中国卫生事业管理2026，Vol.43Issue(3)：279-284,6.
省级三甲医院托管对县级医院医疗服务能力和效率的影响
Empirical Analysis of Impact on Medical Service Capacity and Efficiency of County-Level Hospitals under the Trusteeship from Provincial Top-Tier Tertiary Hospital Based on the Entropy Weight TOPSIS Method
摘要
Abstract
Objective To systematically evaluate the multi-dimensional impact of the trusteeship model of provincial top-tier tertiary hospitals on the medical service quality,service capacity,operational efficiency,and cost control of county-level hospitals,and provide empirical evidence for the sinking of high-quality medical resources and the optimization of the county-level medical service system under the background of hierarchical medical treatment.Methods A county-level hospital in Henan Province under the trusteeship of a provincial top-tier tertiary hospital was selected as the research object.Monthly data of 17 core indicators were collected on 9 months before the trusteeship and 15 months after the trusteeship,and a four-dimen-sional evaluation system covering＂medical quality,service capacity,operational efficiency,and cost control＂was constructed.The Entropy weight-TOPSIS method was used for comprehensive evaluation,and the independent samples t-test was com-bined to compare the differences in indicators before and after the trusteeship.The contribution degree analysis method was a-dopted to identify the key influencing dimensions.Results After the trusteeship,the comprehensive evaluation relative closeness(Ci value)of the hospital increased from 0.470±0.042 to 0.511±0.038,with an overall increase of 8.619%(P=0.023).From the perspective of dimensions,the medical service capacity dimension had the highest contribution degree(44.840%),among which the Case Mix Index(CMI)increased from 0.896±0.011 to 0.916±0.026(P=0.016),and the proportion of grade III/IV surgeries increased from 47.961%±3.438%to 51.498%±3.281%(P=0.020).In the operational efficiency dimension,the cost consumption index decreased from 0.664±0.046 to 0.621±0.036(P=0.018).In the cost control di-mension,the proportion of medical consumables cost significantly decreased from 19.011%±4.142%to 16.127%±1.762%(P=0.026).While there were no significant differences in the core indicators of medical quality.Conclusion Through techni-cal support,management implantation,and brand output,the trusteeship of provincial top-tier tertiary hospitals has effectively improved the medical service capacity and resource utilization efficiency of county-level hospitals,and optimized the medical cost structure,but the effect of medical quality improvement has not yet been demonstrated.This model provides a feasible path for promoting the sinking of high-quality medical resources and achieving the goal of＂treating serious diseases within the coun-ty＂.In the future,it is necessary to strengthen the construction of medical quality and safety system and the long-term assis-tance mechanism.关键词
三甲医院/医院托管/县级医院/医疗服务能力/熵权TOPSISKey words
Top-Tier Tertiary Hospitals/hospital trusteeship/county-level hospitals/medical service capacity/Entropy Weight TOPSIS method分类
医药卫生引用本文复制引用
许丹,李鑫,陈献振,肖鹏磊,焦建鹏,朱国重,张丽芳,梁新亮..省级三甲医院托管对县级医院医疗服务能力和效率的影响[J].中国卫生事业管理,2026,43(3):279-284,6.基金项目
河南省医学科技攻关计划软科学项目"协同治理视角下促进优质医疗资源下沉的路径与策略研究"(RKX202401002) （RKX202401002）
河南省医学科技攻关计划软科学项目"公立医院'智慧病案'一体化管理体系构建研究"(RKX202402002) （RKX202402002）
河南省医学科技攻关计划软科学项目"基于注意力机制的病案首页自动编码体系研究"(RKX202402007) （RKX202402007）
