基于DEA的厦门市养老机构服务效率及其影响因素研究
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摘要
目的评价养老机构的技术效率并探讨其影响因素,为提高社会化养老的服务效率提供决策依据。方法通过文献优选法确定评价模型及指标,对厦门市所有登记在册的养老机构进行问卷调查,选取其中13家机构工作人员进行半结构式访谈,综合运用DEA中的BCC模型对投入不足或过剩等效率问题进行定量分析和SBM模型对决策单元进行技术效率测算与排序,并拟合Tobit回归分析影响效率的因素。结果共调查32家养老机构,其中公办、公办民营和民营机构分别为7、5、20家,总床位数6729张,入住老年人3154人(女性占60%)。所调查的养老机构中技术效率有效者19家(59.4%);BCC模型中,平均技术效率为0.963,5家机构规模报酬递增,8家机构规模报酬递减;SBM模型的平均技术效率0.813,两模型有效决策单元相同,技术效率较好的前8名均为民营机构,后8名中公办机构占4所。民营机构效率高于公办机构,城市的养老机构效率高于农村,人员工作年限越长、培训越多以及入住率越高,机构的技术效率越好。结论厦门市养老机构技术效率整体较高,但在规模资源利用和服务人员质量等方面有待进一步提升;养老机构的技术效率受运营模式、地理位置、人员技能、入住率等因素影响。
Objective The purpose is to evaluate the technical efficiency(TE)of nursing homes and its influencing factors by using models of data envelopment analysis,and to provide information on the efficiency evaluation and improvements.Methods The information of all the registered nursing homes for elders in Xiamen was collected through interviewing and questionnaires.Models and indexes were selected by reading literature.Use of both the BCC model and SBM model allowed a more all-round estimation of technical efficiency of nursing homes.BCC model was used to investigate TE and efficiency related index;SBM model and its super-efficiency model were used to calculate TE and rank units.Tobit model was applied to identify the influencing factors.Results 32 nursing homes were estimated,of which 7 for public,5 for "publicly owned and privately run" and 20 for private.There are 6729 beds and 3154 residents(60% are female)in total.19 of 32 institutions were measured as effective(59.4%).In the BCC model,the average TE is 0.963,with 5 institutions in increasing returns to scale(IRS)status and 8 in decreasing returns to scale(DRS)status.In the SBM model,the average TE is 0.813.All of the top 8 efficient institutions are for private and 4 public institutions into last eight.As for environmental factors,nursing homes located in city or for private are inclined to have better efficiency.As for organizational factors,working years of nurses,training times and occupancy rate tend to be positive.Conclusion Over half the nursing homes in Xiamen are effective,but problems like under-utilization of resources and poor stuffing levels need to be solved.Efficiency of nursing homes is associated with the location,operational mode,personnel allocation and occupational rate.
Objective The purpose is to evaluate the technical efficiency(TE)of nursing homes and its influencing factors by using models of data envelopment analysis,and to provide information on the efficiency evaluation and improvements.Methods The information of all the registered nursing homes for elders in Xiamen was collected through interviewing and questionnaires.Models and indexes were selected by reading literature.Use of both the BCC model and SBM model allowed a more all-round estimation of technical efficiency of nursing homes.BCC model was used to investigate TE and efficiency related index;SBM model and its super-efficiency model were used to calculate TE and rank units.Tobit model was applied to identify the influencing factors.Results 32 nursing homes were estimated,of which 7 for public,5 for "publicly owned and privately run" and 20 for private.There are 6729 beds and 3154 residents(60% are female)in total.19 of 32 institutions were measured as effective(59.4%).In the BCC model,the average TE is 0.963,with 5 institutions in increasing returns to scale(IRS)status and 8 in decreasing returns to scale(DRS)status.In the SBM model,the average TE is 0.813.All of the top 8 efficient institutions are for private and 4 public institutions into last eight.As for environmental factors,nursing homes located in city or for private are inclined to have better efficiency.As for organizational factors,working years of nurses,training times and occupancy rate tend to be positive.Conclusion Over half the nursing homes in Xiamen are effective,but problems like under-utilization of resources and poor stuffing levels need to be solved.Efficiency of nursing homes is associated with the location,operational mode,personnel allocation and occupational rate.
