基于CAS理论的农村医疗服务纵向整合管理模型研究

项目名称： 基于CAS理论的农村医疗服务纵向整合管理模型研究

项目编号： No.71273099

项目类型： 面上项目

立项/批准年度： 2013

项目学科： 管理科学

项目作者： 张亮

作者单位： 华中科技大学

项目金额： 56万元

中文摘要： 割裂的医疗卫生服务体系是全球范围内的问题，中国农村医疗是服务提供体系割裂的典型，医疗服务层级之间不连续、不协调的状况加剧了系统失灵，"不整合"的现状成为制约国家卫生体系发挥整体功效的重要原因。整合服务被证明是融合服务体系缝隙、加强服务连续性的有效手段，自21世纪以来成为医疗卫生服务体系理论研究和改革重点，农村医疗服务体系急需进行整合与重塑，以加强纵向服务的连续性、降低农村居民就医难度和家庭经济风险，提高政府财政和医保投入效率。本研究在系统研究国内外医疗服务整合理论与实践的基础上，首先界定整合型医疗服务的概念内涵，通过研制以服务评判为落脚点的医疗服务整合度评价指标对我国医疗服务不整合的现状进行总体分析，整理出服务整合的机制和供方、需方、政府和医保四方面影响因素，最后在明晰利益主体和服务机制相互作用机理基础上，借助CAS理论构建农村医疗服务纵向整合管理模型。

中文关键词： 再入院；县级医生；新农合；服务整合；博弈

英文摘要： The fragmentation of the medical service system is becoming a heated issue over countries and areas. The fragmented service delivery and system-inconsistence in China rural medical service system cost Chinese government numerous effort and medical resources in order to better meet the comprehensive and complex needs of the rural residents, and in result worsen the problem of resource utilization effiency and system performance. It is recently frequently proved by many countries' experiences that medical service integration is a key element and useful method solving the above problem, and it is also theoretically proved effective in melting and re-bridge the breakage and gaps in the rural medical service system. The medical service system belongs to the research category "the complex system science", and requires meta-synthesis methods and supportive branch-theories like "nonlinear mechanism", "information feedback mechanism", and "synergy mechanism" which are theoretically firm when applied into the medical service system. In this study we firstly expect to make a thorough systematic literature review on integrated medical service theory and models, and then give our definition about the vertical integration of Chinese rural medical service with the purpose to analyze and predict where it is going nowadays, then

英文关键词： Readmission；County Doctor；New Rural Cooperative Medical System；Integrated Care；Game