重庆市卫生服务系统可持续发展系统动力学模型研究
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摘要
卫生事业是社会发展的重要组成部分,作为卫生事业可持续发展的核心载体,卫生服务系统其可持续发展是经济和社会可持续发展的重要保障和重要组成部分。重庆市直辖以来,经济快速发展、人民生活水平及对健康需求的不断提高,卫生事业也得到了快速发展并不断调整完善。在此期间也逐渐暴露出其内在固有矛盾,影响和制约了卫生事业的发展和功能。本研究通过对重庆市卫生事业在直辖10年来的发展动态进行全方位的总结和分析研究,找出这10年中重庆市卫生事业发展的不足与优势,用系统动力学方法建立重庆市卫生服务系统可持续发展宏观系统动力学模型。以该模型作为卫生事业可持续发展卫生政策模拟“实验室”,通过对系统结构、相关政策、外部环境等的模拟研究,获得卫生事业可持续发展系统动态行为特征与内部运行机制,对重庆市卫生事业可持续发展能力进行评价,提出解决阻碍卫生事业可持续发展问题的政策建议,为进一步优化重庆市卫生资源配置提供可靠的参考数据,为决策部门在国家新医疗改革方案出台后,制订具体的规划和实施细则提供一系列有较强针对性的政策性意见或建议,供决策部门参考。同时本研究首次在卫生事业可持续发展研究中引入系统动力学的研究方法,构建宏观系统动力学模型,并进行系统模拟,在卫生事业政策研究数据分析方法上进行了一些探索,拓展了卫生事业政策研究数据分析方法,并积累了宝贵的经验。
本研究资料来源包括常规统计资料:1997-2006《重庆市卫生统计资料汇编》、1998-2007年《重庆市统计年鉴》、《中国卫生统计年鉴》、国家统计局网站(http://www.stats.gov.cn/tjsj/ndsj/)公布的数据;专项调查资料:国家第二次(1998年)、第三次(2003年)卫生服务调查资料,1997-2003年及2005年重庆市卫生总费用测算资料,2004年《重庆市社会发展综合评价研究报告》、2005年重庆市新型合作医疗家庭健康询问调查资料;以及有关卫生政策、法规专著文献与文件资料等。
本研究研究方法包括了定性与定量的分析方法。运用描述性统计、计量经济学模型(主要包括Gini系数、Lorenz曲线、Theil指数、数据包络分析)对重庆市自然和经济状况、居民卫生服务需求和需要、卫生资源供给和利用情况进行分析。运用系统动力学建模方法、系统思考、专家咨询、回归分析、统计预测、计量经济学模型等构建重庆市卫生服务系统可持续发展系
统动力学模型构建并模拟运行。运用系统分析、文献归纳、专家咨询、系统动力学方法进行模型政策干预实验与评价。
主要研究结果发现:
1.慢性非传染性疾病成为危害居民生命健康的主要原因,疾病谱的变化和人口老龄化,使我市卫生服务需求呈现增长的趋势。农村居民的卫生服务需要和需求量高于城市居民,但医疗费用增长过快成为阻碍居民,特别是农村居民利用卫生服务最主要的原因之一。公共卫生服务需求增大,传染病问题日趋严重,部分原已得到控制的传染病重新抬头,艾滋病的预防刻不容缓。
2.目前,我市已基本形成与经济社会发展相适应的城乡三级卫生服务体系、公共卫生服务体系和医疗保障体系。但从卫生资源的配置和利用来看,存在卫生资源总量相对不足,总体水平不高,卫生资源布局与结构不合理,公平性差,利用效率低下,卫生总费用筹资结构不合理,政府卫生投入不足,卫生服务机构发展不平衡、医疗费用增长过快,医疗保险覆盖面小、保障水平低、制度设计不够合理等诸多问题,都严重阻碍了我市卫生事业的可持续发展。
3.构建系统动力学模型,包含114个变量和方程,模型有效。系统动力学模型及模拟结果显示我市卫生服务系统现存问题产生的原因,是在经济体制改革和卫生体制改革的复杂环境下,政府卫生投入的萎缩和投入分配的结构不合理使卫生服务机构发展不平衡,大型医疗机构与基层医疗机构服务目标错位,恶性竞争。按照目前的发展状况,个人现金卫生支出占THE的比重的增长态势虽得到控制,但数值仍然较大,个人负担的医疗费用仍然很高,看病贵的问题没有得到根本改善。妇幼健康指标朝着好的方向发展,但传染病发病率的增长趋势不容乐观。城市医院和卫生院的人力卫生资源得到优化但与国家标准相比差距仍然很大。城市医院卫生资源与卫生院卫生资源的结构性矛盾有所改善,但仍然较为突出。
4.3组政策干预实验模拟了政府卫生投入不同程度增加以及不同的分配方案对卫生服务系统产出的影响。干预实验结果显示:在卫生总费用良性增长的基础上,政府预算卫生支出增长80%～100%,优先发展农村卫生服务体系和医疗保障体系,适当控制城市卫生服务体系的发展。增加部分按比例分配到公共卫生服务体系、城市医疗卫生服务体系,农村卫生服务体系和医疗保障体系的比例可以设定为1.8:1.2:3:4,观测指标可以取得较好的综合优化效果。政策建议:
重庆市卫生事业改革发展的定位应当以建立统筹城乡的、全民覆盖的以提供基本医疗卫生服务为主要目标的卫生服务体系,在未来的改革中,打破城乡、所有制等界限,建立城乡一体化的医疗卫生体制。政策干预重点的选择上首先应当大力扶持成本低效益好的基本医疗服务和公共卫生服务。在政策干预方式上,要重点强化政府职责,一方面强化政府的筹资和分配功能,加大对基层医疗机构、医疗保障和公共卫生的投入;一方面要对医疗卫生服务的地域布局、层级结构、服务目标、服务价格和质量等方面结合市场经济的运行机制全面干预。同时要树立大卫生观念,统筹兼顾,多相关事业协调发展。
The health enterprise is the important component of the society development. The health service system is the base of health enterprise and its sustainable development is the important guarantee and component of the economy and society sustainable development. Since Chongqing’s direct jurisdiction, its economy has been developing and people’s living standard and health demand have been rising quickly. The contradiction in health enterprise has emerged and has restricted its development. In this study we summarized the development of health enterprise since Chongqing’s direct jurisdiction, analyzed the predominance and deficiency of it and established macro system dynamic (SD) model