公立医院利益相关者对综合绩效的影响研究

发布时间：2018-03-05 17:37

本文选题：公立医院　切入点：利益相关者　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：公立医院改革是世界范围内医疗卫生领域的重要主题之一,也是一个世界级难题。目前,公立医院综合绩效整体水平仍不理想,公立医院与各方利益相关者关系恶化、社会满意度低,造成"看病难、看病贵"问题,严重阻碍了公立医院的可持续健康发展。解决这些问题的关键在于处理好公立医院与各方利益相关者之间的关系,本研究立足于此,首先,构建了公立医院利益相关者对综合绩效影响、公立医院综合绩效的指标体系;其次,通过SEM(结构方程模型)方法获得公立医院利益相关者对综合绩效产生影响的路径;最后,基于利益相关者角度与实证分析结果,提出有利于提高综合绩效的公立医院改革建议,为医疗卫生体制改革提供理论支撑与实践指导,对改善公立医院与利益相关者间关系、推进公立医院改革及解决"看病难、看病贵"问题具有重要意义。本文就上述问题展开研究,探讨公立医院利益相关者对综合绩效的影响。论文主要包括:(1)文献综述,系统地整理了利益相关者理论、公立医院利益相关者、综合绩效、公立医院利益相关者对综合绩效影响的相关研究;(2)公立医院利益相关者对综合绩效的整体影响,运用了契约理论、信号传递理论、产权理论这三种理论,并进一步具体分析每一位利益相关者对综合绩效的影响;(3)构建公立医院利益相关者对综合绩效影响的模型与假设;(4)以南京、沈阳、石家庄及周边城市多家公立医院及卫生计生委、高校、医疗保险机构、药厂等内的专业人员,还有公立医院就医的患者及家属等为调查对象进行问卷调查,获取有效问卷312份;(5)借助统计软件SPSS19.0与Lisrel8.70对数据进行信度和效度分析,结构方程模型分析。本研究通过以上理论与实证研究证明了公立医院利益相关者中政府、医院管理者、医护人员及医疗保险机构对综合绩效有着较为显著的影响。据此与调查问卷过程中的访谈,提出提升公立医院综合绩效的建议,即政府角度:加大政府投入,加快政府职能转变,加强政府监督,健全法律法规;公立医院自身角度:建立公立医院法人治理结构,建立科学的薪酬制度,提高医院管理者与医护人员的专业与个人素质,加强公立医院文化建设;医疗保险机构角度:改革医疗保险付费方式,调整医疗保险支付比例,及时调整、更新医保目录;其余各利益相关者角度:加强各方监督,鼓励医院良性竞争。
[Abstract]:The reform of public hospitals is one of the most important topics in the field of medical and health care all over the world, and it is also a world-class problem. At present, the overall level of comprehensive performance of public hospitals is still not ideal, and the relationship between public hospitals and stakeholders is deteriorating. The low degree of social satisfaction causes the problem of "difficult and expensive to see a doctor", which seriously hinders the sustainable and healthy development of the public hospital. The key to solve these problems is to deal with the relationship between the public hospital and the stakeholders. This research is based on this. Firstly, it constructs the index system of the public hospital stakeholders' influence on the comprehensive performance, and the public hospital comprehensive performance. Through the SEM (structural equation Model) method to obtain the impact of public hospital stakeholders on the comprehensive performance path. Finally, based on the stakeholder perspective and empirical analysis results, the paper puts forward the public hospital reform recommendations which are conducive to improve the comprehensive performance. To provide theoretical support and practical guidance for the reform of the medical and health system, to improve the relationship between public hospitals and stakeholders, to promote the reform of public hospitals and to solve the problem of "difficult to see a doctor". The problem of "expensive to see a doctor" is of great significance. This paper studies the above issues and discusses the impact of stakeholders on comprehensive performance in public hospitals. A study on the overall impact of Public Hospital stakeholders on Comprehensive performance using contract Theory and signaling Theory. The three theories of property right theory, and further analyze the impact of each stakeholder on comprehensive performance. (3) to construct the model and hypothesis of the impact of stakeholders on comprehensive performance in public hospitals. Many public hospitals and health and family planning committees, universities, medical insurance institutions, pharmaceutical factories and other professionals in Shijiazhuang and surrounding cities, as well as patients and family members of public hospitals, were investigated by questionnaires. The reliability and validity of the data were analyzed by statistical software SPSS19.0 and Lisrel8.70, and the structural equation model was analyzed. Through the above theoretical and empirical studies, it was proved that the government and hospital managers were the stakeholders of public hospitals. Health care personnel and medical insurance institutions have a significant impact on the comprehensive performance. Based on the interviews with the questionnaire, the author puts forward some suggestions to improve the comprehensive performance of public hospitals, that is, from the government perspective: increase government investment, Speeding up the transformation of government functions, strengthening government supervision, perfecting laws and regulations, from the point of view of public hospitals: to establish the structure of corporate governance in public hospitals, to establish a scientific salary system, to improve the professional and personal qualities of hospital administrators and medical personnel, Strengthen the cultural construction of public hospitals; the perspective of medical insurance institutions: reform medical insurance payment methods, adjust the proportion of medical insurance payments, adjust timely, update the catalogue of medical insurance; other stakeholders' perspective: strengthen the supervision of all parties, Encourage healthy competition in hospitals.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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