新医改背景下中国区域卫生信息化发展路径研究 = Developmental approaches of regional health informatization in China in the context of new medical reform : a comparative analysis
- Publication Type:
- Thesis
- Issue Date:
- 2013
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新医改方案颁布之后，解决中国医疗信息化发展的重点及难点就成了顺利推进医改工作的首要任务。新医改的推进，对区域卫生信息化工作的要求也越来越明确，即通过信息技术实现医疗卫生服务各个环节的协同和整合，使公众能够得到最好的医疗服务，解决长久以来看病难、看病贵、看病烦的问题。文章从中国新医改的实际情况出发，运用有关的学术理论，系统深入地探讨了中国区域卫生信息化的发展问题。文章针对的是中国区域卫生信息化的发展路径，研究的重点是为什么要进行区域卫生信息化、政府和市场在区域卫生信息化过程中的角色和作用分别是怎样的、怎样的发展路径才是可持续的等等。
全文共分为六章，第一章对全文作一个基本的交待，主要介绍研究问题、研究意义、文献综述、概念界定和研究方法等。第二章试图借助于供给与付费分离的理论、利益相关者理论和协同治理理论构建一个用于分析中国区域卫生信息化的发展路径的框架。第三章偏重从新医改的背景来观察中国区域卫生信息化的现状与发展，认为在新医改的推动下，中国卫生信息化建设走上了一条从无到有、从小到大、从被忽视到受重视的发展之路，取得了显著的成绩。但是，对照深化医药卫生体制改革的目标要求，中国卫生信息化建设尚处于探索阶段。第四章侧重探讨政府主导模式的成效与问题。由于区域卫生信息化建设内容庞杂，牵涉政府、医院、市场和群众等多个利益主体，本章首先运用利益相关者理论对各利益主体及其利益进行了分析，在此基础上对政府主导的区域卫生信息化模式进行了探讨，重点分析了这种模式的历史渊源、现实条件与所存争论。第五章重点探讨作为替代的市场主导模式，通过与政府主导模式相比较，分析市场的优势。文章认为，向全体人民提供基本公共服务是政府的责任，这就要求科学界定政府职能与市场功能的边界，准确区分公共服务与非公共服务、基本公共服务与一般性公共服务。在澄清区域卫生信息化并非基本公共服务的基础上，文章对市场化的概念作出了必要的澄清，并对政府的角色进行了恰当的限制，认为政府应该在中国区域卫生信息化中大有作为，自觉地充当好“规划者”、“出资者”和“监管者”的角色，但不是在信息化过程中发挥所谓的“主导作用”。文章最后就如何进一步健全和完善中国区域卫生信息化建设提出了对策性建议。
The development of China's Regional Health Informatization (RHI) becomes the primary task of New Medical Reform (NMR) since 2009. The advancing of NMR has put forward clear requests on RHI, that is, making the public enjoying the best medical care, and solving the difficult problems of inadequate and overly expensive medical services through the improvement of information technology. This dissertation mainly discusses the development issue of China's RHI with the academic support of relevant theories and practical basis of Chinese medical reforms, and focuses on the backgrounds of RHI, different roles of government and market in RHI, different development approaches of RHI, etc.
This dissertation can be divided into 6 chapters, and the contents of each chapter are as follows: Chapter one is the introduction. It brings forward the research questions. Then the key concepts are defined. After the literature review this part introduces the research method adopted and explains the reasons. Finally the so-called fragmentation theory as the research perspective and the analysis framework are introduced here.
Chapter two resorts to such theories as the dichotomy of provision and financing,the stakeholder theory and collaborative governance theory, in order to frame an analysis basis for China's RHI.
Chapter three describes the merits and disadvantages of China's RHI under the background of China's NMR. It concludes that the performance of RHI is obvious and the questions are unavoidable.
Chapter four explains the causes which result in the current government-leading development approach of China's RHI. The causes of the current approach include the difference of multiple stakeholders, the historical path-dependence, the transition of value dimensions, and practical conditions. In addition, this paper tries to explore the theory debates on the approach.
Chapter five evaluates the effect of market-leading development approach of China's RHI by comparing with government-leading approach. This article suggests that in order to clarify the boundary of government and market in RHI, it is necessary to distinguish between the public service and non-public service, and fundamental public service and general public service. It argues that since RHI is not a fundamental public service, the rights of choice should be open to all stakeholders. Government should act as a planner, investor and supervisor, but not a leading role.
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