نوع مقاله : مقاله پژوهشی
نویسندگان
1 کارشناس‌ارشد، گروه اقتصاد سلامت، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشگاه علوم پزشکی قزوین، قزوین، ایران.
2 دانشجوی دکترا، گروه اقتصاد سلامت، دانشکده بهداشت، دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران.
3 کارشناس‌ارشد، گروه پرستاری سالمندی، مرکز تحقیقات سلامت سالمندان، دانشگاه علوم پزشکی سبزوار، سبزوار، ایران.
4 استاد، مرکز تحقیقات عوامل اجتماعی مؤثر بر سلامت، دانشگاه علوم پزشکی قزوین، قزوین، ایران.
5 کارشناس‌ارشد، پژوهشگر اقتصاد سلامت، پژوهشکده مطالعات اقتصادی، دانشکده علوم اقتصادی و اجتماعی، دانشگاه الزهرا، تهران، ایران.
چکیده
اهداف با توجه‌به کمیاب‌بودن منابع در حیطه بهداشت و درمان، استفاده مناسب از این منابع بسیارمهم است. هدف این مطالعه، سنجش کارایی مراکز بهداشتی‌درمانی روستایی استان قزوین در دوره زمانی 1385 تا 1389 است.
مواد و روش ها این پژوهش مطالعه‌ای توصیفی‌تحلیلی است. جامعه پژوهش شامل تمام مراکز بهداشتی‌درمانی روستایی استان قزوین (43 مرکز) است. متغیرهای نهاده شامل تعداد پزشک، کارشناس، کاردان و بهورز است و متغیرهای ستانده را درصد پوشش غربالگری کم‌کاری مادرزادی تیروئید، درصد آهن‌یاری در دانش‌آموزان اول راهنمایی، میزان بازدید از اماکن عمومی و مراکز تهیه‌وتوزیع مواد غذایی، معاینه توسط پزشک و تعداد ارجاع به متخصص توسط پزشک عمومی بود. از مدل نهاده‌محور و فرض بازدهی متغیر نسبت‌به مقیاس استفاده شد. روند زمانی کارایی مراکز هم با مدل رگرسیونی تخمین زده شد. از نرم‌افزار DEA-solver برای سنجش کارایی و از نرم‌افزار Stata برای تخمین مدل‌های رگرسیون استفاده شد.
یافته ها میانگین کارایی فنی در سال‌های 1385 تا 1389 به‌ترتیب 77/0، 77/0، 78/0، 92/0 و 89/0 بود. همچنین میانگین کارایی مقیاس در این دوره زمانی به‌ترتیب 98/0، 95/0، 95/0، 97/0 و 98/0 بود. میانگین نمره کارایی مدیریتی نیز از 78/0 به 92/0رسید. نتایج روند زمانی نمرات کارایی مراکز نشان داد که ضریب میانگین نمرات کارایی مراکز 039/0 و از نظر آماری معنادار بود (03/0P=).
نتیجه گیری میانگین کارایی و میزان برون‌دادهای سلامت در این سال‌ها بهبود یافته است؛ اما هنوز منابع هدر می‌شوند. به‌نظر می‌رسد اقداماتی مانند ارزیابی مداوم عملکرد، بهبود کمّی و کیفی خدمات، برنامه‌ریزی برای تناسب استفاده از نهادها و به‌خصوص نیروی انسانی مفید باشد.
کلیدواژه‌ها
عنوان مقاله [English]
Efficiency Determination of Rural Health Centers of Ghazvin Province Using Data Envelopment Analysis Approach in 2006-2010 Period
نویسندگان [English]
- Fatemeh Rostami Golmohammadi 1
- Ali Kazemi Karyani 2
- Maryam Goudarzian 3
- Saeed Asefzadeh 4
- Sattar Mehraban 5
1 MSc., Department of Health Economic, Research Center of Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran.
2 PhD Candidate, Department of Health Economic, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
3 MSc., Department of Geriatric Nursing, Iranian Research Center on Health Aging, Sabzevar University of Medical Sciences, Sabzevar, Iran.
4 Professor, Research Center of Social Determinants of Health, Qazvin University of Medical Sciences, Qazvin, Iran.
5 MSc., Researcher in Health Economics, Institute of Economic Studies, Faculty of Social Sciences & Economics, Alzahra University, Tehran, Iran.
چکیده [English]
Background Given the scarcity of resources in the areas of health, the efficient use of these resources is very important. The purpose of this study was to assess the efficiency of rural health centers of Ghazvin province in the period of 2006-2010.
Materials & Methods This is a descriptive-analytical study, in which all rural health centers in Qazvin Province, 43 centers, were included. Independent variables were the number of physicians, health experts, technicians, and community health workers, and the dependent variables were percentages of screening for congenital hypothyroidism, percentages of iron supplementation in the first guidance school students, number of visits of public procurements and food distribution centers, number of general practitioner’s visit, and number of specialist referral by the general physician. In this study, input-oriented model and variable returns to scale (VRS) assumption were used. Also, time trend of efficiency was estimated with a regression model. Data envelopment analysis (DEA)-solver and Stata software were used to measure efficiency and estimate regression models, respectively.
Results The mean technical efficiencies during 2006 to 2010 were 0.77, 0.77, 0.78, 0.92, and 0.89, respectively. Also, the average scale efficiencies in these years were 0.98, 0.95, 0.95, 0.97, and 0.97, respectively. Average score of managerial efficiency increased from 0.78 to 0.92 during this period. The results of time trend showed that β-coefficient for average score of efficiency was 0.039 and statistically significant (P=0.03).
Conclusion The mean levels of efficiency and health outcomes have been improved in these years but some of resources are still wasted. It seems that some practices such as ongoing evaluation of performance, improving the quality and quantity of services, and programing for optimal use of inputs, can be particularly useful.
کلیدواژه‌ها [English]
- efficiency
- Rural health center
- Data envelopment analysis (DEA)
- Qazvin
- Health resource
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