向医防合作转型的结核病防治工作困境

发布时间：2018-06-26 23:21

本文选题：结核病防治 + 医防合作　；参考：《清华大学》2014年硕士论文

【摘要】：结核病防治是我国公共卫生和疾病控制领域的重要任务，结核病预防控制机构和定点医院之间医防合作关系的确立推进了防治工作的开展。向医防合作转型意在重新界定结控机构和医疗机构的合作关系，促进定点医院提供更规范的诊疗，，共同促进防治工作。然而，医院却表现出较强的趋利特点和治疗的不规范，不能和结控机构有效合作。为何在转型中，定点医院反而成为结核病防治工作的障碍，而结控机构也不能实现有效的转变并和定点医院有效合作呢？这是本研究关注的问题。本文基于已有文献回顾了建国以来结核病防治工作和机构的发展以及相关制度环境对结核病防治机构的影响。在此基础上，文章采用定性的研究方法，根据在宜昌、镇江和汉中三个地区的访谈资料和机构问卷数据分析了向医防合作转型的结核病防治工作的困境。这里的困境主要包括两个方面。其一是结核病防治的目标置换问题——公益性淡化和趋利性增强；其二是路径依赖对医防合作的阻碍：第一，业已形成的两类机构实力差距大，结控机构资质不足问题；第二，医防合作中医院合作不力，结控机构缺乏权威的问题；第三，这两类机构的定位不清和职能转变滞后的问题；第四是患者及其家人的认知不足问题。文章基于制度与组织发展视角，根据R.Greenwood等人关于制度复杂性与组织应对的研究框架建立了本文的分析框架，探讨了向医防合作转型的结核病防治工作困境的原因所在，这些原因包括我国权威体制下的财政与筹资体系带来的负面影响，90年代趋利性逻辑下的医疗卫生改革，卫生行政部门和结控机构监管滞后，政府与公立医院关系畸形等问题。这里将集中探讨在结核病防治领域的机构公益性淡化、政府监管滞后、政府与公立医院关系畸形等问题。在此基础上，文章提出如何构建更利于医防合作的制度环境的政策建议：其一是合理界定政府、卫生行政部门包括结控机构在结核病防治中的监管职责，其二是根据结核病控制率保证经费投入和人员编制，提供有效激励；其三是建立政府与公立医院合作治理的关系，合理采购医院结核病防治服务；其四是加强两类机构在结核病防治中的合作和人员建设。
[Abstract]:TB prevention and control is an important task in the field of public health and disease control in China. The establishment of the cooperative relationship between TB prevention and control agencies and designated hospitals has promoted the development of prevention and control work. The transformation of medical and defense cooperation is intended to redefine the cooperative relationship between control and medical institutions, promote the provision of more standardized diagnosis and treatment in designated hospitals, and jointly promote the prevention and treatment work. However, the hospital has strong characteristics of profit-seeking and nonstandard treatment, and can not cooperate effectively with the control agency. Why, in the course of transformation, designated hospitals have instead become obstacles to TB prevention and control, and control agencies have not been able to achieve effective changes and cooperate effectively with designated hospitals? This is the concern of this study. This paper reviews the development of TB prevention and control institutions and the impact of relevant institutional environment on TB control institutions since the founding of the people's Republic of China. On this basis, the paper uses qualitative research method, according to the interview data and agency questionnaire data in Yichang, Zhenjiang and Hanzhong areas, analyzes the difficulties of tuberculosis prevention and control in the transition from medical to preventive cooperation. The dilemma here mainly includes two aspects. The first is the problem of objective replacement of TB prevention and treatment-public welfare desalination and interest enhancement; the second is the obstacle of path dependence to medical and preventive cooperation: first, the gap between the strength of the two types of institutions that have been formed is large, and the problem of inadequate qualification of the two types of institutions; second, the lack of qualifications of the two types of institutions; second, The cooperation of hospital in medical and defense cooperation is weak, and the control organization lacks authority; third, the positioning of these two kinds of institutions is unclear and the function transition is lagging behind; the fourth is the problem of insufficient cognition of patients and their families. Based on the perspective of institutional and organizational development, this paper establishes the analytical framework of this paper based on the research framework of R. Greenwood et al on institutional complexity and organizational coping. This paper discusses the reasons for the difficult situation of tuberculosis prevention and control in the transition to medical and preventive cooperation. These reasons include the negative impact of the financial and financing system under the authoritative system of our country and the reform of medical and health care under the logic of profit in the 1990s. Health administration and regulatory control agencies lag behind, the government and public hospitals, malformed relations and other problems. This paper focuses on the problems of public welfare desalination, lag of government supervision and malformation of the relationship between government and public hospitals in the field of tuberculosis prevention and control. On the basis of this, the article puts forward some policy suggestions on how to construct a more favorable institutional environment for medical and preventive cooperation: firstly, it should reasonably define the responsibilities of the government, the health administration department, including the control agencies in the prevention and control of tuberculosis. The second is to guarantee the investment and staff establishment according to the TB control rate and to provide effective incentive. The third is to establish the relationship between the government and the public hospital and to purchase the tuberculosis prevention and control service reasonably. The fourth is to strengthen the two types of institutions in tuberculosis prevention and control cooperation and personnel building.
【学位授予单位】：清华大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R52

【参考文献】