تاثیر اجرای طرح تحول نظام سلامت بر کارایی بیمارستان‌های منتخب اهواز
محورهای موضوعی : -مدیریت خدمات بهداشتی و درمانی
پرستو امیری‌فر
1
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انیسه نیک روان
2
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لیلا نظری منش
3
1 - دانش‌آموخته کارشناسی ارشد مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
2 - استادیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
3 - استادیار، گروه مدیریت خدمات بهداشتی و درمانی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران
کلید واژه: کارایی, تحلیل پوششی داده‌ها, اهواز, آزمون پوآسن, بازده به مقیاس ثابت,
چکیده مقاله :
مقدمه: شکی نیست که تعیین میزان کارایی در بیمارستان ها یکی از گام های اساسی می باشد که باید به‌سرعت برداشته شود. بنابراین بررسی کارایی می تواند به عاملان اجرایی برنامه‌های سلامت کمک کند تا نقاط قوت و ضعف آن را بهتر بشناسند. هدف از مطالعه حاضر بررسی تاثیر طرح تحول نظام سلامت بر کارایی بیمارستان‌های منتخب اهواز در بازه‌ی 1391 تا 1396 می‌باشد. روش پژوهش: داده‌های مربوط به هفت بیمارستان مجری طرح و یک بیمارستان شاهد در سال های 1391، 1392، 1395 و 1396 جمع آوری شدند. کارایی بیمارستان‌ها با استفاده از تکنیک تحلیل پوششی داده‌ها به روش CCR و با استفاده از نرم‌افزار WinDeap2 v 2.1 محاسبه شد و تحلیل استنتاجی با استفاده از آزمون تی مستقل و پوآسن و نرم‌افزار Stata v 15.1انجام شد. یافته‌ها: بیش‌ترین کارایی بیمارستان‌ها مربوط به سال 1396 با میانگین 0.987 بوده و کارایی دو بیمارستان در سال‌های 1395 و 1396، 1 بوده است و دو بیمارستان دیگر طی این دو سال روندی صعودی در کارایی را تجربه کرده‌اند. کارایی، تعداد پذیرش بستری، تعداد پذیرش سرپایی و تعداد اعمال جراحی قبل از طرح تحول تفاوت معنی‌داری با بعد از آن داشته‌اند، اما این تفاوت در مورد تعداد تخت فعال، تعداد پزشک و تعداد پرستار صادق نبوده است. نتیجه‌گیری: به‌طور کلی کارایی بیمارستان‌های مجری طرح روندی صعودی داشته است و از آنجاکه در سال 1393، نظام سلامت کشور شاهد طرح تحول بوده، این امکان وجود دارد که بهبود کارایی، تعداد پذیرش سرپایی، تعداد پذیرش بستری و تعداد اعمال جراحی بیمارستان‌ها، ناشی از طرح تحول بوده باشد.
Introduction: There is no doubt that determining the efficiency of hospitals is one of the key steps that must be taken. Therefore, performance appraisal can help health plan executives to better understand its strengths and weaknesses. The purpose of this study is to evaluate the effect of health system transformation plan on the efficiency of selected hospitals in Ahvaz in the period 2012 to 2017. Methods: Data related to seven hospitals implementing the project and one control hospital in 2012, 2013, 2016 and 2017 were collected. The efficiency of hospitals was calculated using data envelopment analysis technique using CCR method and WinDeap2 v 2.1 software. Independent t-test and Poisson using Stata v 15.1 software were used for inferential analysis. Results: The highest efficiency of hospitals were related to 2017 with average 0.987 and the efficiency of two hospitals in 2016 and 2017 was 1 and the other two hospitals have experienced an upward trend during these two years. Efficiency, number of hospital admissions, number of outpatient admissions and number of surgeries before the transformation plan were significantly different from after, but this difference was not true for the number of active beds, number of physicians and number of nurses. Conclusion: Totally the efficiency of hospitals implementing transformation plan has been experienced an upward trend. considering the health system transformation plan in 2014, the improvement of the efficiency, the number of outpatient admissions, the number of hospital admissions and the number of surgeries was probably due to the transformation plan.
1- Dadgar R, Jahani MA, Mahmoudi Gh. The impact of health system reform plan on the hospital's performance indicators of Lorestan University of Medical Sciences. Yafte, 2017; 19(2): 93-102. [Persian]
2- Hakimzadeh B. Comparison of the efficiency of hospitals in Ahvaz before and after the implementation of the health system transformation plan based on the Paboon Lasso model. Islamic Azad University; 2016. [Persian]
3- Amiri H, Raees Safari M. Investigating the efficiency of commercial banks in Iran and the institutional factors affecting it. Bi-Quarterly Journal of Economic Research Institute of Hawzeh and University, 2005; 2: 3. [Persian]
4- Farrell MJ. The measurement of productive efficiency. J R Stat Soc Series A(General); 1957. https://doi.org/10.2307/2343100.
5- Moradi L, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran: Equity and Sustainability Concerns. International Journal of Health Policy and Management; 2015.
