BOT模式下“医养结合”养老机构项目寿命周期风险配置研究

发布时间：2018-02-28 10:35

本文关键词： 医养结合养老机构项目 BOT模式寿命周期风险风险配置　出处：《天津理工大学》2017年硕士论文　论文类型：学位论文

【摘要】：我国老龄人的养老问题已成为一个较为严重的社会问题。失能老人数量持续增加,对于我国常见的“4+2+1”家庭而言,传统的家庭养老已经不堪重负,社会化专业养老机构成为缓解养老负担问题的重要的途径,并在政策层面成为国家大力推行的养老手段。目前我国养老机构大多处于“有养无医”状态,在条件较好的养老机构中,医疗设施的配置也较为简陋,无法真正满足老人的养老医护需求。急需全面开展“医养结合”型养老机构(MPCPA)项目的建设。但我国财政投资项目往往运行效率低下,且仅依靠政府财政的力量无法承受MPCPA项目的巨额投资压力,这为社会资本参与到MPCPA项目的建设提供了良好的契机。BOT模式作为政府和社会资本合作(PPP)模式的一种,在我国MPCPA项目的建设中受到普遍关注。但是一些BOT项目现状表明,由于政府与社会资本在合约设计时风险配置不合理,导致了我国一些正在建设或运营的项目存在诸多问题。鉴于此,合理的风险配置成为MPCPA-BOT项目成功的关键。由于未发现相关研究,因此本文以MPCPA-BOT项目为分析单元,以政府和社会资本之间的风险配置为主题,开展我国MPCPA项目在BOT模式下的全寿命周期风险配置问题研究。首先,综合采用文献研究、相关案例研究和咨询访谈等多种方法,识别出我国MPCPA-BOT项目的寿命周期风险因素(LCRF)清单。通过对LCRF与MPCPA-BOT项目结果之间的关系的分析,构建了LCRF与MPCPA-BOT项目结果之间的关系模型,即:LCR模型。其次,采用问卷调查的方式进行LCR风险因素的检验,并结合二维综合评价法对LCRF清单中的风险因素从发生概率和影响程度两个维度进行重要度测定,以识别MPCPA-BOT项目的关键风险。最后,通过对风险分担相关理论的分析,构建了风险配置的影响因素模型(RAI),作为本研究风险配置方案的设计依据,由此设计并提出了MPCPA-BOT项目LCR风险配置方案,即:风险分配矩阵,并采用问卷调查法检验了关于风险分配矩阵的假设。研究发现,MPCPA-BOT项目全寿命周期中存在30余个风险因素,其中以医疗机构选取不当风险、工程质量风险等为关键风险因素。在风险分配矩阵中,政府信用风险、适老化设计风险等风险的配置设计获得了以专业人士为主体的调查人群高度认同。
[Abstract]:The problem of the aged has become a serious social problem in our country. The number of disabled old people has been increasing continuously. For the "421" families, the traditional family pension has been overwhelmed. The socialized professional pension institutions have become an important way to alleviate the burden of the aged, and have become the means of the government to promote the pension at the policy level. At present, most of the pension institutions in our country are in the state of "having no medical care". In better conditions for the aged, the allocation of medical facilities is also relatively simple. It is urgent to carry out the construction of MPCPA project. However, the financial investment projects in China are often inefficient. And it can not bear the huge investment pressure of the MPCPA project only relying on the government financial strength, which provides a good opportunity for the social capital to participate in the construction of the MPCPA project. Bot model is one kind of the cooperation between the government and the social capital. In China, the construction of MPCPA projects has received widespread attention. However, the current situation of some BOT projects shows that the allocation of risks between government and social capital in contract design is unreasonable. In view of this, reasonable risk allocation is the key to the success of MPCPA-BOT project. Since no related research has been found, this paper takes the MPCPA-BOT project as an analysis unit. Taking the risk allocation between government and social capital as the theme, this paper studies the whole life cycle risk allocation of MPCPA projects in China under the BOT model. Firstly, it synthesizes the methods of literature research, relevant case studies and consultation interviews, etc. The life cycle risk factors of MPCPA-BOT projects in China are identified. Through the analysis of the relationship between LCRF and the results of MPCPA-BOT projects, the relationship model between LCRF and the results of MPCPA-BOT projects is constructed, that is, the MPCPA-BOT model. The LCR risk factors are tested by questionnaire, and the importance of the risk factors in the LCRF list is measured from two dimensions of occurrence probability and influence degree combined with the two-dimensional comprehensive evaluation method to identify the key risks of the MPCPA-BOT project. Based on the analysis of the related theory of risk sharing, this paper constructs the risk allocation influencing factor model, which is the basis for the design of the risk allocation scheme of this study, and then designs and puts forward the LCR risk allocation scheme of the MPCPA-BOT project, that is, the risk allocation matrix. The hypothesis of risk distribution matrix was tested by questionnaire survey. It was found that there were more than 30 risk factors in the whole life cycle of MPCPA-BOT project, among which improper risk was selected by medical institutions. Project quality risk is the key risk factor. In the risk allocation matrix, the risk allocation design of government credit risk and suitable aging design risk has been highly recognized by the survey crowd with the professional as the main body.
【学位授予单位】：天津理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D669.6;R197.1

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