基于系统动力学的卫生系统绩效非医疗影响因素研究

发布时间：2018-05-02 11:35

本文选题：卫生系统绩效 + 影响因素　；参考：《北京协和医学院》2015年硕士论文

【摘要】：研究目的：本研究旨在从系统思考的角度出发,梳理和总结现有的卫生系统绩效的非医疗影响因素,分析各因素对卫生系统绩效作用的系统动力学逻辑,发掘重要的决策干预点,为构建更加科学、合理的卫生系统绩效评估指标体系提供参考和建议。研究内容：1、梳理和总结现有研究中的非医疗健康影响因素；2、非医疗因素对卫生系统绩效影响的系统动力学逻辑；3、结合中国现状,从非医疗因素的角度对改善卫生系统绩效提出建议。研究方法：1、文献综述通过文献查阅,完成国际卫生系统绩效评估框架、卫生系统绩效影响因素研究进展和研究方法的文献综述；按照系统综述研究的原则和方法,根据预先制定的非医疗因素的分类框架,制定检索策略,总结归纳出影响卫生系统绩效的非医疗因素。2、系统动力学运用系统动力学的理论和方法,绘制非医疗因素和卫生系统绩效的因果关系图／流图,在界定的领域和范围内描述和分析影响因素与卫生系统绩效之间的逻辑关系,发现值得关注的重点因素和得到启示。结果：1、在社会因素中,受教育程度对居民健康水平和卫生服务利用的影响范围最广,受教育程度、就业机会和人口流动是重要的政策干预点；国籍／户籍制度通过影响教育、就业和社会保障制度的公平性对卫生系统公平性产生影响。2、经济因素中,本国经济发展主要通过对人均收入水平、社会公共资源和卫生技术发展三个变量的正反馈,提升卫生系统绩效；经济全球化对卫生系统绩效的影响有正向的也有负面的；产业结构的不同对卫生系统绩效也有一定的影响,健康服务业的整体发展对卫生系统绩效呈现正向作用,信息产业发展对卫生系统绩效的影响主要通过五条途径；居民收入水平对卫生系统绩效呈正向作用,收入分配不平等对卫生系统绩效呈负向作用。3、环境因素对卫生系统绩效的影响作用主要体现在健康水平的维度上,作用机制包括直接作用和通过心理因素中介的间接作用。结论：1、减少社会经济制度中的不公平是提高卫生系统绩效的迫切需要,其中较为突出的问题存在于户籍制度和收入差距两个方面,主要通过直接影响卫生服务利用对居民健康水平产生影响,以及通过对居民的心理健康因素的作用间接影响居民健康水平,从而影响卫生系统绩效。2、从系统思考的角度长远来看,经济发展缓慢和追求过快的经济增长对卫生系统绩效的改善都是不利的,稳定、持续、集约型经济发展是改善卫生系统绩效的重要推动力。我国目前的经济环境对卫生系统绩效的提高是较为有利的,需要把握经济转型的时机,促进健康与经济协调发展。3、在社会经济因素中,教育、就业和人口流动对卫生系统绩效的影响应当引起高度重视。重点解决教育投入在城乡、地域和性别上的不公平,破除户籍制度和社会保障制度对公平就业造成的壁垒,促进流动人口在社会保障制度方面充分享有市民待遇。4、非医疗因素对卫生系统绩效影响的现有研究中,主要涉及卫生系统绩效的健康水平和公平性两个维度,对反应性的影响机制研究相对匮乏；非医疗因素只有部分可以量化的指标,数据的可得、可用也相对较困难,需要进一步加强非医疗因素对卫生系统反应性影响机制的相关研究,并且从国家层面加强数据库的建设和提高统计工作的科学性。建议：1、减少社会经济宏观政策中的不公平,将非医疗因素纳入卫生系统绩效评估指标体系；2、针对性地改善就教育、就业和流动人口因素当中的不公平问题；3、抓住经济转型的有利时机,促进健康与经济协调发展；4、全社会动员和参与,重视居民的心理健康；5、推广健康影响评估工作,及早发现潜在环境危险因素；6、加强非医疗因素数据库建设和统计方法的开发,继续深入非医疗因素对卫生系统绩效的影响研究。
[Abstract]:The purpose of this study is to review and summarize the non medical impact factors of the existing health system performance from the perspective of systematic thinking, analyze the system dynamics logic of various factors on the performance of health system, explore the important decision intervention points, and provide a more scientific and reasonable performance evaluation index system for health systems. Reference and suggestions. Research contents: 1, combing and summarizing the non medical health influencing factors in the existing research; 2, the system dynamics logic of the effects of non medical factors on health system performance; 3, combining with the current situation of China, suggestions for improving health system performance from the perspective of non medical factors. Research methods: 1, literature review through literature review. Read, complete the international health system performance evaluation framework, research progress and research methods of health system performance factors; according to the principles and methods of systematic review and research, according to the pre established classification framework of non medical factors, formulate the retrieval strategy and summarize the non medical factors that affect the performance of health system,.2, The system dynamics uses the theory and method of system dynamics to draw the causality diagram / flow chart of non medical factors and health system performance, and describe and analyze the logical relationship between the influence factors and the health system performance in the domain and scope defined, and find the key factors and enlightenment. Results: 1, in the social factors. Education, employment opportunities and population mobility are important policy intervention points for the health level of residents and the use of health services. The nationality / domicile system affects the fairness of health system through the impact of education, employment and social security system on the fairness of health system.2, economic factors, national classics Economic development mainly through the positive feedback of three variables of per capita income level, social public resources and health technology development, improve the performance of health system; economic globalization has positive