国家卫生系统绩效评价模型理论与方法研究

发布时间：2018-04-02 05:00

  本文选题：卫生系统　切入点：绩效评价　出处：《华中科技大学》2015年博士论文

【摘要】：[目的]2000年世界卫生报告提出卫生系统绩效评价以来,国家卫生系统绩效评价研究迅速发展并引起了广泛关注。世界卫生组织,世界银行、经合组织、欧盟和联邦基金等国际组织纷纷投入到卫生系统绩效评价之中,英国、美国、澳大利亚、加拿大和荷兰等也在实践过程中积累了丰富的经验。国家卫生系统绩效评价在卫生系统绩效监测评价、卫生决策、资源规划和数据系统完善方面发挥着重要作用。 我国正处于卫生改革的关键时期,然而,我国尚未建立一个国家卫生系统绩效评价制度,亦未提出一个国家卫生系统评价的框架或模型,目前研究也没有系统的从理论和方法角度对其进行比较研究和借鉴。尽管国家卫生系统绩效评价尽管受到政治、经济、文化和技术的影响而各具特色,但是通过对国际主流评价框架和典型国家绩效评价系统和结构化比较,总结和借鉴卫生系统绩效评价理论、方法和有益经验,进而构建和完善卫生系统绩效评价模型,对我国卫生系统评价制度的建立仍然具有重要意义。 本研究通过系统梳理和比较国家卫生系统绩效评价框架,总结国家卫生系统绩效评价理论、方法和规律,构建卫生系统绩效评价模型和评价框架,为我国卫生系统绩效评价框架体系和制度建立提供理论和方法支持。 [方法]本研究数据来源三个渠道：(1)文献数据。中外文数据库、Google搜索引擎和官方机构网站系统收集卫生系统及其绩效评价相关文献,主要用于卫生系统基本理论和框架比较研究。(2)西部三省数据。陕西、重庆和广西2008～2012卫生统计数据和第四次、第五次卫生服务调查数据,主要用于中国卫生系统绩效评价指标验证。(3)第五次卫生服务调查扩点省数据。从第五次卫生服务调查22个扩点省分东中西三层,每层选择三个扩点省,共9个扩点省的家庭问卷调查数据,主要用于中国卫生系统绩效评价实证研究,验证评价框架指标和标杆比较方法适用性。本研究将定性和定量方法相结合进行研究：(1)描述性系统综述和科学计量学方法结合研究卫生系统基本理论,同时结合卫生系统分类理论和方法,确定主流框架和典型国家样本。(2)系统分析法和比较分析法相结合,同时利用理想类型指导思想,系统比较和分析卫生系统主流框架和典型国家绩效评价规律。(3)统一建模语言方法用于完善卫生系统绩效评价框架构建流程和卫生系统绩效评价模型,并构建卫生系统绩效评价框架模型。(4)统计学分析方法,包括标杆比较方法和不平等指数等,进行中国卫生系统绩效实证研究。此外,专家咨询法贯穿于整个研究过程。 [结果](1)卫生系统定义既要包含卫生系统“硬件”——结构,同时应该包括卫生系统“软件”——结构和目标之间的联系。(2)国家卫生系统绩效评价框架根据其目的和功能不同可以分为两类,一类是国际组织或机构主导制定的卫生系统绩效评价框架用于不同国家之间卫生系统绩效的评价和比较,其中世界卫生组织,世界银行、经合组织、欧盟和联邦基金为其典型代表：另一类是各个国家针对具体国情制定的适合本国家的卫生系统绩效评价框架,其中英国、澳大利亚、加拿大、荷兰和美国各具特色,各自代表了不同类型的卫生系统。(3)国家卫生系统绩效评价模型包括利益相关者参与、概念模型或方法选择、国家政策环境分析、评价框架构建、评价管理实施以及激励机制和结果应用等关键流程。其中评价框架构建是整个评价模型的核心,构建路径又可以细分为框架构建目的、卫生系统边界、卫生系统目的和构成、评价框架体系形成和指标集建立及筛选等步骤。(4)广义的卫生系统绩效评价框架模型应该包括卫生系统最终目标、非医学健康影响因素、卫生系统投入和卫生系统产出四个方面。而狭义的卫生保健系统与其卫生系统投入和产出两个部分相对应。卫生投入、产出和健康影响因素通过人群影响最终结果,其中卫生系统投入和产出为代表的卫生保健系统不仅能直接影响人群健康,而且能够通过非医学健康影响因素间接影响卫生系统最终结果的绩效。 [结论](1)卫生系统“硬件”、“软件”和“目标”与卫生系统绩效的能力、过程和结果三个层次对应,因此,一个全面的卫生系统绩效评价框架应该涵盖卫生系统的结构、中间过程和最终目标。(2)统一建模语言与卫生系统绩效评价构建路径自下而上和自上而下的框架构架和指标选择思想一致,将统一建模语言融入框架构建路径,提高了卫生系统绩效评价框架构建路径和模型的理论性和方法性。(3)基于Lalonde模型广义卫生系统绩效评价框架模型具有全面、灵活特点,适合我国卫生系统绩效评价。其中,卫生投入和产出是评价的核心,最终目标维度是国际比较的基础。评价过程中应该同时关注水平和分布两个方面,公平与效率相结合。(4)根据卫生系统评价模型和国际经验,我国应成立国家层面的卫生绩效评价主体、构建国家卫生系统绩效评价框架体系、完善评价指标集和数据收集系统、建立卫生系统绩效评价激励机制和定期发布卫生系统绩效评价报告,最终建立国家卫生系统绩效评价制度,支持卫生系统决策和规划配置,达到卫生系统加强和健康改善最终目标。 [创新与不足]创新：(1)科学计量学方法和卫生系统分类理论结合,从科研产出定量角度和分类学角度共同确定了卫生系统绩效评价研究典型国家样本。(2)基于国际经验,构建了卫生系统绩效评价关键流程模型和卫生系统绩效评价框架构建路径,并将UML方法融入到卫生系统绩效评价框架构建路径之中。(3)构建了广义的卫生系统绩效评价框架模型,并通中国卫生绩效评价框架制定和标杆比较方法实证验证了其在中国的适用性。不足：(1)社会保险类型国家和中低收入国家缺少可供借鉴的样本和经验。(2)评价指标筛选缺乏定量可操作的方法依据。(3)实证研究通过标杆比较方法对部分省份部分指标进行了比较和评价,综合评价结果解读和应用需谨慎。
[Abstract]:Since the purpose of]2000 [World Health report health system performance evaluation, performance evaluation of national health system develops rapidly and has aroused wide concern. The WHO, the world bank, OECD, EU and other international organizations have federal funds into the performance evaluation of the health system, the United States, Britain, Australia, Canada and Holland in in the process of practice has accumulated rich experience. The performance evaluation in the national health system, health system performance monitoring health decision-making, resource planning and data system plays an important role.
China is in a critical period of health reform, however, has not yet established a national health system performance evaluation system in our country has not put forward a framework or model of a national health evaluation system, at present there is no systematic study from the perspective of the theory and method of comparative study and reference. Although the performance of national health system despite the political and economic evaluation, and influence of culture and technology and have their own characteristics, but compared with the international mainstream evaluation framework and performance evaluation system of typical countries and structured, summary and reference of health system performance evaluation theory, methods and experience, and then build and perfect health system performance evaluation model, still has an important meaning for our country health system evaluation system.
This study through the analysis and comparison of the performance evaluation system of the national health system framework, summarizes the performance of national health system evaluation theory, methods and rules, construction of health system performance evaluation model and evaluation framework for the performance of China's health system evaluation framework system and establish a system to provide theoretical and methodological support.
