發(fā)布時(shí)間：2018-01-16 23:14

  本文關(guān)鍵詞：農(nóng)村醫(yī)療服務(wù)縱向整合利益相關(guān)者分析和演化博弈理論模型研究　出處：《南京醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 農(nóng)村醫(yī)療 縱向整合 利益相關(guān)者 演化博弈論 因子分析

【摘要】：農(nóng)村衛(wèi)生醫(yī)療服務(wù)體系是衛(wèi)生計(jì)生體系的重要組成部分,以縣級(jí)醫(yī)院為龍頭、鄉(xiāng)鎮(zhèn)衛(wèi)生院為骨干、村衛(wèi)生室為網(wǎng)底的三級(jí)醫(yī)療服務(wù)網(wǎng)絡(luò),承擔(dān)著為廣大農(nóng)村居民提供公共衛(wèi)生和基本醫(yī)療服務(wù)的重要職責(zé)。目前,縣鄉(xiāng)村三級(jí)醫(yī)療機(jī)構(gòu)是相對(duì)獨(dú)立的利益主體,醫(yī)療機(jī)構(gòu)各自為政,與其他機(jī)構(gòu)的合作甚少,無法發(fā)揮協(xié)同效應(yīng)和整體優(yōu)勢(shì)。通過農(nóng)村醫(yī)療服務(wù)縱向整合,促進(jìn)不同醫(yī)療機(jī)構(gòu)間展開協(xié)作,使患者能夠得到連續(xù)、便捷、質(zhì)優(yōu)的醫(yī)療服務(wù)。研究目的針對(duì)我國現(xiàn)階段農(nóng)村醫(yī)療服務(wù)縱向整合的難點(diǎn)和存在問題,本研究分析了整合主要利益相關(guān)者的立場(chǎng)、影響力、政策損益等特征,明確不同利益主體對(duì)整合因素重要性評(píng)價(jià),構(gòu)建農(nóng)村醫(yī)療服務(wù)縱向整合演化博弈理論模型,尋找達(dá)到穩(wěn)定均衡的條件,探索協(xié)調(diào)多元利益主體的利益訴求,調(diào)動(dòng)不同利益主體參與整合的積極性和主動(dòng)性,促進(jìn)我國農(nóng)村醫(yī)療服務(wù)縱向整合的可持續(xù)發(fā)展。研究方法采用文獻(xiàn)分析和小組討論方法界定農(nóng)村醫(yī)療服務(wù)縱向整合的主要利益相關(guān)者。在利益相關(guān)者和演化博弈理論研究基礎(chǔ)上,以定量數(shù)據(jù)和定性訪談作為實(shí)證支撐。以自行設(shè)計(jì)的調(diào)查問卷和利益相關(guān)者訪談提綱進(jìn)行農(nóng)村醫(yī)療服務(wù)縱向整合利益相關(guān)者分析,并通過構(gòu)建農(nóng)村醫(yī)療服務(wù)縱向整合演化博弈理論模型尋找穩(wěn)定均衡條件素。調(diào)查共完成整合因素重要性評(píng)價(jià)問卷330份,利益相關(guān)者問卷202份,利益相關(guān)者訪談共完成119份。研究結(jié)果1.農(nóng)村醫(yī)療服務(wù)縱向整合的主要利益相關(guān)者界定為衛(wèi)生行政部門、縣級(jí)醫(yī)院、鄉(xiāng)鎮(zhèn)衛(wèi)生院、村衛(wèi)生室、醫(yī)保部門和患者。在立場(chǎng)方面,縣級(jí)醫(yī)院處于依從態(tài)度,其余均是較為支持的態(tài)度。衛(wèi)生行政部門在醫(yī)療資源合理配置、提升區(qū)域醫(yī)療水平存在訴求;醫(yī)保部門的需求大多在醫(yī)保資金的收支平衡、提高資金利用效率等方面;縣級(jí)醫(yī)院在整合中著力于提升醫(yī)院聲譽(yù)和市場(chǎng)份額;基層醫(yī)療機(jī)構(gòu)則對(duì)提升醫(yī)療服務(wù)能力和增加經(jīng)濟(jì)效益有較大需求;農(nóng)村患者關(guān)注的是醫(yī)療服務(wù)的質(zhì)量和經(jīng)濟(jì)。整合因素重要性評(píng)價(jià)因子分析中,共提取了 4個(gè)公因子,分別為組織管理因子、激勵(lì)機(jī)制因子、政策及配套措施因子、信息共享及業(yè)務(wù)交流因子。衛(wèi)生行政部門、醫(yī)保部門、縣級(jí)醫(yī)院、鄉(xiāng)鎮(zhèn)衛(wèi)生院、村衛(wèi)生室、患者對(duì)整合因素重要性評(píng)價(jià)的綜合得分分別為0.025、0.030、0.032、0.015、-0.013和-0.037。2.農(nóng)村醫(yī)療服務(wù)縱向整合演化博弈模型中,博弈雙方均嚴(yán)格落實(shí)達(dá)成的穩(wěn)定條件包括:(1)雙方嚴(yán)格落實(shí)收益大于單方表面落實(shí)時(shí)的投機(jī)收益(w_1-v_1-d_10且w_2-v_2-d_20);(2)最終收斂于不同均衡的狀態(tài)決定于演化中的各參數(shù)。博弈雙方均嚴(yán)格落實(shí)的支出越小,收益越大,整個(gè)博弈會(huì)趨向于點(diǎn)B(1,1),即向雙方嚴(yán)格落實(shí)整合方向演化。政策建議有針對(duì)性對(duì)整合提供有關(guān)支持政策,并推動(dòng)政策落實(shí)�？h級(jí)醫(yī)院需要加強(qiáng)對(duì)農(nóng)村基層醫(yī)療機(jī)構(gòu)的合作力度,提升基層的醫(yī)療服務(wù)能力;加強(qiáng)縣域醫(yī)療資源的整合,降低整合組織成本,提高整合的收益,為整合創(chuàng)造更有利的條件;創(chuàng)新醫(yī)保支付方式改革,建立完善的激勵(lì)約束機(jī)制,通過合理的引導(dǎo),增加醫(yī)療機(jī)構(gòu)及其醫(yī)護(hù)人員的積極性;加強(qiáng)對(duì)整合的宣傳力度,提升農(nóng)村居民對(duì)基層醫(yī)療機(jī)構(gòu)的信任度,逐步形成良好的就醫(yī)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.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1

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