本文選題：衛(wèi)生系統(tǒng)　切入點(diǎn)：績(jī)效評(píng)價(jià)　出處：《華中科技大學(xué)》2015年博士論文

【摘要】：[目的]2000年世界衛(wèi)生報(bào)告提出衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)以來(lái),國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)研究迅速發(fā)展并引起了廣泛關(guān)注。世界衛(wèi)生組織,世界銀行、經(jīng)合組織、歐盟和聯(lián)邦基金等國(guó)際組織紛紛投入到衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)之中,英國(guó)、美國(guó)、澳大利亞、加拿大和荷蘭等也在實(shí)踐過(guò)程中積累了豐富的經(jīng)驗(yàn)。國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)在衛(wèi)生系統(tǒng)績(jī)效監(jiān)測(cè)評(píng)價(jià)、衛(wèi)生決策、資源規(guī)劃和數(shù)據(jù)系統(tǒng)完善方面發(fā)揮著重要作用。 我國(guó)正處于衛(wèi)生改革的關(guān)鍵時(shí)期,然而,我國(guó)尚未建立一個(gè)國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)制度,亦未提出一個(gè)國(guó)家衛(wèi)生系統(tǒng)評(píng)價(jià)的框架或模型,目前研究也沒(méi)有系統(tǒng)的從理論和方法角度對(duì)其進(jìn)行比較研究和借鑒。盡管國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)盡管受到政治、經(jīng)濟(jì)、文化和技術(shù)的影響而各具特色,但是通過(guò)對(duì)國(guó)際主流評(píng)價(jià)框架和典型國(guó)家績(jī)效評(píng)價(jià)系統(tǒng)和結(jié)構(gòu)化比較,總結(jié)和借鑒衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)理論、方法和有益經(jīng)驗(yàn),進(jìn)而構(gòu)建和完善衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)模型,對(duì)我國(guó)衛(wèi)生系統(tǒng)評(píng)價(jià)制度的建立仍然具有重要意義。 本研究通過(guò)系統(tǒng)梳理和比較國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架,總結(jié)國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)理論、方法和規(guī)律,構(gòu)建衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)模型和評(píng)價(jià)框架,為我國(guó)衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架體系和制度建立提供理論和方法支持。 [方法]本研究數(shù)據(jù)來(lái)源三個(gè)渠道：(1)文獻(xiàn)數(shù)據(jù)。中外文數(shù)據(jù)庫(kù)、Google搜索引擎和官方機(jī)構(gòu)網(wǎng)站系統(tǒng)收集衛(wèi)生系統(tǒng)及其績(jī)效評(píng)價(jià)相關(guān)文獻(xiàn),主要用于衛(wèi)生系統(tǒng)基本理論和框架比較研究。(2)西部三省數(shù)據(jù)。陜西、重慶和廣西2008～2012衛(wèi)生統(tǒng)計(jì)數(shù)據(jù)和第四次、第五次衛(wèi)生服務(wù)調(diào)查數(shù)據(jù),主要用于中國(guó)衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)指標(biāo)驗(yàn)證。(3)第五次衛(wèi)生服務(wù)調(diào)查擴(kuò)點(diǎn)省數(shù)據(jù)。從第五次衛(wèi)生服務(wù)調(diào)查22個(gè)擴(kuò)點(diǎn)省分東中西三層,每層選擇三個(gè)擴(kuò)點(diǎn)省,共9個(gè)擴(kuò)點(diǎn)省的家庭問(wèn)卷調(diào)查數(shù)據(jù),主要用于中國(guó)衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)實(shí)證研究,驗(yàn)證評(píng)價(jià)框架指標(biāo)和標(biāo)桿比較方法適用性。本研究將定性和定量方法相結(jié)合進(jìn)行研究：(1)描述性系統(tǒng)綜述和科學(xué)計(jì)量學(xué)方法結(jié)合研究衛(wèi)生系統(tǒng)基本理論,同時(shí)結(jié)合衛(wèi)生系統(tǒng)分類理論和方法,確定主流框架和典型國(guó)家樣本。(2)系統(tǒng)分析法和比較分析法相結(jié)合,同時(shí)利用理想類型指導(dǎo)思想,系統(tǒng)比較和分析衛(wèi)生系統(tǒng)主流框架和典型國(guó)家績(jī)效評(píng)價(jià)規(guī)律。(3)統(tǒng)一建模語(yǔ)言方法用于完善衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架構(gòu)建流程和衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)模型,并構(gòu)建衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架模型。