Objective To get the evidence of scale economy and the appropriate number of hospital beds in general hospitals. Methods Through CCR and BCC and Malmquist index model and the experimental analysis by using DEA and Tobit regression model, the efficiency and the change of total factor productivity were analyzed on a panel data of general hospitals at and above 500 beds in Zhejiang Province. Results The average efficiency score is greater than 0.93 in the general efficiency and pure technical efficiency; 36％ units are generally efficient, 65％ are in pure technical efficiency and 43％ are in scale efficiency; 43％ are at the constant returning to scale stage, 15％ at decrease returning to scale;most of the hospitals' productivity decreased; and the influence factors of hospital efficiency include beds, proportion of income from drugs, number of devices, hospital grade, ratio of visits to beds, expenditure over revenue, number of health technicians per bed, number of doctors per thousands people and economic level. Conclusion There are evidences of economies of scale in most of general hospitals. The appropriate number of beds is from 800 to 1 300 for general.hospitals. To improve the efficiency, we should control hospital beds and proportion of income from drugs, raise the level of hospital management and control the level of health resources and enhance the resource utilization level of regional health resource and economic development level.%目的了解医院是否存在规模经济及适宜床位规模大小.方法利用浙江省500张床及以上综合性医院数据,用主、客观结合的方式和效率回归调整模型筛选评价指标,用数据包络分析方法和Tobit回归模型进行实证分析.结果所有决策单元的总体效率和纯技术效率、规模效率平均得分均大于0.93;36%的单元为总体有效,65%的单元为纯技术有效.43%的单元为规模有效;43%的单元处于规模报酬不变区间,42%的单元处于报酬递增区间,15%的单元处于报酬递减区间;全要素生产率平均呈下降;效率的影响因素主要有床位、药品收入比重、设备数量、医院等级、诊次床位比、业务收支比、每床卫技数、每床固定资产、所在地区千人医生数和经济水平等.结论:多数医院存在规模经济.医院床位数在800-1 300张较为合适.提高医院经营效率可采取以下措施:合理控制床位:控制药品收入比重,注重医疗技术的提高;提高管理水平,控制固定资产过度投入;提高地区卫生资源水平和经济发展水平.
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