基于“卫生费用核算体系2011”的政策分析框架研究
发布时间：2018-09-11 08:32
【摘要】：研究背景与目的我国正处于医疗卫生体制改革深水期,在卫生系统的调整和升级过程中迫切需要可靠、稳定的数据支持,反映卫生系统前期改革效果的现状、调整与把握医药卫生体制改革方向。而卫生总费用作为宏观核算体系,可以全面系统地反映卫生服务经济运行过程,揭示卫生领域经济活动规律,为制定政策、监测和评价政策执行情况提供信息。如今,卫生总费用核算已逐步被列为计财部门的经常性工作,其分析研究正朝着"发挥更有效的政策咨询作用"方向前进。SHA2011(System of Health Accounts 2011)是最先进的卫生总费用核算体系,可以进行任意维度的交叉平衡核算与分析,全方位反映卫生资金流动过程。伴随SHA2011在我国"亚国家级(省/市)"的核算推广,SHA2011即将产出的大量卫生费用数据可以有力地支持核算地的政策应用研究。然而,现阶段基于卫生费用政策应用研究仍存在以下问题:1、卫生费用的分析研究多伴随核算研究而展开,往往局限于对数据结果的描述性分析,缺乏评价性分析;2、后置于数据结果的卫生费用分析研究往往缺乏主动的政策应用研究设计,容易忽略重要的卫生政策关注点;3、我国尚未出台"SHA2011卫生费用的分析指南","亚国家级"在运用SHA2011数据进行卫生政策的应用转化中存在困难。鉴于此情景,为了更好地应用SHA2011为政策研究服务,本研究拟建立基于政策需求的SHA2011政策分析框架,开发SHA2011指标并拓展其政策应用意义,理清SHA2011指标研究空白点与下一步研究方向,指导SHA2011卫生费用发挥更有效的政策咨询作用。研究方法与结果本研究依托于北京市2014年卫生总费用研究课题,运用文献研究法和归纳演绎等逻辑思维方法,借鉴政策研究指标体系的构建方法,主要研究结果如下:1、构建了 SHA2011政策分析概念框架本文首先从卫生政策评估分析的基本理论与方法入手,借鉴"卫生系统宏观模型"的研究思路,结合"系统论"和"结构-过程-结果"理论,确定基于SHA2011的"卫生筹资系统"的研究范围,和基于"结构-过程-结果"的SHA2011政策分析框架模型基础;通过研究"结构-过程-结果"理论三个维度的内涵与演变,合理调整适用于SHA2011的"结构-过程"框架要素和"结果"的"评价准则",创造性地构建了 SHA2011政策分析概念框架模型。其次,本研究借鉴指标属性分组法"范围法"与"问题法"的思路,分别从卫生筹资系统"全局"和"局部(具体)"卫生政策的视角对以上框架模型进行拓展,构建了基于卫生筹资系统和基于卫生政策子系统的SHA2011政策分析概念框架。2、构建了 SHA2011政策分析框架指标体系本研究借鉴指标体系的构建方法,主要研究过程分两步:第一步,运用"文献研究法、综合法、交叉法"开发SHA2011指标群。通过对"指标别"和传统卫生总费用常见指标的系统总结,归纳卫生总费用"指标别"的共性特点,以此为依据拓展开发SHA2011指标(群),推演探索其政策应用意义。该步骤是对SHA2011指标(群)的系统开发与总结。第二步,构建SHA2011政策分析框架指标体系。首先运用"范围法",根据SHA2011的主要研究内容(筹资功能)将SHA2011指标群与本研究的"概念框架"对接,从卫生筹资系统"全局"的视角构建了 SHA2011的政策分析框架指标体系。该框架将SHA2011卫生费用变化视为各类卫生政策交互作用的共同结果,是通过SHA2011指标体系评价"整体"卫生政策(群)的实施效果。该框架构建了对"整体"卫生筹资政策的SHA2011分析评价方法。其次,运用"指标属性分组法-问题法和目标法",依据划分的六个政策问题子系统提炼"政策目标",再以"政策目标"分别匹配本研究概念框架的"结果"和"结构、过程"(SHA2011)指标,构建基于政策问题子系统的SHA2011政策分析框架指标体系。该框架将"政策目标"对接具体的SHA2011指标,更有针对性地解读SHA2011指标的政策应用意义。一方面,构建(验证)本研究中部分SHA2011指标群的政策应用情景;另一方面,根据政策目标需求进一步补充SHA2011指标群,拓展政策应用意义。该框架构建了对"局部(具体)"卫生筹资政策的SHA2011分析评价方法。3、研究SHA2011指标体系现状首先,汇总本研究中所涉及的全部SHA2011指标群,展示其在SHA2011政策分析概念框架中的应用,总结我国SHA2011文献研究中"尚未应用分析"的指标(群);其次,对北京市SHA2011已有核算数据支持系统的情况进行指标群的现况总结:一方面,总结已有核算数据支持的SHA2011指标(群),列明其数据表来源;另一方面,对尚无核算数据支持的指标群,列明其尚需补充的数据。研究结论与意义1、本研究创造性地构建了 SHA2011政策分析概念框架,为SHA2011的评价研究提供新思路:1)本研究以卫生筹资理论和福利经济学理论为基础,首先论证了卫生筹资目标在筹资功能中的体现,其次论证了 SHA2011与卫生筹资的紧密联系,得出以下结论:"SHA2011与卫生筹资系统展现了相似的卫生资金流动过程,SHA2011可以体现卫生筹资的全部功能与目标;卫生筹资目标(充足、可持续、公平、效率)可作为SHA2011卫生费用的评价准则"。2)本研究创造性地调整、构建了适用于SHA2011的"结构-过程-结果"分析框架。首先,通过对框架要素的调整(将传统"结构"概念中的"投入要素"部分归入"过程"中),形成适用于SHA2011的"狭义结构"指标和"广义过程"指标,分别以SHA2011资本形成费用和经常性卫生费用代表。其次,通过对"结果"指标的讨论,选定以卫生筹资目标作为"系统结果"指标,完成SHA2011政策分析概念框架的构建。3)本研究探讨了 SHA2011框架中"结构-过程-结果"的辩证关系。提出以下观点:SHA2011 "结构"与"过程"不仅可以单独反映"结果",二者还相辅相成,且在同向变化时更易取得最优"结果"。具体如下:改变"结构"的目的是引起"过程"的改变;"过程"的改变又可以反向促进"结构"的改变;"结构"与"过程"同向改变时更易取得最优"结果"。SHA2011政策分析概念框架的提出,不仅为SHA2011的分析与政策应用研究提供了"评价准则"和分析思路,还提出在分析研究中应将SHA2011相互独立的资本形成费用与经常性卫生费用联合分析,在政策应用研究中关注二者联系、以"联合"分析取代"割裂"分析的观点,为SHA2011的评价与分析研究提供新思路。2、本研究拓展开发了 SHA2011指标(群),推演探索了其政策应用意义,为SHA2011数据的政策应用转化提供参考。1)按"指标别"归纳传统卫生总费用指标的共性和特点,拓展、开发SHA2011指标(群)及其政策应用意义。一方面,研究SHA2011尚未开展核算的扩展维度分类口径,构建SHA2011指标(群)及其可能的政策应用情景;另一方面,掌握SHA2011现有数据及核算过程,拓展分析角度,创新SHA2011指标及其应用意义。2)根据"政策问题子系统"中总结的"政策目标",以及"政策目标"与具体SHA2011指标的对接,构建SHA2011指标群的政策应用情景,验证指标的政策应用意义,并根据政策需求进一步扩充SHA2011指标。3、本研究基于政策需求系统构建了 SHA2011政策分析框架的指标体系,为政策评估分析服务。1)从卫生筹资系统"全局"的视角构建了涵盖SHA2011主要研究内容的政策分析框架指标体系。该框架构建了 SHA2011对"整体"卫生筹资系统政策的分析评价方法。2)从"局部"视角构建了基于"政策问题子系统"的SHA2011政策分析框架指标体系。该框架构建了 SHA2011对"局部(具体)"卫生筹资政策的分析评价方法。4、本研究系统总结了 SHA2011指标体系的研究现状,理清SHA2011现阶段研究的空白点,指出目前已分析应用的指标和尚未分析应用的指标,为北京市下一步的研究方向提供参考。其中,"尚未分析应用的指标"又包括"尚无"核算数据支持的指标和"已有"核算数据支持的指标。一方面,对尚无核算方法和数据支持的指标群,本研究探索其政策应用意义,为SHA2011下一步的核算与分析研究提供方向性指导;另一方面,对已有核算数据系统支持的指标群,本研究根据可得数据拓展了分析角度,开发其政策应用意义,为SHA2011的深度分析研究提供参考。
[Abstract]:Background and Objectives China is in the deep-water period of medical and health system reform. Reliable and stable data support is urgently needed in the process of adjustment and upgrading of the health system, reflecting the status quo of pre-reform effect of the health system, and adjusting and grasping the direction of medical and health system reform. It reflects the economic operation process of health services systematically, reveals the law of economic activities in the health field, and provides information for formulating policies, monitoring and evaluating the implementation of policies. SHA2011 (System of Health Accounts 2011) is the most advanced system of total health expenditure accounting, which can carry out cross-balanced accounting and analysis of any dimension and reflect the process of health fund flow in an all-round way. However, there are still some problems in the application of health expenditure policy: 1. The analysis of health expenditure is usually carried out with accounting research, which is limited to the descriptive analysis of data results and lacks of evaluation analysis; 2. The analysis of health expenditure based on data results is placed in the past. In the past, there was a lack of active policy application design, which tended to overlook important health policy concerns. 