【作者】 陆斌杰；

【导师】 戴昌钧；

【作者基本信息】 东华大学 ， 管理科学与工程， 2011， 博士

【摘要】 我国的第一轮医疗卫生改革历经十年,尽管围绕投资主体、针对行政隶属关系探索医院集团的发展以及医院委托管理等方面的探索取得了一定的进步,但伴随经济的发展和社会的进步,医疗行业生存的环境发生了变化,普通民众对医疗的需求也产生了巨大变化,当前我国医疗行业面临的最大问题是“看病难、看病贵”的社会矛盾越来越激烈,已经成为影响和谐社会建设的巨大隐患。全体国民都关注着医疗行业的变革这一关系国计民生的大事,值此新一轮医疗改革启动的关键年,论文研究了当前医疗卫生行业的弊端并提出了区域整体医疗方案。医疗改革作为全世界,包括发达国家都关注的一个重大民生问题,众多不同的改革方案以及对于各种方案的争议反映了对这一领域的研究尚缺乏扎实的理论及方法等基础工具,因此本文的研究具有理论价值和实际意义。本文的研究内容主要围绕区域整体医疗模式,包括区域整体医疗模式的建立,区域整体医疗的关键技术在医疗行业的应用示范,区域整体医疗模式的经济学理论论证,区域整体医疗模式的效益分析等。具体研究内容包括：第一,分析我国当前医疗问题的原因。回顾十年医疗改革的实践,探讨分析其利弊得失,总结出当前我国医疗行业存在问题的深层次原因,即我国卫生资源的绝对不足和配置不均衡、卫生资源效率低下、各医疗机构行政隶属关系复杂、条块分割、各自为政、同时国家医疗保险政策的欠缺等导致对我国医疗行业的发展产生了严重的影响。第二,总结数字化技术在医疗行业应用的基础。通过文献检索等总结国内外数字化技术在医疗行业的应用,尤其是对其中的电子病历、远程医疗和专家系统、区域规模互联和数据挖掘等四方面技术的国内外发展做了综述,这些信息化技术在医疗行业的应用对整个医疗服务能力和水平的提高起了巨大的推动作用,也为论文提出的区域整体医疗模式奠定了扎实的技术基础和建设环境。第三,提出区域整体医疗模式。在分析了现有的各种医疗卫生行业改革的探索和实践以及国内外研究现状,论文提出了区域整体医疗的概念,在当前体制和机制环境下,在不改变行政隶属关系和产权归属以及投入没有明显增长的基础上,以数字化信息技术为支撑手段,通过社会化分工来提高资源效率,构建区域整体医疗方案,比当前探索中的协同医疗更进一步,区域内核心大型医院通过数字化技术手段来“兼并”下级医院从而实现整个区域医疗机构形成虚拟的整体医院,在核心大型医院统领下统一运作的模式,从理论和技术上来解决卫生资源不足和配置不均衡的问题,解决普通民众“看病难、看病贵”的社会矛盾。第四,区域整体医疗方案关键技术在医疗行业的应用示范。选取了区域整体医疗方案关键技术中的基于知识的专家系统和数据挖掘技术,通过对这些技术在医疗行业的应用示范来表明区域整体医疗方案对提高医疗服务和医疗管理的能力和水平的意义。第五,构建区域整体医疗方案数学模型并从经济学理论上论证其可行性。从经济学社会化分工理论出发,结合超边际分析方法,构造一个基于专业化分工的区域整体医疗演进模型,并比较分析模型中的有关参数来进行区域整体医疗方案的经济学理论分析,期望为各级医院的实践活动提供理论依据。第六,区域整体医疗方案的有效性和可行性的大样本问卷调查的实证研究。为了解区域整体医疗方案的有效性和可行性及其被普通民众的接受程度,论文设计了关于区域整体医疗方案的问卷调查,并选择在上海交通大学医学院附属仁济医院进行了大样本问卷调查,在了解民意的同时也是获取大量的客观数据,为分析和计算区域整体医疗的效益提供了基础数据。第七,区域整体医疗的效益分析。通过模拟区域整体医疗的真实场景,对影响普通病人就诊的各类因素进行了归纳,通过数学模型来计算各因素导致对普通病人的就诊影响,分析并计算出病人的收益,结果显示病人不仅就诊费用大大降低,而且可以节约大量的就诊时间,表明区域整体医疗能够切实改善当前的“看病难、看病贵”的社会问题。论文创新点体现在：1、提出了引入社会资本实现社会专业化分工,建立区域检验中心,实现卫生物流集中配送的方案。集中配送医疗标本和病人,既补充了国家卫生投入的不足,新增了卫生辅助行业,同时可以将医疗覆盖面迅速扩大到边远地区和经济欠发达地区,符合国家宏观政策。2、论文提出通过信息技术“兼并”区域内所有的医疗机构,从而整合区域内的卫生资源来提高区域卫生资源的效率和效益,从技术上解决了新的运行模式的可行性,是在我国当前的体制和环境下切实可行的医疗卫生改革的新解决方案。3、论文将商业智能技术中的专家系统和数据挖掘作为区域整体医疗方案关键应用技术之一引入医疗行业,通过选择以单一学科的应用专家系统作为示例,描述其对医疗服务能力和水平提升的应用；通过示范性地举例来阐述数据挖掘技术在医疗机构管理方面的广泛应用以及其对管理水平和能力的提升作用,增强了整个行业的医疗管理的科学决策水平。4、论文采用社会分工的经济学理论来分析区域内不同医疗机构间的分工和合作,并通过数学模型验证其有效性,从而为本文提出的医疗改革方案提供了理论基础,也弥补了这一领域理论基础的不足。更多还原