6- Emamgholipour S, Jaafaripooyan E, Mohammadshahi M, Mohammadi Yazani E. The Effect of Health Sector Evolution Plan on the Performance Indices of Emergency Department in Hospitals of Tehran & Iran Universities of Medical Sciences: Interrupted Time Series Analysis. Iranian Journal of Emergency Medicine, 1396; 5. [Persian]
7- Sorani MD. The effect of health transformation plan implementation on performance and financial indicators of Hajar Hospital in Shahrekord. Islamic Azad University, Science and Research Branch of Fars; 2016. [Persian]
8- Yardim MS, Cilingiroglu N, Yardim N. Financial protection in health in Turkey: the effects of the Health Transformation Programme. Health Policy Plan; 2014: 177-192.
9- Wees PJ, Zaslavsky AM, Ayanian JZ. Improvements in health status after Massachusetts health care reform. Milbank Quarterly, 2013; 91(4): 663- 689.
10- Request to approve master agreement for emergency shelter care sevices with various licensed foster parents. county of Los Angeles. department of children and family services; 2004. Available From: https://www.lawinsider.com/documents/lt4noI9eDnI
11- Mental Health Institutes. Iowa Department of Human Services Employees’ Manual. Title 3, Chapter A; 2020.
12- Small group Health Maintenance Organization (HMO) POINT OF SERVICE (POS) contract. ABC company; 2017. Available From: https://www.lawinsider.com/documents/a1i1rbiKRWD
13- Aigner D, Lovell CK, Schmidt P. Formulation and estimation of stochastic frontier production function models. J Econom 1977. Available From: https://doi.org/10.1016/0304-4076(77)90052-5
14- Pabon LH. Evaluating hospital performance through simultaneous application of several indicators; 1986.
15- Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. Eur J Oper Res 1978. Available From: https://doi.org/10.1016/03772217(78)90138-8
16- Mehregan MR. Quantitative models in evaluating the performance of organizations (data envelopment analysis). Tehran: University of Tehran Press; 2006.
17- Bal H, Orkcu H, Celebioglu S. Improving the discrimination power and weights dispersion in the data envelopment analysis. Computers & Operations Research, 2010; 37: 99–107.
18- Reggiannini B, Sheinkopf SJ, Silverman HF Li, X Lester BM. A flexible analysis tool for the quantitative acoustic assessment of infant cry. J Speech Lang Hear Res 2013; 56: 28-1416.
19- Coelli T.j. A Guide to DEAP Version 2.1: A Data Envelopment Analysis (Computer) Program. The University of New England, Centre for Efficiency and Productivity Analysis (CEPA) Working Papers, No 8/96.
20- Cooper W, Seiford L, K Tone. Data Envelopment Analysis: A Comprehensive Text with Models, Applications, References and DEA-Solver Software. Kluwer Academic Publishing, Boston at al, 2001.
21- Nabilou B, Salem Safi P, Yusefzadeh H. Performance Assessment of Health System Reform Plan in the Hospital Affilliated with Urmia University of Medical Sciences. The J Urmia Nurs Midwifery Fac, 2017; 14(11). [Persian]
22- Warton D, K.C Hui F. The arcsine is asinine: the analysis of proportions in ecology. Ecology 2011; 92; 1: 3–10.
23- Armitage P, Berry G, Matthews J.N.S. statistical mothods in medical research. Wiley 2013; fourth eddition.
24- Asghari Jafarabadi M, Soltani A, Mohammadi SM. Statistical Series: The Analysis of Contingency Tables 1 (Chi-Square Tests). Iranian journal of Diabetes and Metabolism, 2014; 13: 2. [Persian]
25- Fazeli E, Vafaei F, Jamshidinavid B. Investigation on efficacy of the hospitals affiliated to Ilam University of Medical Sciences by DEA method. Scientific Journal of Ilam University of Medical Sciences, 2015; 23: 1. [Persian]
26- Amponsah S, Edward Amanfo S. Efficiency and Productivity Growth in the Health Care Systems of Ghana: Regional Comparison Analysis using DEA, 2017.
27- Muthuri Kirigia J, G Sambo L, Emrouznejad L, Liambila W. Using Data Envelopment Analysis to Measure the Technical Efficiency of Public Health Centers in Kenya. Journal of Medical Systems, 2004; 28: 2.
28- Pirani N, Zahiri M, Ahmadi Engali K, Torabipour A. Hospital Efficiency Measurement Before and After Health Sector Evolution Plan in Southwest of Iran: a DEA-Panel Data Study. Acta Informed; 2018: 106-110.
_||_1- Dadgar R, Jahani MA, Mahmoudi Gh. The impact of health system reform plan on the hospital's performance indicators of Lorestan University of Medical Sciences. Yafte, 2017; 19(2): 93-102. [Persian]
2- Hakimzadeh B. Comparison of the efficiency of hospitals in Ahvaz before and after the implementation of the health system transformation plan based on the Paboon Lasso model. Islamic Azad University; 2016. [Persian]
3- Amiri H, Raees Safari M. Investigating the efficiency of commercial banks in Iran and the institutional factors affecting it. Bi-Quarterly Journal of Economic Research Institute of Hawzeh and University, 2005; 2: 3. [Persian]
4- Farrell MJ. The measurement of productive efficiency. J R Stat Soc Series A(General); 1957. https://doi.org/10.2307/2343100.
