【作者】 邢晓辉；

【导师】 李从东；

【作者基本信息】 天津大学 ， 管理科学与工程， 2012， 博士

【摘要】 公立非营利性医院改革是“新医改”的重点和难点。“新医改”在推进公立医院改革试点中,明确提出补偿体系和补偿机制改革,逐步取消药品加成收入。因此,如何构建科学适宜的公立非营利性医院补偿体系、完善补偿机制,决定着公立医院能否可持续发展,也直接影响着新一轮医药卫生体制改革的成败。论文首先对比分析了国际上三种代表性的医院补偿机制,即公共集成模式、公共合约模式和商业保险模式,并综述了国内外公立医院补偿体系和补偿机制的相关理论成果。在此基础上,论文深入分析了我国公立非营利性医院成本结构和收入结构的特点,建立了规范的医院成本发生与补偿之间的映射关系,构建了包括政府补偿、市场补偿和社会补偿三大补偿渠道的公立非营利性医院补偿体系,并定性分析了补偿体系的结构和功能。其次,利用系统动力学理论和方法,基于Vensim仿真平台深入分析了公立非营利性医院补偿机制的因果关系图,通过流图和方程构建了系统动力学模型,并进行系统检验和测试。最后,在补偿机制模型的基础上,依据2002年到2010年《广东省卫生统计年鉴》,研究了广东省公立非营利性医院补偿现状,并通过数据的分析和处理,确定仿真模型中各参数的初试值。通过模型的模拟、敏感性试验和政策干预试验,论文模拟出了政府补偿、市场补偿和社会补偿系统的结构特征和行为机制,据此分析了广东省公立非营利医院补偿机制,并提出相应的政策建议,对国家宏观层面医改政策设计及具体操作具有一定的借鉴作用。更多还原

【Abstract】 Public Non-profit Hospitals Reform is the emphasis and difficulty of the New Medical Reform in China. While in the process of promoting the reform, the government clearly states that they will carry out reforms in compensatory system and compensatory mechanism, and gradually remove drug-add income from revenue of public non-profit hospitals, therefore, the ways by which a scientific and suitable compensatory system and compensatory mechanisms may build will decide sustainable development of public non-profit hospitals, as well as success in the New Medical Reform.To begin with, the author compares and analyzes three main representative hospitals compensatory mechanisms worldwide, which are public integrated model, public contract model and commercial insurance model, and summarize related theories on compensatory system and compensatory mechanisms for public non-profit hospital. On this basis, the author thoroughly analyzes cost structure and revenue structure in Chinese public non-profit hospitals, and then establishes a standard mapped relationship between hospital costs occurrence and compensation. Furthermore, the author builds a new compensatory system equipped with three compensation channels (government, market and society) for public non-profit hospitals, and undertakes a qualitative analysis for structure and function of the new compensation system.Secondly, the author makes use of theory and method of system dynamics and Vensim platform to analyze causal relationship diagram in the new compensatory mechanisms, and builds a system dynamics model by flow and equation before systemic testing.Finally, the author analyzes status quo of public non-profit hospitals in Guangdong province, according to“the Health Statistics Yearbook of Guangdong Province (2002-2010)”. while using the new compensation mechanism model to determines the initial value of the parameters in the simulation model by datum analysis and processing, the author also simulates system structure characters and behavior mechanism of three compensatory channels mentioned-above by model simulation, sensitivity testing and policy intervention trial, and brings forward the corresponding policy recommendations. The results are supposed to has use for reference to policy making in the New Medical Reform from microscopic aspect.更多还原