3. China has not yet published the "SHA2011 health expenditure analysis guide" and "sub-national" in the use of SHA2011 data in the application of health policy transformation difficulties. The purpose of this study is to establish a policy analysis framework for SHA2011 based on policy needs, develop SHA2011 indicators and expand its policy application significance, clarify the research gaps and future research directions of SHA2011 indicators, and guide SHA2011 health expenditure to play a more effective policy advisory role. The main research results are as follows: 1. The conceptual framework of SHA2011 policy analysis is constructed. Firstly, the basic theories and methods of health policy evaluation and analysis are introduced, and the research of "macro model of health system" is used for reference. Based on the theory of "system theory" and "structure-process-result", the research scope of "health financing system" based on SHA 2011 and the model foundation of SHA 2011 policy analysis framework based on "structure-process-result" are determined. The conceptual framework model of SHA2011 policy analysis is constructed creatively by the evaluation criteria of process "framework elements" and "outcome". Secondly, this study extends and constructs the above framework model from the perspective of "overall" and "partial (specific) health policy" of health financing system, drawing on the ideas of "scope" and "problem" of index attribute grouping method. The conceptual framework of SHA2011 policy analysis based on health financing system and health policy subsystem was established. 2. The index system of SHA2011 policy analysis framework was constructed. The main research process was divided into two steps. The first step was to develop SHA2011 index group by using "literature research method, comprehensive method and cross method". This paper summarizes the common characteristics of the "indicators" and the "indicators" of the traditional total health expenditure, expands the development of SHA2011 indicators (groups) and explores the significance of its policy application. Firstly, according to the main research content (financing function) of SHA2011, the index group of SHA2011 was docked with the conceptual framework of this study, and the index system of SHA2011 policy analysis was constructed from the perspective of "overall situation" of health financing system. The common result is to evaluate the implementation effect of the "holistic" health policy (group) through the SHA2011 index system. The framework constructs the SHA2011 analysis and evaluation method for the "holistic" health financing policy. Secondly, the "policy objectives" are refined according to the six policy subsystems by using the "index attribute grouping method - problem method and goal method". The target "matches the result" and "process" of the conceptual framework of this study respectively, and constructs the SHA2011 policy analysis framework index system based on the subsystem of policy issues. On the other hand, according to the needs of policy objectives, the SHA2011 index group is further supplemented to expand the significance of policy application. The framework constructs the SHA2011 analysis and evaluation method for "partial (specific)" health financing policy. 3. To study the status quo of SHA2011 index system. First, summarize the research involved in this study. And all the SHA2011 index groups, show its application in the conceptual framework of SHA2011 policy analysis, summarize the indicators of "not yet applied analysis" in the literature research of SHA2011 in China; secondly, summarize the status quo of the existing accounting data support system in Beijing SHA2011: on the one hand, summarize the existing accounting data support SHA201. 