多目标协同与优化视角下的全民医保理论模型构建、效果评价及制度体系重构研究

项目名称： 多目标协同与优化视角下的全民医保理论模型构建、效果评价及制度体系重构研究

项目编号： No.71333003

项目类型： 重点项目

立项/批准年度： 2014

项目学科： 管理科学

项目作者： 吴群红

作者单位： 哈尔滨医科大学

项目金额： 225万元

中文摘要： 本研究以制度经济学、社会保障及系统论等相关理论为主要指导，综合运用制度评价与分析、政策问题分析、利益博弈分析、系统协同优化模型构建等多学科的研究方法，针对我国全民医保制度面临的深层问题，基于“理论构建－制度实施评价－问题根源分析—制度试点解析--制度优化设计仿真模拟－最佳优化策略与路径选择”这一基本研究思路和框架，探讨和研究全民医保的概念、理论框架；开发涵盖全民医保目标、内涵、功能、实施效果等多维视角的评价模型与工具；运用模糊数学综合评价方法对全民医保制度实施效果进行评价研究，开展问题诊断及制度根源分析。在此基础上，运用复杂系统协同理论和多目标优化方法，构建全民医保系统协同优化路径模型，运用ProModel模拟仿真工具，求解系统优化最优路径集，为全民医保制度的体系重构和实施路径选择提供可操作和量化的研究依据。

中文关键词： 全民医保制度;体系重构;效果评价;多目标协同;系统协同优化模型

英文摘要： With the theoretical guidance of institutional economics, social security and system theory, as well as multidisciplinary research methods of system evaluation, policy analysis, game analysis of stakeholders and system optimization model, this study, targeting at the deep rooted problems of universal health care system in China, aims to address the issue of concept and theoretical framework of universal coverage; develop evaluation models and tools from multi-dimensional perspectives covering the goal, connotation, function, implementation effect of universal health insurance; and conduct problem diagnosis and institutional roots analysis by using fuzzy mathematics comprehensive evaluation method to assess the effectiveness of universal coverage, this study will be carried out in line with the following research procedure of theoretical construct - evaluation on system implementation - root cause analysis – case study on pilot reform - system optimization design and analogue simulation - optimization strategy and path selection ”.Furthermore, By applying systems synergistic theory and multi-objective optimization method to build a model on system collaborative optimization path of universal health care with ProModel simulation tool. The ultimate aim is to provide the operational strategies, path selection and scientific evidence for reconstruction the universal health insurance system in China.

英文关键词： universal coverage;system reconstruction;KPI evaluation;multi-objective collaboration;system synergy and optimizatio