本文選題：結(jié)核病防治 + 醫(yī)防合作��； 參考：《清華大學(xué)》2014年碩士論文

【摘要】：結(jié)核病防治是我國公共衛(wèi)生和疾病控制領(lǐng)域的重要任務(wù)，結(jié)核病預(yù)防控制機(jī)構(gòu)和定點醫(yī)院之間醫(yī)防合作關(guān)系的確立推進(jìn)了防治工作的開展。向醫(yī)防合作轉(zhuǎn)型意在重新界定結(jié)控機(jī)構(gòu)和醫(yī)療機(jī)構(gòu)的合作關(guān)系，促進(jìn)定點醫(yī)院提供更規(guī)范的診療，，共同促進(jìn)防治工作。然而，醫(yī)院卻表現(xiàn)出較強(qiáng)的趨利特點和治療的不規(guī)范，不能和結(jié)控機(jī)構(gòu)有效合作。為何在轉(zhuǎn)型中，定點醫(yī)院反而成為結(jié)核病防治工作的障礙，而結(jié)控機(jī)構(gòu)也不能實現(xiàn)有效的轉(zhuǎn)變并和定點醫(yī)院有效合作呢？這是本研究關(guān)注的問題。 本文基于已有文獻(xiàn)回顧了建國以來結(jié)核病防治工作和機(jī)構(gòu)的發(fā)展以及相關(guān)制度環(huán)境對結(jié)核病防治機(jī)構(gòu)的影響。在此基礎(chǔ)上，文章采用定性的研究方法，根據(jù)在宜昌、鎮(zhèn)江和漢中三個地區(qū)的訪談資料和機(jī)構(gòu)問卷數(shù)據(jù)分析了向醫(yī)防合作轉(zhuǎn)型的結(jié)核病防治工作的困境。這里的困境主要包括兩個方面。其一是結(jié)核病防治的目標(biāo)置換問題——公益性淡化和趨利性增強(qiáng)；其二是路徑依賴對醫(yī)防合作的阻礙：第一，業(yè)已形成的兩類機(jī)構(gòu)實力差距大，結(jié)控機(jī)構(gòu)資質(zhì)不足問題；第二，醫(yī)防合作中醫(yī)院合作不力，結(jié)控機(jī)構(gòu)缺乏權(quán)威的問題；第三，這兩類機(jī)構(gòu)的定位不清和職能轉(zhuǎn)變滯后的問題；第四是患者及其家人的認(rèn)知不足問題。文章基于制度與組織發(fā)展視角，根據(jù)R.Greenwood等人關(guān)于制度復(fù)雜性與組織 應(yīng)對的研究框架建立了本文的分析框架，探討了向醫(yī)防合作轉(zhuǎn)型的結(jié)核病防治工作困境的原因所在，這些原因包括我國權(quán)威體制下的財政與籌資體系帶來的負(fù)面影響，90年代趨利性邏輯下的醫(yī)療衛(wèi)生改革，衛(wèi)生行政部門和結(jié)控機(jī)構(gòu)監(jiān)管滯后，政府與公立醫(yī)院關(guān)系畸形等問題。這里將集中探討在結(jié)核病防治領(lǐng)域的機(jī)構(gòu)公益性淡化、政府監(jiān)管滯后、政府與公立醫(yī)院關(guān)系畸形等問題。在此基礎(chǔ)上，文章提出如何構(gòu)建更利于醫(yī)防合作的制度環(huán)境的政策建議：其一是 合理界定政府、衛(wèi)生行政部門包括結(jié)控機(jī)構(gòu)在結(jié)核病防治中的監(jiān)管職責(zé)，其二是根據(jù)結(jié)核病控制率保證經(jīng)費(fèi)投入和人員編制，提供有效激勵；其三是建立政府與公立醫(yī)院合作治理的關(guān)系，合理采購醫(yī)院結(jié)核病防治服務(wù)；其四是加強(qiáng)兩類機(jī)構(gòu)在結(jié)核病防治中的合作和人員建設(shè)。
[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.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R52

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