1. Indicator (group) lists the sources of the data tables. On the other hand, it lists the data that need to be supplemented for those indicators which have not yet been supported by accounting data. On the basis of the theory, this paper firstly demonstrates the embodiment of health financing objectives in the financing function, secondly demonstrates the close relationship between SHA2011 and health financing, and draws the following conclusions: "SHA2011 and health financing system show a similar process of health financing flow, SHA2011 can reflect the full function and objectives of health financing; Sufficiency, sustainability, equity, and efficiency can be used as the criteria for assessing health costs in SHA2011.2) This study creatively adjusted and constructed a "structure-process-result" analytical framework for SHA2011. First, through adjusting the framework elements (by "partially incorporating" the input elements of the traditional "concept" into the "process" of SHA2011), a suitable framework for SHA2011 was formed. The narrow structure index and the broad process index are represented by the capital formation cost and the recurrent health cost of SHA2011 respectively. Secondly, through the discussion of the "results" index, the health financing target is selected as the "system results" index to complete the construction of the conceptual framework of SHA2011 policy analysis. The dialectical relationship between process and result is proposed as follows: the structure of SHA2011 and process can not only reflect the result individually, but also complement each other, and it is easier to obtain the optimal result when changing in the same direction. The conceptual framework of SHA2011 policy analysis not only provides the evaluation criteria and analysis ideas for the analysis and policy application of SHA2011, but also suggests that the independent capital formation costs and recurrent health costs of SHA2011 should be analyzed jointly in the analysis and research. In the study of policy application, we pay attention to the relationship between the two, and replace the "split" analysis with "joint" analysis, which provides a new idea for the evaluation and analysis of SHA2011. 2. This study expands and develops the SHA2011 index (group), deduces and explores its policy application significance, and provides a reference for the policy application transformation of SHA2011 data. On the one hand, it studies the expanded dimension classification caliber of SHA2011, constructs the SHA2011 index (group) and its possible policy application scenarios; on the other hand, it grasps the existing data and accounting process of SHA2011, expands the analysis angle, and creates a new policy application scenario. The new SHA2011 index and its application significance. The index system of SHA2011 policy analysis framework is constructed systematically to serve for policy evaluation and analysis. 1) The index system of policy analysis framework covering the main research contents of SHA2011 is constructed from the perspective of "overall situation" of health financing system. The index system of SHA2011 policy analysis framework based on "subsystem of policy issues" is constructed. The index system of SHA2011 policy analysis framework is constructed. The evaluation method of SHA2011 on "partial (specific)" health financing policy is constructed. 4. This study systematically summarizes the research status of SHA2011 index system, clarifies the blank points of SHA2011 research at this stage, and points out that the analysis should be done at present. The indicators used and those not yet analyzed and applied provide references for the future research direction of Beijing. Among them, the indicators that have not yet been analyzed and applied include those that have not yet been supported by the accounting data and those that have been supported by the accounting data. Meaning can provide directional guidance for the next step of accounting and analysis in SHA2011. On the other hand, this study expands the analysis angle and develops its policy application significance based on the available data for the index group supported by the existing accounting data system, which provides a reference for the further analysis of SHA2011.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R197.1
，
本文编号：2236162
