bmjopen-2017-016195.
［5］佘瑞芳，朱晓丽，杨顺心.分级诊疗下基层医疗卫生机构的发展现状及建议［J］．中国全科医学，2016，19（28）：3413-3416．DOI：10.3969/j.issn.1007-9572.2016.28.006.
SHE R F，ZHU X L，YANG S X.Development status and suggestions of primary medical and health institutions under the circumstance of hierarchical diagnosis and treatment［J］．Chinese General Practice，2016，19（28）：3413-3416．DOI：10.3969/j.issn.1007-9572.2016.28.006.
［6］明延飞，黄蓉，张艳春，等．基层医改后哈密地区乡镇卫生院运营效率研究［J］．中国全科医学，2015，18（5）：759-763．DOI：10.3969/j.issn.1007-9572.2015.07.008.
MING Y F，HUANG R，ZHANG Y C，et al．Operation efficiency of rural health centers in Hami Prefecture after health care reform at basic level［J］．Chinese General Practice，2015，18（5）：759-763．DOI：10.3969/j.issn.1007-9572.2015.07.008.
［7］王敏，力晓蓉，应桂英，等．卫生统计数据质量调查与存在的问题［J］．中国卫生信息管理杂志，2012，9（5）：82-88．
WANG M，LI X R，YING G Y，et al．A survey on the quality of health statistic data［J］．Chinese Journal of Health Informatics and Management，2012，9（5）：82-88．
［8］应桂英，段占祺，王敏.卫生统计数据质量影响因素的探讨［J］．中国卫生信息管理杂志，2013，10（4）：345-356．DOI：10.3969/j.issn.1672-5166.2013.04.015.
YING G Y，DUAN Z Q，WANG M.Explore on the inlfuential factors of health statistics data quality［J］．Chinese Journal of Health Informatics and Management，2013，10（4）：345-356．DOI：10.3969/j.issn.1672-5166.2013.04.015.
［9］王小万，刘丽杭.医院效率特征研究：理论与模型［J］．卫生经济研究，2015，32（8）：8-14.
WANG X W，LIU L H.Research on the characteristics of hospital efficiency：theory and model［J］．Health Economics Research，2015，32（8）：8-14.
［10］蒋霄鹤，匡莉.广东省1 211家乡镇卫生院效率评价与分析［J］．中国卫生经济，2012，31（8）：77-79．DOI：10.3969/j.issn.1003-0743.2012.08.026.
JIANG X H，KUANG L.Evaluation and analysis of the operation efficiency of 1 211 township hospitals in Guangdong Province［J］．Chinese Health Economics，2012，31（8）：77-79．DOI：10.3969/j.issn.1003-0743.2012.08.026.
［11］秦江梅，明延飞，林春梅，等．新医改以来我国基层医疗卫生机构的效率变动分析［J］．中国卫生经济，2015，34（8）：21-23．DOI：10.7664/CHE20150805.
QIN J M，MING Y F，LIN C M，et al．Analysis on the efficiency changing of Chinese basic medical institutions since new medical reform［J］．Chinese Health Economics，2015，34（8）：21-23．DOI：10.7664/CHE20150805.
［12］韩华为.中国农村居民的健康状况和就医行为：基于医疗需要和医疗需求视角的实证研究［D］．北京：北京大学，2011.
［13］王燕平，赵军.医疗服务特性的分析和认识［J］．中国医药导报，2007，4（4）：76．DOI：10.3969/j.issn.1673-7210.2007.04.039.
WANG Y P，ZHAO J.Analysis and recognition of the characteristics of medical services［J］．China Medical Herald，2007，4（4）：76．DOI：10.3969/j.issn.1673-7210.2007.04.039.
［14］吴明，李睿.健康需要与需求的概念及测量［J］．中国卫生经济，1995，14（1）：44-46.
WU M，LI R.Concept and measurement of health needs and demands［J］．Chinese Health Economics，1995，14（1）：44-46.
［15］赵颖波，王建伟，尹畅，等．基于洛伦兹曲线和基尼系数的我国卫生资源配置公平性研究［J］．中国医院，2018，22（2）：124．DOI：10.19660/j.issn.1671-0592.2018.02.07.
ZHAO Y B，WANG J W，YIN C，et al．Study on equity of health resource allocation in China based on Lorentz Curve and Gini Coefficient［J］．Chinese Hospitals，2018，22（2）：124．DOI：10.19660/j.issn.1671-0592.2018.02.07.
［16］胡琳琳，曹英南，王班，等．我国基层医疗卫生机构卫生服务支付制度改革探讨［J］．中华医院管理杂志，2015，31（2）：87-90．DOI：10.3760/cma.j.issn.1000-6672.2015.02.003.
HU L L，CAO Y N，WANG B，et al．Studies on the reform of payment system of grass-roots health care institutions in China［J］．Chinese Journal of Hospital Administration，2015，31（2）：87-90．DOI：10.3760/cma.j.issn.1000-6672.2015.02.003.
［17］桂小海，王洪波，刘慧，等．基于家庭医生服务制度的弹性薪酬模型构建研究［J］．中国全科医学，2018，21（25）：3038-3043．DOI：10.12114/j.issn.1007-9572.2018.25.003.