and negative effects on health system performance; the difference of industrial structure has certain influence on health system performance and health service industry as a whole Development has a positive effect on health system performance. The impact of information industry development on health system performance is mainly through five ways; residents' income level has a positive effect on health system performance, income distribution inequality has a negative effect on health system performance.3, and the influence of environmental factors on health system performance is mainly reflected in the effect of environmental factors on health system performance. On the dimension of health level, the mechanism of action includes direct action and indirect effect through psychological factors. Conclusion: 1, reducing the unfairness in the social and economic system is the urgent need to improve the performance of the health system, and the more prominent problems exist in the two aspects of the household registration system and the income gap, mainly through the direct impact of health. Service utilization has an impact on the health level of the residents, and indirectly affects the health level of the residents through the role of the mental health factors of the residents, thus affecting the health system performance.2. From the perspective of systematic thinking, the slow economic development and the rapid economic growth are both unfavorable and stable to the improvement of health system performance. Continuous, intensive economic development is an important driving force to improve the performance of health system. The current economic environment in China is more favorable to the improvement of health system performance. It is necessary to grasp the opportunity of economic transformation and promote the coordinated development of health and economy.3. In social and economic factors, education, employment and population flow to health system performance The impact should be paid much attention to. It should focus on the unfairness of education input in urban and rural, regional and gender, break down the barriers to the fair employment of the household registration system and social security system, and promote the full enjoyment of the citizen treatment in the social security system of the floating population in.4, and the existing research on the effect of non medical factors on the performance of health system, It is mainly involved in two dimensions of health level and fairness of health system performance. The research on the mechanism of reactivity is relatively scarce; non medical factors are only partly quantifiable, data availability and availability are relatively difficult. Further strengthening of the related research on the mechanism of reactive influence of non medical factors to health systems should be further strengthened. And strengthen the construction of the database and improve the scientificity of the statistical work from the national level. 1, to reduce the unfairness in the macro-economic policies, and to bring the non medical factors into the performance evaluation index system of the health system; 2, to improve the unfairness among the factors of education, employment and floating population, and 3, to seize the economic turn. A favorable opportunity to promote the coordinated development of health and economy; 4, the whole society mobilizes and participates, pays attention to the mental health of the residents; 5, promote the health impact assessment work, find the potential environmental risk factors as early as possible; 6, strengthen the development of the non medical factors database construction and statistical methods, and continue to deepen the non-medical factors to the health system performance. Influence research.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1

【参考文献】