[Abstract]:Background and Objectives China is in the deep-water period of medical and health system reform. Reliable and stable data support is urgently needed in the process of adjustment and upgrading of the health system, reflecting the status quo of pre-reform effect of the health system, and adjusting and grasping the direction of medical and health system reform. It reflects the economic operation process of health services systematically, reveals the law of economic activities in the health field, and provides information for formulating policies, monitoring and evaluating the implementation of policies. SHA2011 (System of Health Accounts 2011) is the most advanced system of total health expenditure accounting, which can carry out cross-balanced accounting and analysis of any dimension and reflect the process of health fund flow in an all-round way. However, there are still some problems in the application of health expenditure policy: 1. The analysis of health expenditure is usually carried out with accounting research, which is limited to the descriptive analysis of data results and lacks of evaluation analysis; 2. The analysis of health expenditure based on data results is placed in the past. In the past, there was a lack of active policy application design, which tended to overlook important health policy concerns. 3. China has not yet published the "SHA2011 health expenditure analysis guide" and "sub-national" in the use of SHA2011 data in the application of health policy transformation difficulties. The purpose of this study is to establish a policy analysis framework for SHA2011 based on policy needs, develop SHA2011 indicators and expand its policy application significance, clarify the research gaps and future research directions of SHA2011 indicators, and guide SHA2011 health expenditure to play a more effective policy advisory role. The main research results are as follows: 1. The conceptual framework of SHA2011 policy analysis is constructed. Firstly, the basic theories and methods of health policy evaluation and analysis are introduced, and the research of "macro model of health system" is used for reference. Based on the theory of "system theory" and "structure-process-result", the research scope of "health financing system" based on SHA 2011 and the model foundation of SHA 2011 policy analysis framework based on "structure-process-result" are determined. The conceptual framework model of SHA2011 policy analysis is constructed creatively by the evaluation criteria of process "framework elements" and "outcome". Secondly, this study extends and constructs the above framework model from the perspective of "overall" and "partial (specific) health policy" of health financing system, drawing on the ideas of "scope" and "problem" of index attribute grouping method. The conceptual framework of SHA2011 policy analysis based on health financing system and health policy subsystem was established. 2. The index system of SHA2011 policy analysis framework was constructed. The main research process was divided into two steps. The first step was to develop SHA2011 index group by using "literature research method, comprehensive method and cross method". This paper summarizes the common characteristics of the "indicators" and the "indicators" of the traditional total health expenditure, expands the development of SHA2011 indicators (groups) and explores the significance of its policy application. Firstly, according to the main research content (financing function) of SHA2011, the index group of SHA2011 was docked with the conceptual framework of this study, and the index system of SHA2011 policy analysis was constructed from the perspective of "overall situation" of health financing system. The common result is to evaluate the implementation effect of the "holistic" health policy (group) through the SHA2011 index system. The framework constructs the SHA2011 analysis and evaluation method for the "holistic" health financing policy. Secondly, the "policy objectives" are refined according to the six policy subsystems by using the "index attribute grouping method - problem method and goal method". The target "matches the result" and "process" of the conceptual framework of this study respectively, and constructs the SHA2011 policy analysis framework index system based on the subsystem of policy issues. On the other hand, according to the needs of policy objectives, the SHA2011 index group is further supplemented to expand the significance of policy application. The framework constructs the SHA2011 analysis and evaluation method for "partial (specific)" health financing policy. 3. To study the status quo of SHA2011 index system. First, summarize the research involved in this study. And all the SHA2011 index groups, show its application in the conceptual framework of SHA2011 policy analysis, summarize the indicators of "not yet applied analysis" in the literature research of SHA2011 in China; secondly, summarize the status quo of the existing accounting data support system in Beijing SHA2011: on the one hand, summarize the existing accounting data support SHA201. 