發(fā)布時(shí)間：2018-01-10 00:25

  本文關(guān)鍵詞：區(qū)域衛(wèi)生信息化建設(shè)中利益博弈與合作機(jī)制的研究　出處：《山西醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 區(qū)域衛(wèi)生規(guī)劃 區(qū)域衛(wèi)生信息化 利益博弈 信息技術(shù) 博弈論

【摘要】：目的:整合區(qū)域衛(wèi)生信息化研究領(lǐng)域的研究熱點(diǎn),比較不同國家的研究特色,分析其相關(guān)因素;以政策為切入點(diǎn)提取區(qū)域衛(wèi)生信息化建設(shè)中的主要利益相關(guān)集團(tuán),分析其中的利益關(guān)系、存在的囚徒困境以及利益博弈過程,完善合作機(jī)制,為該領(lǐng)域的學(xué)者、管理者、政策制定者開展研究、制定政策提供信息。方法:運(yùn)用關(guān)鍵詞詞頻分析、關(guān)鍵詞共現(xiàn)分析、主成分分析、多維尺度分析法、可視化技術(shù)分析區(qū)域衛(wèi)生信息化領(lǐng)域的研究熱點(diǎn)。運(yùn)用內(nèi)容分析法和社會(huì)網(wǎng)絡(luò)分析法提取國內(nèi)2009—2013年區(qū)域衛(wèi)生信息化政策中的主要利益相關(guān)集團(tuán)。運(yùn)用案例分析、專題討論、定性訪談及主要利益相關(guān)集團(tuán)分析法分析各利益集團(tuán)之間的合作現(xiàn)狀及存在的問題。運(yùn)用博弈論分析各利益集團(tuán)之間的利益博弈過程。結(jié)果:(1)區(qū)域衛(wèi)生信息化研究的關(guān)鍵詞數(shù)量逐年上升,研究領(lǐng)域廣泛。1994—2014年,區(qū)域衛(wèi)生信息化研究熱點(diǎn)由醫(yī)院規(guī)劃轉(zhuǎn)向社區(qū)衛(wèi)生規(guī)劃,與信息技術(shù)相關(guān)的關(guān)鍵詞數(shù)量增多,與組織管理相關(guān)的研究明顯增多。部分關(guān)鍵詞濃縮成知識(shí)群。6國的研究除了與主流研究趨勢相似以外,相互之間在研究水平和新興熱點(diǎn)之間存在差異。(2)遠(yuǎn)程醫(yī)療文獻(xiàn)中的Me SH數(shù)量隨著時(shí)間呈上升趨勢。1962—2015年間遠(yuǎn)程醫(yī)療文獻(xiàn)中最常見學(xué)科分支為:Remote Consultation、Teleradiology和Telepathology,最常見的信息媒介為Internet和Cell phones。近年來,與Patient Satisfaction,Treatment Outcomes和Home Care Services相關(guān)的遠(yuǎn)程醫(yī)療文獻(xiàn)數(shù)量明顯增多,近6年中包含Cell Phones和Self-Care的文獻(xiàn)急劇增多。不同國家的文獻(xiàn)熱點(diǎn)不同。(3)國內(nèi)研究大約于1984年起步,共形成了9大主流知識(shí)群,其中,基礎(chǔ)信息化研究和醫(yī)療信息化研究占據(jù)最大份額。研究方法偏重于定性的描述性研究。國內(nèi)科研合作群體規(guī)模小,71.74%(165/230)的2-plexes的規(guī)模為3,E-I Index=-0.901,表明該研究領(lǐng)域派系林立程度小,研究關(guān)系趨向于發(fā)生在群體之內(nèi)。主要科研力量集中在軍隊(duì)醫(yī)院。全國各省市之間建立了科研合作網(wǎng)絡(luò),北京、廣東、江蘇、湖北為研究的核心地區(qū)。(4)政策分析提取了主要利益集團(tuán),構(gòu)建了部門關(guān)系圖,其中,政府、醫(yī)院、基層醫(yī)療衛(wèi)生機(jī)構(gòu)、醫(yī)保部門、居民是目前區(qū)域衛(wèi)生信息化建設(shè)中的核心部門和人群。縱向的行政隸屬關(guān)系和橫向的部門關(guān)系構(gòu)成了復(fù)雜的部門合作網(wǎng)絡(luò)。各利益集團(tuán)之間需要進(jìn)行的投入、可動(dòng)用的資源不同、立場不同,但相互之間又存在利益契合點(diǎn)。(5)利益博弈貫穿在系統(tǒng)整合的整個(gè)過程,合作機(jī)制是建設(shè)和完善的重點(diǎn)。在所有參與人中,政府是投資主體、監(jiān)督者,同時(shí)也是主要參與人。居民健康檔案中死檔、假檔案、不規(guī)范檔案問題突出。現(xiàn)有的建設(shè)機(jī)制和政府監(jiān)督機(jī)制難以解決這些問題。(6)各部門在利益博弈過程中會(huì)因?yàn)樾畔⒉粚ΨQ,或者參與人不夠理性、監(jiān)督機(jī)制不完善、政府官員腐敗而陷入利益博弈的囚徒困境:橫向政府部門之間的替代性,縱向政府之間的單邊囚徒困境、醫(yī)療機(jī)構(gòu)聯(lián)網(wǎng)涉及的公共產(chǎn)品提供的囚徒困境,居民健康檔案督導(dǎo)中的不合理博弈等影響區(qū)域衛(wèi)生信息化建設(shè)的進(jìn)程。通過政府界定部門職能,完善獎(jiǎng)罰機(jī)制,增加博弈的次數(shù),完善市場機(jī)制等可以解決當(dāng)前區(qū)域衛(wèi)生信息化建設(shè)中存在的囚徒困境,達(dá)成部門合作。增加基層醫(yī)療機(jī)構(gòu)與居民之間的互動(dòng)可以解決當(dāng)前居民健康檔案造假、死檔、不規(guī)范等問題。結(jié)論:區(qū)域衛(wèi)生信息化研究內(nèi)容一直在不斷拓展,研究熱點(diǎn)不斷演變。不同國家研究熱點(diǎn)不同,與各國衛(wèi)生政策、衛(wèi)生體制、地理環(huán)境等因素有關(guān)。其中,政策是不可忽視的重要因素。以政策為切入點(diǎn)提取到了我國區(qū)域衛(wèi)生信息化建設(shè)的主要利益相關(guān)集團(tuán),這些利益相關(guān)集團(tuán)之間縱橫交錯(cuò),利益關(guān)系復(fù)雜,利益博弈貫徹其中。政府作為投資者、監(jiān)督者和重要的參與人,在區(qū)域衛(wèi)生信息化政策制定過程中以利益博弈的視角分析不同階段各利益集團(tuán)之間的利益關(guān)系,完善合作機(jī)制,可以引導(dǎo)各部門走出利益博弈的囚徒困境。博弈論是研究區(qū)域衛(wèi)生信息化建設(shè)中利益博弈和合作機(jī)制的理想方法。本研究客觀、系統(tǒng)的分析為該領(lǐng)域的學(xué)者、管理者、政策制定者提供了有用的信息,為區(qū)域衛(wèi)生信息化的研究和建設(shè)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.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1
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本文編號(hào)：1403141