[method] this study data from three channels: (1) the literature data. In the database, Google search engine and official website system to collect the health system and the performance evaluation of the relevant literature, mainly for the comparative study of the basic theory and framework of the health system. (2) three. Shaanxi Province data of Western Chongqing and Guangxi, 2008~2012 health the statistical data and the fourth, fifth health services survey data, mainly for the evaluation of health system performance China verification. (3) the fifth health service investigation data. The enlarged province divided east three layer from the fifth health service investigation in 22 enlarged Province, three expansion per layer, a total of 9 a little, family survey data, mainly for the empirical study on the evaluation of health system performance China, validating the evaluation framework of indicators and benchmarking methods. This study combines the qualitative and quantitative research methods Study: (1) combined with the basic theory of health systems research methods of Descriptive Systematic Review and scientific metrology, combined with the health system classification theory and method, determine the main framework and typical national samples. (2) the system analysis method and comparative analysis method of combining, while using the ideal type of guiding ideology, system analysis and comparison of mainstream health system the framework and performance evaluation of typical countries. (3) the unified modeling language is used to perfect the construction process and method of performance evaluation of health system model of health system performance evaluation framework, and constructs the performance evaluation of the health system framework model. (4) statistical analysis methods, including benchmarking method and inequality index, carried out an empirical study of the performance of the health system China. In addition, the expert consultation method throughout the entire study.
[results] (1) the health system not only contains the definition of health system "hardware" of the structure, but also include health system "software" - structure and target contact. (2) the framework of performance evaluation for national health system according to the different purposes and functions can be divided into two categories, one is the health system performance evaluation the framework of international organizations led the development of different countries for the evaluation of health system performance and comparison, the WHO, the world bank, OECD, EU and federal funds for its typical representative: another kind is the country specific national conditions for the evaluation of health system performance of the national framework, the United Kingdom, Australia Holland, Canada, and the United States have their own characteristics, each representing the health systems of different types. (3) the national health system performance evaluation model, including stakeholder participation, The concept models and methods, analysis of national policy environment, evaluation framework, evaluation and implementation of management incentive mechanism and the application of the key process. The evaluation framework is the core of the evaluation model, constructing path can be subdivided to construct the framework of health system, health system boundaries, purpose and structure, and set up and index set screening step formation evaluation framework. (4) the framework model of health system performance evaluation should include the ultimate goal of general health system, factors affecting medical health, the four aspects of the health system and health system input output. And the two part of the health care system and special health system input and output. The corresponding health input the output and the factors affecting the health through the crowd affect the final result, the health care system and health system input and output as the representative can not only direct It affects the health of the population and can indirectly affect the performance of the final results of the health system through non medical health impact factors.
[Conclusion] (1) health system "hardware", "software" and "target" and health system performance, process and results of the corresponding three levels, therefore, a comprehensive evaluation of the performance of the health system should cover the health system frame structure, intermediate and final target. (2) choose a consensus unified modeling language and performance evaluation of health system construction path of bottom-up and top-down frame and index, unified modeling language into the framework of path, improve the theory and method of constructing the path and model of health system performance evaluation framework. (3) the general performance evaluation of health system framework model based on Lalonde model has the characteristics of comprehensive, flexible for our health system, performance evaluation. Among them, the health input and output is the evaluation of the core, the ultimate goal is the dimension of international comparisons. At the same time should be in the process of evaluation Two aspects of attention level and distribution, the combination of fairness and efficiency. (4) evaluation model and according to the international experience of health system, health performance evaluation subject in China should be established at the national level, construct the evaluation framework of performance of national health system, improve the evaluation index set and data collection system, the establishment of health system performance evaluation and incentive mechanism regularly publish health system performance evaluation report, the eventual establishment of the national health system performance evaluation system, decision support and planning and allocation of health system, improve health and strengthen the ultimate goal of the health system.
[] lack of innovation and Innovation: (1) the scientific measurement method and health system classification theory, from the quantitative point of view of scientific research output and taxonomy jointly determine the health system performance evaluation of typical national samples. (2) based on the international experience, constructs the construction path of health system performance evaluation key performance process model and evaluation of health system the framework, and the UML method are integrated into the health system to build a performance evaluation framework of path. (3) builds a framework of performance evaluation of the health system generalized, and the framework of performance China health plan and evaluate benchmarking empirical methods to verify its applicability in Chinese. Disadvantages: (1) the type of social insurance and the low countries the lack of national income for reference sample and experience. (2) evaluation system is lack of quantitative operational basis. (3) an empirical study by benchmarking methods on the part of the province Part of the indexes are compared and evaluated, and the interpretation and application of the comprehensive evaluation results should be cautious.

【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R197.1
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本文编号：1698865