of Chongqing’s health service system. Based on the SD model, we made a series simulation experiments to analysis the dynamic behavior and internal mechanism of the system and to evaluate the sustainable development ability of Chongqing’s health enterprise. With the study results, we proposed a series policy suggestions to improve the development of the system and provided credible data support aimed at optimizing the health resources allocation. At the same time, we made some methodological exploration with the SD model first used in the study on sustainable development of health service system and extended the methods on the study.
The data used in this study included conventional statistical data including Health Statistical Data Collection of Chonging during 1997-2006, Statistical Yearbook of Chongqing during 1998-2007, Health Statistical Yearbook of China, and the data announced on the website of National Bureau of Statistics (http://www.stats.gov.cn/tjsj/ndsj/); special investigation data including the data of investigation of health service in 1998 and 2003, the data of the total health expenditure (THE) in Chongqing during 1997-2003 and 2005, the report of society development synthetic evaluation study in Chongqing in 2004, the data of survey of new rural cooperative medical system family health inquiry of Chongqing in 2005, and some other data and information such as health policies, monographs, literatures etc. The methods used in this study included qualitative and quantitative methods. We used descriptive statistics and econometrics model (such as Gini coefficient, Lorenz curve, Theil index and Data Envelop Analysis) to analyzed the natural and economical situation in Chongqing, the health service need and demand of people, health resources supply and utilization. We also used SD methods, system thinking, expert consultation, regression analysis, statistical prediction and econometrics model to established the SD model of Chongqing’s health service system sustainable development, and then we used the model by simulating runs. At last, we used the methods of systematical analysis, literature concluding, expert consultation and SD methods to made a series of policy intervention experiments to evaluate the effect of the model.
The main results of this study included:
1. The chronic non-infectious diseases have been the main causations harming people’s health. The change of disease spectrum and population aging bring the increase of health service need and demand. The health service need and demand in rural are more than those in urban. The too fast growth of medical care expenditure has been one of the severest obstacles preventing people, especially people in rural, from using the health service. The demand of public health has been increased. The problem of infectious diseases has been still serious because some infectious diseases which had been controlled revive. Especially, the prevention of AIDS has been very urgent.