【Abstract】 After almost ten years of hard work, Chinese first cycle of health care reform ended in failure. Although it had obtained some progress on the exploration of different investors, the development of hospital groups to break the administrative affiliation and the exploration of hospital commission management, however, with the economic development and social progress, the environment of medical industry has changed, and the demand for health care has also changed a lot. Currently, the biggest problem of our medical industry is the social conflicts that medical service turns to be more and more difficult and expensive, and it also has become the potential and great danger that influence the construction of harmonious society, hence, it has come to the time to reform as soon as possible. From the speeches of Chinese leaders either of the Central Committee of the Party and State Council, or of National Development and Reform Commission and Ministry of Health, we can find out they always concern about changes in the health care industry. Even ordinary people also take care of this; after all, this is a great event that concerns every one of us. At the beginning of a new cycle of health care reform, this paper studies the shortcomings of current health care industry and put forward a valuable program with its own considerable theoretical and practical significance.This study mainly focus on the Digital Regional Holistic Healthcare Solution, it includes establishment of Digital Regional Holistic Healthcare pattern, applied demonstration of key technologies among the Digital Regional Holistic Healthcare, economic theory argument of Digital Regional Holistic Healthcare Solution and the efficiency analysis of Digital Regional Holistic Healthcare Solution. The concrete research contents are as follows:Chapter 1. Analyzing the reasons of current medical problems. Through reviewing ten years practice of health care reform in China, this paper probed into its advantages and disadvantages, summarized that the intrinsic reasons of Chinese medical industry, including the absolute lack, unbalanced allocation and inefficiency of health resources, complex and fragmented administrative affiliation of medical institution and the limitation of national health insurance policy. As a result, all these problems have made a serious impact on the development of Chinese medical industry.Chapter 2 Summarizing the applied basis of information technology in medical industry. Through document research, this study concluded the applications of information technologies in medical industry at home and abroad, especially focused on electronic medical records, telemedicine and Regional-scale Internet. All these applications of information technology have played a huge role in promoting the medical service capability and level, and also lay a solid technical foundation for the Digital Regional Holistic Healthcare Solution.Chapter 3. Putting forward the Digital Regional Holistic Healthcare Solution. After analyzing the exploration and research of healthcare reform, this paper put forward a concept of the Digital Regional Holistic Healthcare Solution. In the great context of current institution and mechanisms environment, on the basis of no change on administrative affiliation and property ownership, and without improvement on investment, this program use information technologies as support means, through social division to improve medical resource efficiency to establish the Digital Regional Holistic Healthcare solution. By using of information technology to integrate all the regional hospitals as a whole virtual hospital and operating unified under the command of the large core hospital, The program try to solve the problems of lack in medical resources and the imbalance in allocation from the theoretical and technical point view, eventually to solve the social conflicts of "difficult and expensive of medical service".Chapter 4. Applied demonstration of key technology of Digital Regional Holistic Healthcare solution in the medical industry. By using knowledge-based expert system and data mining technology, this paper shows the significance of Digital Regional Holistic Healthcare program in improving the capabilities and level of medical services and medical management.Chapter 5. Establishing mathematical model of the Digital Regional Holistic Healthcare Solution and demonstrated its feasibility from economic theory. From economic theory of social division, combined with ultra-marginal analysis, this paper put forward a reduced mathematical model of Digital Regional Holistic Healthcare Solution. Through comparative analysis of parameters in the model, this paper try to demonstrate the feasible of Digital Regional Holistic Healthcare Solution from economic theory and hope to provide a theoretical basis for the practice in all levels of hospitals.Chapter 6. The empirical research of large sample questionnaire survey To understand the acceptance of Digital Regional Holistic Healthcare Solution by ordinary people, this paper designed a questionnaire survey. Besides obtaining public opinion, we also got a lot of objective data which provide solid foundation for the analysis of efficiency of Digital Regional Holistic Healthcare Solution.Chapter 7. Efficiency analysis of Digital Regional Holistic Healthcare Solution.By simulating the real scene of Digital Regional Holistic Healthcare program and summarizing various types of factors which affect medical service, this paper used mathematical models to calculate and analyze the benefit for patients. The results showed that patients may not only reduce medical costs greatly, but also save a lot of medical time, hence we can say that Digital Regional Holistic Healthcare Solution may effectively solve the social conflicts of "difficult and expensive of medical service".The paper’s main innovation points are as follows:1. This paper introduced social capital into medical logistics for social specialization for the first time to establish regional laboratory center and centralize distribution of medical samples and patients. It may not only supplement the lack of national health investment, add new subsidiary industry, but also rapidly expand medical service to rural and less-developed areas, which is consistent with national macro-policy.2. This paper put forward innovatively that through information technology, large medical institution "merger" all kinds of health resource to improve the efficiency and effectiveness of regional health resources. It shows that the feasibility of the new operating mode under our current system and environment from technology.3.It is the first time to introduce knowledge-based expert system, data mining and other technology of business intelligence into medical industry. Take the application of expert system in the selected subject as an example, this paper describes the significance for medical services to enhance their ability and level. Taking the application of data mining as an example, this paper describes the significance for medical management in enhancing the ability and level, and to improve the scientific decision-making level of hospital management.4. This paper firstly made use of economic theory of social division to analyze division and cooperation among different medical institution, and validated its effectiveness through mathematical model.更多还原