区域卫生信息化建设中利益博弈与合作机制的研究

发布时间：2018-01-10 00:25

  本文关键词：区域卫生信息化建设中利益博弈与合作机制的研究　出处：《山西医科大学》2017年博士论文　论文类型：学位论文

  更多相关文章： 区域卫生规划 区域卫生信息化 利益博弈 信息技术 博弈论

【摘要】：目的:整合区域卫生信息化研究领域的研究热点,比较不同国家的研究特色,分析其相关因素;以政策为切入点提取区域卫生信息化建设中的主要利益相关集团,分析其中的利益关系、存在的囚徒困境以及利益博弈过程,完善合作机制,为该领域的学者、管理者、政策制定者开展研究、制定政策提供信息。方法:运用关键词词频分析、关键词共现分析、主成分分析、多维尺度分析法、可视化技术分析区域卫生信息化领域的研究热点。运用内容分析法和社会网络分析法提取国内2009—2013年区域卫生信息化政策中的主要利益相关集团。运用案例分析、专题讨论、定性访谈及主要利益相关集团分析法分析各利益集团之间的合作现状及存在的问题。运用博弈论分析各利益集团之间的利益博弈过程。结果:(1)区域卫生信息化研究的关键词数量逐年上升,研究领域广泛。1994—2014年,区域卫生信息化研究热点由医院规划转向社区卫生规划,与信息技术相关的关键词数量增多,与组织管理相关的研究明显增多。部分关键词浓缩成知识群。6国的研究除了与主流研究趋势相似以外,相互之间在研究水平和新兴热点之间存在差异。(2)远程医疗文献中的Me SH数量随着时间呈上升趋势。1962—2015年间远程医疗文献中最常见学科分支为:Remote Consultation、Teleradiology和Telepathology,最常见的信息媒介为Internet和Cell phones。近年来,与Patient Satisfaction,Treatment Outcomes和Home Care Services相关的远程医疗文献数量明显增多,近6年中包含Cell Phones和Self-Care的文献急剧增多。不同国家的文献热点不同。(3)国内研究大约于1984年起步,共形成了9大主流知识群,其中,基础信息化研究和医疗信息化研究占据最大份额。研究方法偏重于定性的描述性研究。国内科研合作群体规模小,71.74%(165/230)的2-plexes的规模为3,E-I Index=-0.901,表明该研究领域派系林立程度小,研究关系趋向于发生在群体之内。主要科研力量集中在军队医院。全国各省市之间建立了科研合作网络,北京、广东、江苏、湖北为研究的核心地区。(4)政策分析提取了主要利益集团,构建了部门关系图,其中,政府、医院、基层医疗卫生机构、医保部门、居民是目前区域卫生信息化建设中的核心部门和人群。纵向的行政隶属关系和横向的部门关系构成了复杂的部门合作网络。各利益集团之间需要进行的投入、可动用的资源不同、立场不同,但相互之间又存在利益契合点。(5)利益博弈贯穿在系统整合的整个过程,合作机制是建设和完善的重点。在所有参与人中,政府是投资主体、监督者,同时也是主要参与人。居民健康档案中死档、假档案、不规范档案问题突出。现有的建设机制和政府监督机制难以解决这些问题。(6)各部门在利益博弈过程中会因为信息不对称,或者参与人不够理性、监督机制不完善、政府官员腐败而陷入利益博弈的囚徒困境:横向政府部门之间的替代性,纵向政府之间的单边囚徒困境、医疗机构联网涉及的公共产品提供的囚徒困境,居民健康档案督导中的不合理博弈等影响区域卫生信息化建设的进程。通过政府界定部门职能,完善奖罚机制,增加博弈的次数,完善市场机制等可以解决当前区域卫生信息化建设中存在的囚徒困境,达成部门合作。增加基层医疗机构与居民之间的互动可以解决当前居民健康档案造假、死档、不规范等问题。结论:区域卫生信息化研究内容一直在不断拓展,研究热点不断演变。不同国家研究热点不同,与各国卫生政策、卫生体制、地理环境等因素有关。其中,政策是不可忽视的重要因素。以政策为切入点提取到了我国区域卫生信息化建设的主要利益相关集团,这些利益相关集团之间纵横交错,利益关系复杂,利益博弈贯彻其中。政府作为投资者、监督者和重要的参与人,在区域卫生信息化政策制定过程中以利益博弈的视角分析不同阶段各利益集团之间的利益关系,完善合作机制,可以引导各部门走出利益博弈的囚徒困境。博弈论是研究区域卫生信息化建设中利益博弈和合作机制的理想方法。本研究客观、系统的分析为该领域的学者、管理者、政策制定者提供了有用的信息,为区域卫生信息化的研究和建设提供了方向。
[Abstract]:Objective: to research the regional health information integration research field, research characteristics comparison of different countries, to analyze the related factors; policy as the breakthrough point from the main interests of the construction of regional health information in related groups, analysis of the relations of interests, the prisoner's Dilemma and the interests of the game process, improve the cooperation mechanism for the field the researchers, managers, policy makers to carry out research, provide information policy. Methods: using keywords frequency analysis, keywords co-occurrence analysis, principal component analysis, multidimensional scaling analysis, analysis of research focus in the field of regional health information visualization technology. With the method of content analysis and social network analysis method to extract the domestic region from 2009 to 2013 health information policy in major stakeholder groups. Topics using case analysis, qualitative analysis, interviews and major stakeholder group method Analysis of present situation of cooperation between various interest groups and problems. The analysis on the interests of the game between different interest groups with the game. Results: (1) the number of keywords in the research of health information area increased year by year, the research of.1994 - 2014, research focus of regional health information from hospital to community health planning and planning, the number of key words related to information technology increased, research and management increased significantly. Some of the words condensed into the study of knowledge in group.6 in addition to similar to mainstream research trend, each other between the research and emerging hot spots are different. (2) the number of Me SH in remote medical literature increased with time.1962 2015 remote medical literature in the most common branch: Remote Consultation, Teleradiology and Telepathology, the information media is the most common Intern ET and Cell phones. in recent years, with Patient Satisfaction, Treatment Outcomes and Home Care Services remote medical literature significantly increased the number of Phones and Cell, including the literature of Self-Care increased sharply in the past 6 years. The focus