GUI X H，WANG H B，LIU H，et al．Construction of incentive salary model based on family doctor services system［J］．Chinese General Practice，2018，21（25）：3038-3043．DOI：10.12114/j.issn.1007-9572.2018.25.003.
［18］邱夕来.分级诊疗不落地难抑大医院扩张冲动［J］．中国医疗保险，2015，8（5）：25.
QIU X L.Graded diagnosis and treatment can hardly restrain the impulse of large hospitals to expand［J］．China Health Insurance，2015，8（5）：25.

[1]	YANG Xinying, WANG Kairong, LI Jun, YE Fanting, WANG Mengyao, LI Binbin. Analysis of the Current Situation and Influencing Factors of Gastric Precancerous Conditions in Opportunistic Screening Populations [J]. Chinese General Practice, 2026, 29(32): 4716-4720.
[2]	ZHAI Jiayi, ZHANG Xueyan, SHI Feng, GU Qinle, WAN Heping, LU Yuan. Anxiety Status and Community-specific Analysis of Influencing Factors among Population in Functional Communities [J]. Chinese General Practice, 2026, 29(32): 4730-4737.
[3]	YAN Ziwei, NIE Jiahua, SHI Yan, WEI Limin. Correlation between the Albumin/Gamma-glutamyl Transferase Ratio and Metabolic-associated Fatty Liver Disease in Type 2 Diabetes Mellitus [J]. Chinese General Practice, 2026, 29(30): 4431-4437.
[4]	SUN Xiuqin, FENG Zhenlong, WEI Lanxuan, ZENG Yuxin, LIU Jinbo, MA Lin, AN Zhantian, WANG Hongyu. Analysis of the Current Status of Metabolic Syndrome among Middle-aged and Elderly People in Shijingshan District, Beijing, and Its Behavioral and Lifestyle Influencing Factors [J]. Chinese General Practice, 2026, 29(30): 4424-4430.
[5]	HUANG Jiating, LIU Lingna, NING Yanhua, SHI Jing, LI Xinjin, YANG Cailing, YAO Jing. Consistency between Expressed and Perceived Needs for Family Doctor Contracted Services among Rural Older Adults: a Survey of 456 Residents in Ningxia [J]. Chinese General Practice, 2026, 29(29): 4217-4225.
[6]	LI Wanyu, JIN Hua, ZHANG Qianqian, YU Dehua. Knowledge, Attitude and Practice of Community-based General Practitioners in Implementing Proactive Health Management in Shanghai and Their Influencing Factors [J]. Chinese General Practice, 2026, 29(28): 4157-4163.
[7]	ZHANG Rui, LU Wang, YANG Fan, LUO Yuan, CHEN Dandi. Trend Characteristics and Driving Mechanisms of Primary Care Service Volume under the Hierarchical Medical System: an Empirical Study Based on Its and Lmdi Models [J]. Chinese General Practice, 2026, 29(28): 4100-4106.
[8]	Guangdong Provincial Association of Primary Health Care Precision Nutrition Application Branch. Expert Consensus on the Construction of Primary Care Nutrition Clinics Based on Medical-prevention Integration and N-RCSP Precision Nutrition Health Management [J]. Chinese General Practice, 2026, 29(28): 4033-4046.
[9]	ZHANG Fan, CHANG Jianhua, YANG Juan, QIAO Hui, XIE Yongxin. The Prevalence Trend and Association Rules of Chronic Disease Comorbidity among Rural Residents in Ningxia Hui Autonomous Region [J]. Chinese General Practice, 2026, 29(27): 3956-3968.
[10]	FU Mengru, XUE Meiqiyang, JIANG Yutong, CHEN Mingsheng, QIAN Dongfu, LI Zhong. Study on the Influencing Factors of Self-management Ability of Atrial Fibrillation Patients in Rural Areas [J]. Chinese General Practice, 2026, 29(27): 3947-3955.
[11]	JIAO Shuting, JING Haoran, ZHAO Yali. The Severity and Influencing Factors of Chronic Pruritus Symptoms in Elderly Patients Seeking Medical Treatment in Urban Communities in Beijing [J]. Chinese General Practice, 2026, 29(25): 3655-3663.
[12]	CHEN Long, HU Wei, YE Bing. Outpatient Healthcare-seeking Behavior and Influencing Factors among Residents in Guangdong Province: an Analysis Based on the Seventh National Health Service Survey in 2023 [J]. Chinese General Practice, 2026, 29(25): 3608-3613.
[13]	PEI Ruqing, ZHOU Yuqiu, ZHANG Siyu, LIU Xijun. Meta-analysis of Influencing Factors of Relapse in Chinese Patients with Schizophrenia [J]. Chinese General Practice, 2026, 29(23): 3359-3370.
[14]	LI Jiawei, GAO Xinyi, GE Aoqi, LI Juanjuan, YUAN Beibei. Demand and Associated Factors for Integrated Medical Care and Preventive Services among Patients with Type 2 Diabetes [J]. Chinese General Practice, 2026, 29(21): 3028-3039.
[15]	LI Feng, HU Changhao, LUO Xu. Progress in the Study of Influencing Factors and Intervention Strategies of Mental Health in Elderly Patients with Multiple Chronic Conditions [J]. Chinese General Practice, 2026, 29(20): 2816-2828.