1. Indicator (group) lists the sources of the data tables. On the other hand, it lists the data that need to be supplemented for those indicators which have not yet been supported by accounting data. On the basis of the theory, this paper firstly demonstrates the embodiment of health financing objectives in the financing function, secondly demonstrates the close relationship between SHA2011 and health financing, and draws the following conclusions: "SHA2011 and health financing system show a similar process of health financing flow, SHA2011 can reflect the full function and objectives of health financing; Sufficiency, sustainability, equity, and efficiency can be used as the criteria for assessing health costs in SHA2011.2) This study creatively adjusted and constructed a "structure-process-result" analytical framework for SHA2011. First, through adjusting the framework elements (by "partially incorporating" the input elements of the traditional "concept" into the "process" of SHA2011), a suitable framework for SHA2011 was formed. The narrow structure index and the broad process index are represented by the capital formation cost and the recurrent health cost of SHA2011 respectively. Secondly, through the discussion of the "results" index, the health financing target is selected as the "system results" index to complete the construction of the conceptual framework of SHA2011 policy analysis. The dialectical relationship between process and result is proposed as follows: the structure of SHA2011 and process can not only reflect the result individually, but also complement each other, and it is easier to obtain the optimal result when changing in the same direction. The conceptual framework of SHA2011 policy analysis not only provides the evaluation criteria and analysis ideas for the analysis and policy application of SHA2011, but also suggests that the independent capital formation costs and recurrent health costs of SHA2011 should be analyzed jointly in the analysis and research. In the study of policy application, we pay attention to the relationship between the two, and replace the "split" analysis with "joint" analysis, which provides a new idea for the evaluation and analysis of SHA2011. 2. This study expands and develops the SHA2011 index (group), deduces and explores its policy application significance, and provides a reference for the policy application transformation of SHA2011 data. On the one hand, it studies the expanded dimension classification caliber of SHA2011, constructs the SHA2011 index (group) and its possible policy application scenarios; on the other hand, it grasps the existing data and accounting process of SHA2011, expands the analysis angle, and creates a new policy application scenario. The new SHA2011 index and its application significance. The index system of SHA2011 policy analysis framework is constructed systematically to serve for policy evaluation and analysis. 1) The index system of policy analysis framework covering the main research contents of SHA2011 is constructed from the perspective of "overall situation" of health financing system. The index system of SHA2011 policy analysis framework based on "subsystem of policy issues" is constructed. The index system of SHA2011 policy analysis framework is constructed. The evaluation method of SHA2011 on "partial (specific)" health financing policy is constructed. 4. This study systematically summarizes the research status of SHA2011 index system, clarifies the blank points of SHA2011 research at this stage, and points out that the analysis should be done at present. The indicators used and those not yet analyzed and applied provide references for the future research direction of Beijing. Among them, the indicators that have not yet been analyzed and applied include those that have not yet been supported by the accounting data and those that have been supported by the accounting data. Meaning can provide directional guidance for the next step of accounting and analysis in SHA2011. On the other hand, this study expands the analysis angle and develops its policy application significance based on the available data for the index group supported by the existing accounting data system, which provides a reference for the further analysis of SHA2011.
【学位授予单位】：北京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R197.1
，
本文编号：2236162
本文链接：https://www.wllwen.com/shoufeilunwen/yxlbs/2236162.html
教材专著