2. At present, the medical service system of urban and rural, public health service system and medical security system have been established which are accordant with the development of social economy. However, to speak with the allocation and utilization of health resources, there are lots of problems such as the low total quantity and quality of health resources, the low equity and utility efficiency, the unreasonable structure of THE financing, the low level of the government investment, the imbalance of the development among health service institutions, the too fast growth of medical expenditure, the low coverage and level of medical security etc, which are seriously obstructing the development of health enterprise.
3. In the study we established SD model which had 114 variables and equations, and the effect of it was passable. The results showed that the main cause of Chongqing health service system were the low government investment and the unreasonable allocation of it, which brought the imbalance of the development among health service institutions and aim dislocation. According to current status, the increasing tendency of the percentage of personal health expenditure to THE would be controlled, but still high. The problem of high medical expenditure paid by people would not be solved radically. The maternal and child health status would be better, but the infectious diseases status would still austere. The health human resources would be optimized but still far from the national criterion. The structural illogicality would be improved but still serious.
4. In our study three policy intervention experiments were conducted under different government investment increase and different distribution projects. The results showed that with the precondition of THE’s benign increase, government health expenditure would increase 80%~100%, the priority would be given to health service system development, and the urban medical service system would be controlled properly. The distribution proportion of increased government investment to public service system, urban medical system and rural health service system might be 1.8:1.2:3:4. With the forgoing framework, the problem exposed during sustain development of health service system in Chongqing would be greatly improved.
Policy suggestion: The target should be located on preferential guarantee of people’s basic medical need. The emphases of policy intervention should firstly be public health service. Secondly, the medical resources should be allocated on the basic clinical services with low cost and high efficiency. Thirdly, those clinical services with good treatment effect but high cost should be developed restrainedly. Fourthly, those clinical services with bad effect and thigh cost should be given up. Fifthly, more attention should be put into the improvement of medical technique. The government function should be strong in the sustainable development of health service system, which means to strong the ability of government financing and distribution and to make comprehensive intervention on the constructing and development of health service system. The policy framework in the future is to establish a medical service system covering all people with no limit between urban and rural, to increase the government investment on public health and basic medical institutions, to increase the coverage and level of medical security system and to separate pharmacy from medical service.
本研究资料来源包括常规统计资料:1997-2006《重庆市卫生统计资料汇编》、1998-2007年《重庆市统计年鉴》、《中国卫生统计年鉴》、国家统计局网站(http://www.stats.gov.cn/tjsj/ndsj/)公布的数据;专项调查资料:国家第二次(1998年)、第三次(2003年)卫生服务调查资料,1997-2003年及2005年重庆市卫生总费用测算资料,2004年《重庆市社会发展综合评价研究报告》、2005年重庆市新型合作医疗家庭健康询问调查资料;以及有关卫生政策、法规专著文献与文件资料等。
