Objective To evaluate comprehensively the economic performance of secondary general hospitals in Shanghai by taking the scientific quantitative evaluation as the starting point,providing references for the development of a tiered healthcare system and refined hospital management.Methods Based on economic operational data from 53 secondary general hospitals in Shanghai from 2019 to 2023,comprehensive evaluation and positive analysis were carried out,using the TOPSIS model,Dagum Gini coefficient and its decomposition model,and Kernel density estimation model.Results From the dimension perspective,the secondary general hospitals in Shanghai demonstrated relatively strong performance in budget management while their development capacity and cost management underperformed.From theregion perspective,suburban hospitals recorded gradual improvements in quality and efficiency of their economic performance,leading to the gradually narrowing gap between urban and suburban areas.Hospitals in urban areas are now facing the challenge of being overtaken by suburban ones in the quality and efficiency of economic performance and a high degree of internal imbalanced development.Conclusion The functional positioning of secondary general hospitals is inadequately implemented,greatly affected by the siphoning effect caused by tertiary Grade-A hospitals.To solve this problem,secondary hospitals should proactively engage in inter-regional cooperation,adopt flexible operational models,and make solid steps to strengthen cost control to increase income and decrease expenses,thus achieving a sound and sustained operation of the hospitals.

Objective To evaluate comprehensively the economic performance of secondary general hospitals in Shanghai by taking the scientific quantitative evaluation as the starting point,providing references for the development of a tiered healthcare system and refined hospital management.Methods Based on economic operational data from 53 secondary general hospitals in Shanghai from 2019 to 2023,comprehensive evaluation and positive analysis were carried out,using the TOPSIS model,Dagum Gini coefficient and its decomposition model,and Kernel density estimation model.Results From the dimension perspective,the secondary general hospitals in Shanghai demonstrated relatively strong performance in budget management while their development capacity and cost management underperformed.From theregion perspective,suburban hospitals recorded gradual improvements in quality and efficiency of their economic performance,leading to the gradually narrowing gap between urban and suburban areas.Hospitals in urban areas are now facing the challenge of being overtaken by suburban ones in the quality and efficiency of economic performance and a high degree of internal imbalanced development.Conclusion The functional positioning of secondary general hospitals is inadequately implemented,greatly affected by the siphoning effect caused by tertiary Grade-A hospitals.To solve this problem,secondary hospitals should proactively engage in inter-regional cooperation,adopt flexible operational models,and make solid steps to strengthen cost control to increase income and decrease expenses,thus achieving a sound and sustained operation of the hospitals.

Public hospitals stand in need of strengthening cost control and improving operational efficiency to balance public welfare and economic benefits.Taking practice and exploration of ultrasound department as an exam-ple,it integrates the advantages of TDABC with cost management.Take the merits of time driver and activity driver,realizes direct cost accounting under the clinical pathway,strengthen capacity management capabilities un-der the integration of industry and finance,with a view to providing a powerful cost control tool for public hospitals to sensibly respond to pricing reform and reasonably make operational decisions.