5- Moradi L, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran: Equity and Sustainability Concerns. International Journal of Health Policy and Management; 2015.
6- Emamgholipour S, Jaafaripooyan E, Mohammadshahi M, Mohammadi Yazani E. The Effect of Health Sector Evolution Plan on the Performance Indices of Emergency Department in Hospitals of Tehran & Iran Universities of Medical Sciences: Interrupted Time Series Analysis. Iranian Journal of Emergency Medicine, 1396; 5. [Persian]
7- Sorani MD. The effect of health transformation plan implementation on performance and financial indicators of Hajar Hospital in Shahrekord. Islamic Azad University, Science and Research Branch of Fars; 2016. [Persian]
8- Yardim MS, Cilingiroglu N, Yardim N. Financial protection in health in Turkey: the effects of the Health Transformation Programme. Health Policy Plan; 2014: 177-192.
9- Wees PJ, Zaslavsky AM, Ayanian JZ. Improvements in health status after Massachusetts health care reform. Milbank Quarterly, 2013; 91(4): 663- 689.
10- Request to approve master agreement for emergency shelter care sevices with various licensed foster parents. county of Los Angeles. department of children and family services; 2004. Available From: https://www.lawinsider.com/documents/lt4noI9eDnI
11- Mental Health Institutes. Iowa Department of Human Services Employees’ Manual. Title 3, Chapter A; 2020.
12- Small group Health Maintenance Organization (HMO) POINT OF SERVICE (POS) contract. ABC company; 2017. Available From: https://www.lawinsider.com/documents/a1i1rbiKRWD
13- Aigner D, Lovell CK, Schmidt P. Formulation and estimation of stochastic frontier production function models. J Econom 1977. Available From: https://doi.org/10.1016/0304-4076(77)90052-5
14- Pabon LH. Evaluating hospital performance through simultaneous application of several indicators; 1986.
15- Charnes A, Cooper WW, Rhodes E. Measuring the efficiency of decision making units. Eur J Oper Res 1978. Available From: https://doi.org/10.1016/03772217(78)90138-8
16- Mehregan MR. Quantitative models in evaluating the performance of organizations (data envelopment analysis). Tehran: University of Tehran Press; 2006.
17- Bal H, Orkcu H, Celebioglu S. Improving the discrimination power and weights dispersion in the data envelopment analysis. Computers & Operations Research, 2010; 37: 99–107.
18- Reggiannini B, Sheinkopf SJ, Silverman HF Li, X Lester BM. A flexible analysis tool for the quantitative acoustic assessment of infant cry. J Speech Lang Hear Res 2013; 56: 28-1416.
19- Coelli T.j. A Guide to DEAP Version 2.1: A Data Envelopment Analysis (Computer) Program. The University of New England, Centre for Efficiency and Productivity Analysis (CEPA) Working Papers, No 8/96.
20- Cooper W, Seiford L, K Tone. Data Envelopment Analysis: A Comprehensive Text with Models, Applications, References and DEA-Solver Software. Kluwer Academic Publishing, Boston at al, 2001.
21- Nabilou B, Salem Safi P, Yusefzadeh H. Performance Assessment of Health System Reform Plan in the Hospital Affilliated with Urmia University of Medical Sciences. The J Urmia Nurs Midwifery Fac, 2017; 14(11). [Persian]
22- Warton D, K.C Hui F. The arcsine is asinine: the analysis of proportions in ecology. Ecology 2011; 92; 1: 3–10.
23- Armitage P, Berry G, Matthews J.N.S. statistical mothods in medical research. Wiley 2013; fourth eddition.
24- Asghari Jafarabadi M, Soltani A, Mohammadi SM. Statistical Series: The Analysis of Contingency Tables 1 (Chi-Square Tests). Iranian journal of Diabetes and Metabolism, 2014; 13: 2. [Persian]
25- Fazeli E, Vafaei F, Jamshidinavid B. Investigation on efficacy of the hospitals affiliated to Ilam University of Medical Sciences by DEA method. Scientific Journal of Ilam University of Medical Sciences, 2015; 23: 1. [Persian]
26- Amponsah S, Edward Amanfo S. Efficiency and Productivity Growth in the Health Care Systems of Ghana: Regional Comparison Analysis using DEA, 2017.
27- Muthuri Kirigia J, G Sambo L, Emrouznejad L, Liambila W. Using Data Envelopment Analysis to Measure the Technical Efficiency of Public Health Centers in Kenya. Journal of Medical Systems, 2004; 28: 2.
28- Pirani N, Zahiri M, Ahmadi Engali K, Torabipour A. Hospital Efficiency Measurement Before and After Health Sector Evolution Plan in Southwest of Iran: a DEA-Panel Data Study. Acta Informed; 2018: 106-110.