合作医疗保险改革与中国农村地区乡镇卫生院效率外文翻译(编辑修改稿)

合作医疗保险改革与中国农村地区乡镇卫生院效率外文翻译(编辑修改稿)内容摘要：

easing the volume of THs39。 activities should not harm the quality of services. . The DEA models As the purpose is to model the production function of the DMUs, DEA requires the specification of the inputs used to produce the outputs, the orientation of the model, the nature of the returns to scale and the temporal dimension to run the DEA model. THs deliver two main kinds of medical activities: curative and preventive healthcare services, which are characterized by two different production processes with two different objectives. Thus, two distinct DEA models are defined. The model characterizing the production process of curative activities consists of one output and three inputs. THs delivered a large set of curative activities. Therefore, the number of outputs used in the DEA framework needs to be minimized,3 but the diversity of activities has to be taken into account. A posite index is calculated using a workload equivalent weighting system4 suggested by a Chinese experts mittee5 and already used in a previous study (Audibert et al., 2020). Two main categories of input enter in the curative production process of THs: staff and equipment. The former are measured by the number of curative staff members, while equipment includes the number of operational beds and a posite index which gives the endowment of the TH in equipment. It is puted from principal ponent analysis and incorporates the number of operational Xrays, echographs, endoscope and The objective assigned to THs is to maximize the volume of healthcare delivered,. an output orientation is relevant. The model characterizing the production process of preventive activities consists of one output (the total volume of vaccinations delivered) and one input (the number of staff for preventive activities), as only human resources are used to produce preventive activities. The level of production is previously defined by the government. The input orientation appears more suitable as THs can minimize their use of preventive resources in order to produce the target volume of preventive activities In both models, the casemix was not taken into consideration because of the lack of data. Yet, the potential bias occurrence is not an important limitation to this specific study as THs are homogeneous in terms of disease treated (source: personal munication from Weifang Health Bureau). They are located in the same prefecture and face similar disease 济南大学毕业 论文外文资料翻译 6 patterns. They belong to the same hierarchical level in the Chinese health delivery system and have therefore mon missions defined by the , according to our data, severe cases are treated in county hospitals and THs mainly deal with respiratory and cardiovascular pathologies, diabetes and injuries. Inpatient activity represents a weak share of the curative activities delivered by THs (less than 5% of patients on average). 4. Determinants of technical inefficiency In line with the existing literature and the discussion with our Chinese partners, this paper focuses on two kinds of factors which can contribute to explain the efficiency level of THs: the internal characteristics of THs and the characteristics of the environment in which THs are situated. Two Tobit models are estimated, one for efficiency scores calculated from the curative DEA model and one from the preventive DEA model, as explaining factors may differ for both estimations. . Internal factors The position of the staff (balance between qualified and unqualified staff), the staff work load and staff incentives are considered as important channels for technical efficiency (Puenpatom amp。 Rosenman, 2020。 Yip et al., 2020). Variables are different according to the production process. We consider the proportion of qualified staff in the total staff for the regression on the curative technical efficiency as a high ratio is expected to have an attractive effect on patients. The number of households per staff is used in the regression on preventive technical efficiency as the delivery of preventive activities is often much more managed by coverage rate considerations than by considerations of staff qualifications. The efficiency of THs may be subjected to financial constraints (Preker amp。 Harding, 2020), creating a hard or a ―soft budget constraint‖ (SCB). As pointed out by Kornai (2020) (p. 119–120), SBC is ―not a single event, (…) but a mental condition, present in the head—the thinking, the perception of a decision maker (…). There are grades of ha rdness and softness‖. That means that indicators should be continuous, not discrete. Theoretical and empirical literatures provide us with some evidence showing that SBC can decrease efficiency. Regarding THs, one of the most important factors of budget constraint es from the current share of subsidies in total expenditures (excluding staff related expenditures), rather than from the deficit, as the deficit implies a kind of informal ―agreement‖ (the so called ―guanxi‖) between each TH, the health authorities and local municipalities. Therefore, a high proportion of subsidies may have a negative effect on efficiency as they lower the financial constraint of THs, creating a ―soft budget constraint‖. 济南大学毕业 论文外文资料翻译 7 Selecting the current amount of subsidies (ratio), instead of the lagged one, is relevant because the volume of subsidies cannot be anticipated by the TH as it is decided at the beginning of the year. We then also take into consideration the potential effect that the efficiency of a TH in a specific production process (for example, in curative healthcare delivery) can also have an effect on the efficiency of this same TH in other production processes (for example, in preventive healthcare delivery). To assess cross services39。 potential additional effects on efficiency behavior in different production technologies。