本文選題：衛(wèi)生系統(tǒng)績效 + 影響因素��； 參考：《北京協(xié)和醫(yī)學院》2015年碩士論文

【摘要】：研究目的：本研究旨在從系統(tǒng)思考的角度出發(fā),梳理和總結現(xiàn)有的衛(wèi)生系統(tǒng)績效的非醫(yī)療影響因素,分析各因素對衛(wèi)生系統(tǒng)績效作用的系統(tǒng)動力學邏輯,發(fā)掘重要的決策干預點,為構建更加科學、合理的衛(wèi)生系統(tǒng)績效評估指標體系提供參考和建議。研究內(nèi)容：1、梳理和總結現(xiàn)有研究中的非醫(yī)療健康影響因素；2、非醫(yī)療因素對衛(wèi)生系統(tǒng)績效影響的系統(tǒng)動力學邏輯；3、結合中國現(xiàn)狀,從非醫(yī)療因素的角度對改善衛(wèi)生系統(tǒng)績效提出建議。研究方法：1、文獻綜述通過文獻查閱,完成國際衛(wèi)生系統(tǒng)績效評估框架、衛(wèi)生系統(tǒng)績效影響因素研究進展和研究方法的文獻綜述；按照系統(tǒng)綜述研究的原則和方法,根據(jù)預先制定的非醫(yī)療因素的分類框架,制定檢索策略,總結歸納出影響衛(wèi)生系統(tǒng)績效的非醫(yī)療因素。2、系統(tǒng)動力學運用系統(tǒng)動力學的理論和方法,繪制非醫(yī)療因素和衛(wèi)生系統(tǒng)績效的因果關系圖／流圖,在界定的領域和范圍內(nèi)描述和分析影響因素與衛(wèi)生系統(tǒng)績效之間的邏輯關系,發(fā)現(xiàn)值得關注的重點因素和得到啟示。結果：1、在社會因素中,受教育程度對居民健康水平和衛(wèi)生服務利用的影響范圍最廣,受教育程度、就業(yè)機會和人口流動是重要的政策干預點；國籍／戶籍制度通過影響教育、就業(yè)和社會保障制度的公平性對衛(wèi)生系統(tǒng)公平性產(chǎn)生影響。2、經(jīng)濟因素中,本國經(jīng)濟發(fā)展主要通過對人均收入水平、社會公共資源和衛(wèi)生技術發(fā)展三個變量的正反饋,提升衛(wèi)生系統(tǒng)績效；經(jīng)濟全球化對衛(wèi)生系統(tǒng)績效的影響有正向的也有負面的；產(chǎn)業(yè)結構的不同對衛(wèi)生系統(tǒng)績效也有一定的影響,健康服務業(yè)的整體發(fā)展對衛(wèi)生系統(tǒng)績效呈現(xiàn)正向作用,信息產(chǎn)業(yè)發(fā)展對衛(wèi)生系統(tǒng)績效的影響主要通過五條途徑；居民收入水平對衛(wèi)生系統(tǒng)績效呈正向作用,收入分配不平等對衛(wèi)生系統(tǒng)績效呈負向作用。3、環(huán)境因素對衛(wèi)生系統(tǒng)績效的影響作用主要體現(xiàn)在健康水平的維度上,作用機制包括直接作用和通過心理因素中介的間接作用。結論：1、減少社會經(jīng)濟制度中的不公平是提高衛(wèi)生系統(tǒng)績效的迫切需要,其中較為突出的問題存在于戶籍制度和收入差距兩個方面,主要通過直接影響衛(wèi)生服務利用對居民健康水平產(chǎn)生影響,以及通過對居民的心理健康因素的作用間接影響居民健康水平,從而影響衛(wèi)生系統(tǒng)績效。2、從系統(tǒng)思考的角度長遠來看,經(jīng)濟發(fā)展緩慢和追求過快的經(jīng)濟增長對衛(wèi)生系統(tǒng)績效的改善都是不利的,穩(wěn)定、持續(xù)、集約型經(jīng)濟發(fā)展是改善衛(wèi)生系統(tǒng)績效的重要推動力。我國目前的經(jīng)濟環(huán)境對衛(wèi)生系統(tǒng)績效的提高是較為有利的,需要把握經(jīng)濟轉型的時機,促進健康與經(jīng)濟協(xié)調(diào)發(fā)展。3、在社會經(jīng)濟因素中,教育、就業(yè)和人口流動對衛(wèi)生系統(tǒng)績效的影響應當引起高度重視。重點解決教育投入在城鄉(xiāng)、地域和性別上的不公平,破除戶籍制度和社會保障制度對公平就業(yè)造成的壁壘,促進流動人口在社會保障制度方面充分享有市民待遇。4、非醫(yī)療因素對衛(wèi)生系統(tǒng)績效影響的現(xiàn)有研究中,主要涉及衛(wèi)生系統(tǒng)績效的健康水平和公平性兩個維度,對反應性的影響機制研究相對匱乏；非醫(yī)療因素只有部分可以量化的指標,數(shù)據(jù)的可得、可用也相對較困難,需要進一步加強非醫(yī)療因素對衛(wèi)生系統(tǒng)反應性影響機制的相關研究,并且從國家層面加強數(shù)據(jù)庫的建設和提高統(tǒng)計工作的科學性。建議：1、減少社會經(jīng)濟宏觀政策中的不公平,將非醫(yī)療因素納入衛(wèi)生系統(tǒng)績效評估指標體系；2、針對性地改善就教育、就業(yè)和流動人口因素當中的不公平問題；3、抓住經(jīng)濟轉型的有利時機,促進健康與經(jīng)濟協(xié)調(diào)發(fā)展；4、全社會動員和參與,重視居民的心理健康；5、推廣健康影響評估工作,及早發(fā)現(xiàn)潛在環(huán)境危險因素；6、加強非醫(yī)療因素數(shù)據(jù)庫建設和統(tǒng)計方法的開發(fā),繼續(xù)深入非醫(yī)療因素對衛(wèi)生系統(tǒng)績效的影響研究。
[Abstract]:The purpose of this study is to review and summarize the non medical impact factors of the existing health system performance from the perspective of systematic thinking, analyze the system dynamics logic of various factors on the performance of health system, explore the important decision intervention points, and provide a more scientific and reasonable performance evaluation index system for health systems. Reference and suggestions. Research contents: 1, combing and summarizing the non medical health influencing factors in the existing research; 2, the system dynamics logic of the effects of non medical factors on health system performance; 3, combining with the current situation of China, suggestions for improving health system performance from the perspective of non medical factors. Research methods: 1, literature review through literature review. Read, complete the international health system performance evaluation framework, research progress and research methods of health system performance factors; according to the principles and methods of systematic review and research, according to the pre established classification framework of non medical factors, formulate the retrieval strategy and summarize the non medical factors that affect the performance of health system,.2, The system dynamics uses the theory and method of system dynamics to draw the causality diagram / flow chart of non medical factors and health system performance, and describe and analyze the logical relationship between the influence factors and the health system performance in the domain and scope defined, and find the key factors and enlightenment. Results: 1, in the social factors. Education, employment opportunities and population mobility are important policy intervention points for the health level of residents and the use of health services. The nationality / domicile system affects the fairness of health system through the impact of education, employment