(4)統(tǒng)計(jì)學(xué)分析方法,包括標(biāo)桿比較方法和不平等指數(shù)等,進(jìn)行中國(guó)衛(wèi)生系統(tǒng)績(jī)效實(shí)證研究。此外,專家咨詢法貫穿于整個(gè)研究過(guò)程。 [結(jié)果](1)衛(wèi)生系統(tǒng)定義既要包含衛(wèi)生系統(tǒng)“硬件”——結(jié)構(gòu),同時(shí)應(yīng)該包括衛(wèi)生系統(tǒng)“軟件”——結(jié)構(gòu)和目標(biāo)之間的聯(lián)系。(2)國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架根據(jù)其目的和功能不同可以分為兩類,一類是國(guó)際組織或機(jī)構(gòu)主導(dǎo)制定的衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架用于不同國(guó)家之間衛(wèi)生系統(tǒng)績(jī)效的評(píng)價(jià)和比較,其中世界衛(wèi)生組織,世界銀行、經(jīng)合組織、歐盟和聯(lián)邦基金為其典型代表：另一類是各個(gè)國(guó)家針對(duì)具體國(guó)情制定的適合本國(guó)家的衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架,其中英國(guó)、澳大利亞、加拿大、荷蘭和美國(guó)各具特色,各自代表了不同類型的衛(wèi)生系統(tǒng)。(3)國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)模型包括利益相關(guān)者參與、概念模型或方法選擇、國(guó)家政策環(huán)境分析、評(píng)價(jià)框架構(gòu)建、評(píng)價(jià)管理實(shí)施以及激勵(lì)機(jī)制和結(jié)果應(yīng)用等關(guān)鍵流程。其中評(píng)價(jià)框架構(gòu)建是整個(gè)評(píng)價(jià)模型的核心,構(gòu)建路徑又可以細(xì)分為框架構(gòu)建目的、衛(wèi)生系統(tǒng)邊界、衛(wèi)生系統(tǒng)目的和構(gòu)成、評(píng)價(jià)框架體系形成和指標(biāo)集建立及篩選等步驟。(4)廣義的衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架模型應(yīng)該包括衛(wèi)生系統(tǒng)最終目標(biāo)、非醫(yī)學(xué)健康影響因素、衛(wèi)生系統(tǒng)投入和衛(wèi)生系統(tǒng)產(chǎn)出四個(gè)方面。而狹義的衛(wèi)生保健系統(tǒng)與其衛(wèi)生系統(tǒng)投入和產(chǎn)出兩個(gè)部分相對(duì)應(yīng)。衛(wèi)生投入、產(chǎn)出和健康影響因素通過(guò)人群影響最終結(jié)果,其中衛(wèi)生系統(tǒng)投入和產(chǎn)出為代表的衛(wèi)生保健系統(tǒng)不僅能直接影響人群健康,而且能夠通過(guò)非醫(yī)學(xué)健康影響因素間接影響衛(wèi)生系統(tǒng)最終結(jié)果的績(jī)效。 [結(jié)論](1)衛(wèi)生系統(tǒng)“硬件”、“軟件”和“目標(biāo)”與衛(wèi)生系統(tǒng)績(jī)效的能力、過(guò)程和結(jié)果三個(gè)層次對(duì)應(yīng),因此,一個(gè)全面的衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架應(yīng)該涵蓋衛(wèi)生系統(tǒng)的結(jié)構(gòu)、中間過(guò)程和最終目標(biāo)。(2)統(tǒng)一建模語(yǔ)言與衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)構(gòu)建路徑自下而上和自上而下的框架構(gòu)架和指標(biāo)選擇思想一致,將統(tǒng)一建模語(yǔ)言融入框架構(gòu)建路徑,提高了衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架構(gòu)建路徑和模型的理論性和方法性。(3)基于Lalonde模型廣義衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架模型具有全面、靈活特點(diǎn),適合我國(guó)衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)。其中,衛(wèi)生投入和產(chǎn)出是評(píng)價(jià)的核心,最終目標(biāo)維度是國(guó)際比較的基礎(chǔ)。評(píng)價(jià)過(guò)程中應(yīng)該同時(shí)關(guān)注水平和分布兩個(gè)方面,公平與效率相結(jié)合。(4)根據(jù)衛(wèi)生系統(tǒng)評(píng)價(jià)模型和國(guó)際經(jīng)驗(yàn),我國(guó)應(yīng)成立國(guó)家層面的衛(wèi)生績(jī)效評(píng)價(jià)主體、構(gòu)建國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架體系、完善評(píng)價(jià)指標(biāo)集和數(shù)據(jù)收集系統(tǒng)、建立衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)激勵(lì)機(jī)制和定期發(fā)布衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)報(bào)告,最終建立國(guó)家衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)制度,支持衛(wèi)生系統(tǒng)決策和規(guī)劃配置,達(dá)到衛(wèi)生系統(tǒng)加強(qiáng)和健康改善最終目標(biāo)。 [創(chuàng)新與不足]創(chuàng)新：(1)科學(xué)計(jì)量學(xué)方法和衛(wèi)生系統(tǒng)分類理論結(jié)合,從科研產(chǎn)出定量角度和分類學(xué)角度共同確定了衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)研究典型國(guó)家樣本。(2)基于國(guó)際經(jīng)驗(yàn),構(gòu)建了衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)關(guān)鍵流程模型和衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架構(gòu)建路徑,并將UML方法融入到衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架構(gòu)建路徑之中。(3)構(gòu)建了廣義的衛(wèi)生系統(tǒng)績(jī)效評(píng)價(jià)框架模型,并通中國(guó)衛(wèi)生績(jī)效評(píng)價(jià)框架制定和標(biāo)桿比較方法實(shí)證驗(yàn)證了其在中國(guó)的適用性。不足：(1)社會(huì)保險(xiǎn)類型國(guó)家和中低收入國(guó)家缺少可供借鑒的樣本和經(jīng)驗(yàn)。(2)評(píng)價(jià)指標(biāo)篩選缺乏定量可操作的方法依據(jù)。(3)實(shí)證研究通過(guò)標(biāo)桿比較方法對(duì)部分省份部分指標(biāo)進(jìn)行了比較和評(píng)價(jià),綜合評(píng)價(jià)結(jié)果解讀和應(yīng)用需謹(jǐn)慎。
[Abstract]:Since the purpose of]2000 [World Health report health system performance evaluation, performance evaluation of national health system develops rapidly and has aroused wide concern. The WHO, the world bank, OECD, EU and other international organizations have federal funds into the performance evaluation of the health system, the United States, Britain, Australia, Canada and Holland in in the process of practice has accumulated rich experience. The performance evaluation in the national health system, health system performance monitoring health decision-making, resource planning and data system plays an important role.
China is in a critical period of health reform, however, has not yet established a national health system performance evaluation system in our country has not put forward a framework or model of a national health evaluation system, at present there is no systematic study from the perspective of the theory and method of comparative study and reference. Although the performance of national health system despite the political and economic evaluation, and influence of culture and technology and have their own characteristics, but compared with the international mainstream evaluation framework and performance evaluation system of typical countries and structured, summary and reference of health system performance evaluation theory, methods and experience, and then build and perfect health system performance evaluation model, still has an important meaning for our country health system evaluation system.
This study through the analysis and comparison of the performance evaluation system of the national health system framework, summarizes the performance of national health system evaluation theory, methods and rules, construction of health system performance evaluation model and evaluation framework for the performance of China's health system evaluation framework system and establish a system to provide theoretical and methodological support.