引文
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[10] 任洁.机构养老服务效率研究——以厦门市为例.人口与经济,2016,(2):58-68.
[11] Min A,Park CG,Scott LD.Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling.Western Journal of Nursing Research,2016,38(11):1489-1508.
[12] Shimshak D,Lenard M,Klimber G R.Incorporating quality into data envelopment analysis of nursing home performance:A case study.Omega,2009,37(3):672-685.
[13] 张淑卿.台湾地区护理之家经营效率分析.长庚科技学刊,2011,(14):33-45.
[14] Wang Y-HCL.The efficiency of nursing homes in Taiwan:an empirical study using data envelopment analysis.Fu Jen Management Review,2005,12(1):167-194.
[15] 周颖,柴哲军.宁波市养老机构效率评价研究.宁波大学学报(人文科学版),2015,(3):79-84.
[16] Garavaglia G,Lettieri E,Agasisti T,et al.Efficiency and quality of care in nursing homes:an Italian case study.Health Care Management Science,2011,14(1):22-35.
[17] 刘雅倩,潘晓平,廖菁,等.不同数据包络分析模型评价医院技术效率的比较分析.中国卫生经济,2011,(3):65-67.
[18] Zhang NJ,Unruh L,Wan TTH.Has the Medicare Prospective Payment System Led to Increased Nursing Home Efficiency.Health Services Research,2008,43(3):1043-1061.
[2] 国家统计局.2016年社会服务发展统计公报.http://www.mca.gov.cn/article/sj/tjgb/201708/20170800005382.shtml.
[3] 王莉莉,董彭滔,孔伟.“十二五”我国养老机构发展现状回顾与分析.老龄科学研究,2017,(4):13-24.
[4] 崔树义,田杨.养老机构发展“瓶颈”及其破解——基于山东省45家养老机构的调查.中国人口科学,2017,(2):115-125.
[5] 吴敏.基于需求与供给视角的机构养老服务发展现状研究.山东大学,2011:12.
[6] 伍小兰.中国长期照护体系的发展与思考.老龄科学研究,2017,(5):3-14.
[7] 陈玮尧,薛兴利.养老机构运行效率研究综述.对外经贸,2017,(5):66-70.
[8] Cooper WWSLMZ.Handbook on data envelopment analysis.Springer Science & Business Media,2011:26-28.
[9] Tone K.A slacks-based measure of efficiency in data envelopment analysis.European Journal of Operational Research,2001,130(3):498-509.
[10] 任洁.机构养老服务效率研究——以厦门市为例.人口与经济,2016,(2):58-68.
[11] Min A,Park CG,Scott LD.Evaluating Technical Efficiency of Nursing Care Using Data Envelopment Analysis and Multilevel Modeling.Western Journal of Nursing Research,2016,38(11):1489-1508.
[12] Shimshak D,Lenard M,Klimber G R.Incorporating quality into data envelopment analysis of nursing home performance:A case study.Omega,2009,37(3):672-685.
[13] 张淑卿.台湾地区护理之家经营效率分析.长庚科技学刊,2011,(14):33-45.
[14] Wang Y-HCL.The efficiency of nursing homes in Taiwan:an empirical study using data envelopment analysis.Fu Jen Management Review,2005,12(1):167-194.
[15] 周颖,柴哲军.宁波市养老机构效率评价研究.宁波大学学报(人文科学版),2015,(3):79-84.
[16] Garavaglia G,Lettieri E,Agasisti T,et al.Efficiency and quality of care in nursing homes:an Italian case study.Health Care Management Science,2011,14(1):22-35.
[17] 刘雅倩,潘晓平,廖菁,等.不同数据包络分析模型评价医院技术效率的比较分析.中国卫生经济,2011,(3):65-67.
[18] Zhang NJ,Unruh L,Wan TTH.Has the Medicare Prospective Payment System Led to Increased Nursing Home Efficiency.Health Services Research,2008,43(3):1043-1061.