and social security system on the fairness of health system.2, economic factors, national classics Economic development mainly through the positive feedback of three variables of per capita income level, social public resources and health technology development, improve the performance of health system; economic globalization has positive and negative effects on health system performance; the difference of industrial structure has certain influence on health system performance and health service industry as a whole Development has a positive effect on health system performance. The impact of information industry development on health system performance is mainly through five ways; residents' income level has a positive effect on health system performance, income distribution inequality has a negative effect on health system performance.3, and the influence of environmental factors on health system performance is mainly reflected in the effect of environmental factors on health system performance. On the dimension of health level, the mechanism of action includes direct action and indirect effect through psychological factors. Conclusion: 1, reducing the unfairness in the social and economic system is the urgent need to improve the performance of the health system, and the more prominent problems exist in the two aspects of the household registration system and the income gap, mainly through the direct impact of health. Service utilization has an impact on the health level of the residents, and indirectly affects the health level of the residents through the role of the mental health factors of the residents, thus affecting the health system performance.2. From the perspective of systematic thinking, the slow economic development and the rapid economic growth are both unfavorable and stable to the improvement of health system performance. Continuous, intensive economic development is an important driving force to improve the performance of health system. The current economic environment in China is more favorable to the improvement of health system performance. It is necessary to grasp the opportunity of economic transformation and promote the coordinated development of health and economy.3. In social and economic factors, education, employment and population flow to health system performance The impact should be paid much attention to. It should focus on the unfairness of education input in urban and rural, regional and gender, break down the barriers to the fair employment of the household registration system and social security system, and promote the full enjoyment of the citizen treatment in the social security system of the floating population in.4, and the existing research on the effect of non medical factors on the performance of health system, It is mainly involved in two dimensions of health level and fairness of health system performance. The research on the mechanism of reactivity is relatively scarce; non medical factors are only partly quantifiable, data availability and availability are relatively difficult. Further strengthening of the related research on the mechanism of reactive influence of non medical factors to health systems should be further strengthened. And strengthen the construction of the database and improve the scientificity of the statistical work from the national level. 1, to reduce the unfairness in the macro-economic policies, and to bring the non medical factors into the performance evaluation index system of the health system; 2, to improve the unfairness among the factors of education, employment and floating population, and 3, to seize the economic turn. A favorable opportunity to promote the coordinated development of health and economy; 4, the whole society mobilizes and participates, pays attention to the mental health of the residents; 5, promote the health impact assessment work, find the potential environmental risk factors as early as possible; 6, strengthen the development of the non medical factors database construction and statistical methods, and continue to deepen the non-medical factors to the health system performance. Influence research.

【學位授予單位】：北京協(xié)和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R197.1

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