of different countries. (3) the domestic research about starting in 1984, has formed 9 major among them, the basic information of knowledge base, research and medical information research accounted for the largest share. Descriptive research methods focus on qualitative. The cooperative group of domestic research in small scale, the scale of 71.74% (165/230) 2-plexes 3, E-I Index=-0.901, showed that the research area with small faction degree, relationship tends to occur in groups. Major scientific research is concentrated in the military hospital. The scientific collaboration network is established between the various provinces and cities nationwide, Beijing, Guangdong, Jiangsu, Hubei as the core area of research. (4) policy On the extraction of the main interest groups, the Department of construction diagram, among them, government, hospitals, primary health care institutions, health departments, residents is the core Department of regional health informatization construction in the administrative relationship and the crowd. Horizontal and vertical departments constitute a complex network of cooperation to the investment department. Among the various interest groups, different resources, different positions, but there are also interests between each other. (5) the interests of the game throughout the entire process of system integration, the cooperation mechanism is the key point of construction and improvement. In all participants, the government is the main body of investment, is also a major participant in the supervisor. The health of the residents. Files in the dead file, false documents, non-standard file problems. The existing building mechanism and government supervision mechanism to solve these problems. (6) departments in the interests of the game in the process because of the letter Asymmetric information, or in person is not reasonable, supervision mechanism imperfect, government officials of corruption and fall into the prisoner's dilemma game interests: alternative laterally between government departments, between the government of the prisoner's dilemma of unilateral vertical, the prisoner's dilemma of medical institutions involved in Internet of the provision of public goods, the process of the construction of regional health information health records in supervision the game is not reasonable. Through the definition of government functions, improve the reward and punishment mechanism, increase the number of games, perfecting market mechanism can solve the prisoner's dilemma existing in the regional health informatization construction, to achieve departmental cooperation. Increasing the interaction between grassroots medical institutions and residents can solve the residents health records fraud, dead file, problem is not standardized. Conclusion: regional health informatization research content has been expanding, research evolve. Different countries. The focus of different countries and health policy, health system, the geographical environment and other factors. The policy is an important factor that can not be ignored. With the policy as the starting point to extract the main interests of the regional health information construction of our country related groups, among these stakeholder groups arranged in a crisscross pattern, the complex relations of interests, the interests of the game to carry out the government. As investors, supervisors and an important participant in the formulation of regional health information policy in the perspective of interest game analysis between different stages of various interest groups, improve the cooperation mechanism, the prisoner's dilemma can guide the departments out of the interests of the game. The game theory is an ideal method for the construction of regional health information research interests game and cooperation mechanism. The research objective, systematic analysis for the scholars, managers, policy makers provide useful information, It provides the direction for the research and construction of regional health information.

【学位授予单位】：山西医科大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R197.1
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本文编号：1403141