[method] this study data from three channels: (1) the literature data. In the database, Google search engine and official website system to collect the health system and the performance evaluation of the relevant literature, mainly for the comparative study of the basic theory and framework of the health system. (2) three. Shaanxi Province data of Western Chongqing and Guangxi, 2008~2012 health the statistical data and the fourth, fifth health services survey data, mainly for the evaluation of health system performance China verification. (3) the fifth health service investigation data. The enlarged province divided east three layer from the fifth health service investigation in 22 enlarged Province, three expansion per layer, a total of 9 a little, family survey data, mainly for the empirical study on the evaluation of health system performance China, validating the evaluation framework of indicators and benchmarking methods. This study combines the qualitative and quantitative research methods Study: (1) combined with the basic theory of health systems research methods of Descriptive Systematic Review and scientific metrology, combined with the health system classification theory and method, determine the main framework and typical national samples. (2) the system analysis method and comparative analysis method of combining, while using the ideal type of guiding ideology, system analysis and comparison of mainstream health system the framework and performance evaluation of typical countries. (3) the unified modeling language is used to perfect the construction process and method of performance evaluation of health system model of health system performance evaluation framework, and constructs the performance evaluation of the health system framework model. (4) statistical analysis methods, including benchmarking method and inequality index, carried out an empirical study of the performance of the health system China. In addition, the expert consultation method throughout the entire study.
[results] (1) the health system not only contains the definition of health system "hardware" of the structure, but also include health system "software" - structure and target contact. (2) the framework of performance evaluation for national health system according to the different purposes and functions can be divided into two categories, one is the health system performance evaluation the framework of international organizations led the development of different countries for the evaluation of health system performance and comparison, the WHO, the world bank, OECD, EU and federal funds for its typical representative: another kind is the country specific national conditions for the evaluation of health system performance of the national framework, the United Kingdom, Australia Holland, Canada, and the United States have their own characteristics, each representing the health systems of different types. (3) the national health system performance evaluation model, including stakeholder participation, The concept models and methods, analysis of national policy environment, evaluation framework, evaluation and implementation of management incentive mechanism and the application of the key process. The evaluation framework is the core of the evaluation model, constructing path can be subdivided to construct the framework of health system, health system boundaries, purpose and structure, and set up and index set screening step formation evaluation framework. (4) the framework model of health system performance evaluation should include the ultimate goal of general health system, factors affecting medical health, the four aspects of the health system and health system input output. And the two part of the health care system and special health system input and output. The corresponding health input the output and the factors affecting the health through the crowd affect the final result, the health care system and health system input and output as the representative can not only direct It affects the health of the population and can indirectly affect the performance of the final results of the health system through non medical health impact factors.
[Conclusion] (1) health system "hardware", "software" and "target" and health system performance, process and results of the corresponding three levels, therefore, a comprehensive evaluation of the performance of the health system should cover the health system frame structure, intermediate and final target. (2) choose a consensus unified modeling language and performance evaluation of health system construction path of bottom-up and top-down frame and index, unified modeling language into the framework of path, improve the theory and method of constructing the path and model of health system performance evaluation framework. (3) the general performance evaluation of health system framework model based on Lalonde model has the characteristics of comprehensive, flexible for our health system, performance evaluation. Among them, the health input and output is the evaluation of the core, the ultimate goal is the dimension of international comparisons. At the same time should be in the process of evaluation Two aspects of attention level and distribution, the combination of fairness and efficiency. (4) evaluation model and according to the international experience of health system, health performance evaluation subject in China should be established at the national level, construct the evaluation framework of performance of national health system, improve the evaluation index set and data collection system, the establishment of health system performance evaluation and incentive mechanism regularly publish health system performance evaluation report, the eventual establishment of the national health system performance evaluation system, decision support and planning and allocation of health system, improve health and strengthen the ultimate goal of the health system.
[] lack of innovation and Innovation: (1) the scientific measurement method and health system classification theory, from the quantitative point of view of scientific research output and taxonomy jointly determine the health system performance evaluation of typical national samples. (2) based on the international experience, constructs the construction path of health system performance evaluation key performance process model and evaluation of health system the framework, and the UML method are integrated into the health system to build a performance evaluation framework of path. (3) builds a framework of performance evaluation of the health system generalized, and the framework of performance China health plan and evaluate benchmarking empirical methods to verify its applicability in Chinese. Disadvantages: (1) the type of social insurance and the low countries the lack of national income for reference sample and experience. (2) evaluation system is lack of quantitative operational basis. (3) an empirical study by benchmarking methods on the part of the province Part of the indexes are compared and evaluated, and the interpretation and application of the comprehensive evaluation results should be cautious.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R197.1
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本文編號(hào)：1698865