农村医疗服务纵向整合利益相关者分析和演化博弈理论模型研究

发布时间：2018-01-16 23:14

本文关键词：农村医疗服务纵向整合利益相关者分析和演化博弈理论模型研究　出处：《南京医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：农村卫生医疗服务体系是卫生计生体系的重要组成部分,以县级医院为龙头、乡镇卫生院为骨干、村卫生室为网底的三级医疗服务网络,承担着为广大农村居民提供公共卫生和基本医疗服务的重要职责。目前,县乡村三级医疗机构是相对独立的利益主体,医疗机构各自为政,与其他机构的合作甚少,无法发挥协同效应和整体优势。通过农村医疗服务纵向整合,促进不同医疗机构间展开协作,使患者能够得到连续、便捷、质优的医疗服务。研究目的针对我国现阶段农村医疗服务纵向整合的难点和存在问题,本研究分析了整合主要利益相关者的立场、影响力、政策损益等特征,明确不同利益主体对整合因素重要性评价,构建农村医疗服务纵向整合演化博弈理论模型,寻找达到稳定均衡的条件,探索协调多元利益主体的利益诉求,调动不同利益主体参与整合的积极性和主动性,促进我国农村医疗服务纵向整合的可持续发展。研究方法采用文献分析和小组讨论方法界定农村医疗服务纵向整合的主要利益相关者。在利益相关者和演化博弈理论研究基础上,以定量数据和定性访谈作为实证支撑。以自行设计的调查问卷和利益相关者访谈提纲进行农村医疗服务纵向整合利益相关者分析,并通过构建农村医疗服务纵向整合演化博弈理论模型寻找稳定均衡条件素。调查共完成整合因素重要性评价问卷330份,利益相关者问卷202份,利益相关者访谈共完成119份。研究结果1.农村医疗服务纵向整合的主要利益相关者界定为卫生行政部门、县级医院、乡镇卫生院、村卫生室、医保部门和患者。在立场方面,县级医院处于依从态度,其余均是较为支持的态度。卫生行政部门在医疗资源合理配置、提升区域医疗水平存在诉求;医保部门的需求大多在医保资金的收支平衡、提高资金利用效率等方面;县级医院在整合中着力于提升医院声誉和市场份额;基层医疗机构则对提升医疗服务能力和增加经济效益有较大需求;农村患者关注的是医疗服务的质量和经济。整合因素重要性评价因子分析中,共提取了 4个公因子,分别为组织管理因子、激励机制因子、政策及配套措施因子、信息共享及业务交流因子。卫生行政部门、医保部门、县级医院、乡镇卫生院、村卫生室、患者对整合因素重要性评价的综合得分分别为0.025、0.030、0.032、0.015、-0.013和-0.037。2.农村医疗服务纵向整合演化博弈模型中,博弈双方均严格落实达成的稳定条件包括:(1)双方严格落实收益大于单方表面落实时的投机收益(w_1-v_1-d_10且w_2-v_2-d_20);(2)最终收敛于不同均衡的状态决定于演化中的各参数。博弈双方均严格落实的支出越小,收益越大,整个博弈会趋向于点B(1,1),即向双方严格落实整合方向演化。政策建议有针对性对整合提供有关支持政策,并推动政策落实。县级医院需要加强对农村基层医疗机构的合作力度,提升基层的医疗服务能力;加强县域医疗资源的整合,降低整合组织成本,提高整合的收益,为整合创造更有利的条件;创新医保支付方式改革,建立完善的激励约束机制,通过合理的引导,增加医疗机构及其医护人员的积极性;加强对整合的宣传力度,提升农村居民对基层医疗机构的信任度,逐步形成良好的就医秩序。
[Abstract]:Medical and health service system in rural areas is an important part of the health system, leading to the county hospital, township hospitals as the backbone, village health room three basic medical service network, bear the heavy responsibility to provide public health and basic medical service for rural residents. At present, three county level medical institutions the country is relatively independent of the interests of medical institutions, lack of coordination and cooperation with other organizations is very little, unable to play a synergistic effect and the overall advantages of rural medical service. Through vertical integration, promote the expansion of cooperation between different medical institutions, so that the patient can obtain continuous, convenient and high quality medical services. The purpose of the study aiming at the difficulty of rural medical service our country at the present stage of vertical integration and the existing problems, this study analyzed the integration of key stakeholders position, influence, policy loss characteristics, clearly different interests Evaluation on the integration of the importance of factors, construction of vertical integration of evolutionary game theory model of rural medical service, to seek stable equilibrium conditions, explore the interests coordination of multi stakeholders, mobilize the enthusiasm and initiative of different stakeholders involved in the integration, and promote the sustainable development of rural medical service in China. The main benefits of vertical integration of research methods to discuss the method defines the rural medical service vertical integration based on literature analysis and group stakeholders. In stakeholder and evolutionary game theory on the basis of the research, the quantitative data and qualitative interviews as empirical support. With the self-designed questionnaire and interview outline of stakeholders of rural medical service vertical integration of stakeholder analysis, and through the construction of rural medical service vertical integration of evolutionary game theory model to find the stable equilibrium condition. Investigation completed a total integration The importance of factors evaluation of 330 questionnaires, 202 questionnaires of stakeholders, stakeholder interviews completed a total of 119 copies. The results of the study the main interests of the 1. rural medical service vertical integration of stakeholders is defined as the administrative department of health, county hospitals, township hospitals, village clinics, health department and patients. In position, county hospital in compliance with attitude, the rest are more supportive attitude. The health administrative departments in the reasonable allocation of medical resources, enhance the level of existing regional medical insurance sector demand demand; mostly in the balance of medical insurance funds, improve the efficiency of utilization of funds; county hospitals in the integration efforts to enhance the hospital's reputation and market share; basic medical institutions to enhance the ability of medical services and increase the economic benefit of a greater demand; patients in rural areas is concerned with the quality of medical services and economic integration. To evaluate the importance of factors In factor analysis, a total of 4 common factors were extracted, respectively. The organization management factor, incentive factor, policy factor and supporting measures, information sharing and business communication factors. The health administrative departments, health departments, county hospitals, township hospitals, village health room, comprehensive evaluation of the integrated score of patients with the importance of factors respectively. 0.025,0.030,0.032,0.015 -0.013 and -0.037.2., the evolutionary game model of rural medical service vertical integration, the game both sides strictly implement stability conditions including: (1) the two sides agreed to strictly implement the implementation of the unilateral gain is greater than the surface of speculative gains (w_1-v_1-d_10 and w_2-v_2-d_20); (2) the parameters converge to different equilibrium depends on the evolution of the the two sides of the game. All the strict implementation of expenditure is small, the greater the benefits, the whole game will tend to point B (1,1), which is both to strictly implement the integration of policy direction evolution. To provide policy support for the integration, and promote the implementation of the policy. County hospitals need to strengthen rural grassroots medical institutions of cooperation, enhance the ability of grassroots medical services; strengthen the integration of the medical resources, reduce the organization cost, improve the integration benefits, and create more favorable conditions for the integration of innovation of the medical insurance payment; reform, establish a sound incentive and restraint mechanisms, through reasonable guidance, increase the enthusiasm of medical institutions and medical personnel; to strengthen the integration of propaganda, enhance the trust of rural residents' basic medical institutions, and gradually form a good order of the treatment.

【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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