本研究研究方法包括了定性与定量的分析方法。运用描述性统计、计量经济学模型(主要包括Gini系数、Lorenz曲线、Theil指数、数据包络分析)对重庆市自然和经济状况、居民卫生服务需求和需要、卫生资源供给和利用情况进行分析。运用系统动力学建模方法、系统思考、专家咨询、回归分析、统计预测、计量经济学模型等构建重庆市卫生服务系统可持续发展系
统动力学模型构建并模拟运行。运用系统分析、文献归纳、专家咨询、系统动力学方法进行模型政策干预实验与评价。
主要研究结果发现:
1.慢性非传染性疾病成为危害居民生命健康的主要原因,疾病谱的变化和人口老龄化,使我市卫生服务需求呈现增长的趋势。农村居民的卫生服务需要和需求量高于城市居民,但医疗费用增长过快成为阻碍居民,特别是农村居民利用卫生服务最主要的原因之一。公共卫生服务需求增大,传染病问题日趋严重,部分原已得到控制的传染病重新抬头,艾滋病的预防刻不容缓。
2.目前,我市已基本形成与经济社会发展相适应的城乡三级卫生服务体系、公共卫生服务体系和医疗保障体系。但从卫生资源的配置和利用来看,存在卫生资源总量相对不足,总体水平不高,卫生资源布局与结构不合理,公平性差,利用效率低下,卫生总费用筹资结构不合理,政府卫生投入不足,卫生服务机构发展不平衡、医疗费用增长过快,医疗保险覆盖面小、保障水平低、制度设计不够合理等诸多问题,都严重阻碍了我市卫生事业的可持续发展。
3.构建系统动力学模型,包含114个变量和方程,模型有效。系统动力学模型及模拟结果显示我市卫生服务系统现存问题产生的原因,是在经济体制改革和卫生体制改革的复杂环境下,政府卫生投入的萎缩和投入分配的结构不合理使卫生服务机构发展不平衡,大型医疗机构与基层医疗机构服务目标错位,恶性竞争。按照目前的发展状况,个人现金卫生支出占THE的比重的增长态势虽得到控制,但数值仍然较大,个人负担的医疗费用仍然很高,看病贵的问题没有得到根本改善。妇幼健康指标朝着好的方向发展,但传染病发病率的增长趋势不容乐观。城市医院和卫生院的人力卫生资源得到优化但与国家标准相比差距仍然很大。城市医院卫生资源与卫生院卫生资源的结构性矛盾有所改善,但仍然较为突出。
4.3组政策干预实验模拟了政府卫生投入不同程度增加以及不同的分配方案对卫生服务系统产出的影响。干预实验结果显示:在卫生总费用良性增长的基础上,政府预算卫生支出增长80%～100%,优先发展农村卫生服务体系和医疗保障体系,适当控制城市卫生服务体系的发展。增加部分按比例分配到公共卫生服务体系、城市医疗卫生服务体系,农村卫生服务体系和医疗保障体系的比例可以设定为1.8:1.2:3:4,观测指标可以取得较好的综合优化效果。政策建议:
重庆市卫生事业改革发展的定位应当以建立统筹城乡的、全民覆盖的以提供基本医疗卫生服务为主要目标的卫生服务体系,在未来的改革中,打破城乡、所有制等界限,建立城乡一体化的医疗卫生体制。政策干预重点的选择上首先应当大力扶持成本低效益好的基本医疗服务和公共卫生服务。在政策干预方式上,要重点强化政府职责,一方面强化政府的筹资和分配功能,加大对基层医疗机构、医疗保障和公共卫生的投入;一方面要对医疗卫生服务的地域布局、层级结构、服务目标、服务价格和质量等方面结合市场经济的运行机制全面干预。同时要树立大卫生观念,统筹兼顾,多相关事业协调发展。
The health enterprise is the important component of the society development. The health service system is the base of health enterprise and its sustainable development is the important guarantee and component of the economy and society sustainable development. Since Chongqing’s direct jurisdiction, its economy has been developing and people’s living standard and health demand have been rising quickly. The contradiction in health enterprise has emerged and has restricted its development. In this study we summarized the development of health enterprise since Chongqing’s direct jurisdiction, analyzed the predominance and deficiency of it and established macro system dynamic (SD) model of Chongqing’s health service system. Based on the SD model, we made a series simulation experiments to analysis the dynamic behavior and internal mechanism of the system and to evaluate the sustainable development ability of Chongqing’s health enterprise. With the study results, we proposed a series policy suggestions to improve the development of the system and provided credible data support aimed at optimizing the health resources allocation. At the same time, we made some methodological exploration with the SD model first used in the study on sustainable development of health service system and extended the methods on the study.
The data used in this study included conventional statistical data including Health Statistical Data Collection of Chonging during 1997-2006, Statistical Yearbook of Chongqing during 1998-2007, Health Statistical Yearbook of China, and the data announced on the website of National Bureau of Statistics (http://www.stats.gov.cn/tjsj/ndsj/); special investigation data including the data of investigation of health service in 1998 and 2003, the data of the total health expenditure (THE) in Chongqing during 1997-2003 and 2005, the report of society development synthetic evaluation study in Chongqing in 2004, the data of survey of new rural cooperative medical system family health inquiry of Chongqing in 2005, and some other data and information such as health policies, monographs, literatures etc. The methods used in this study included qualitative and quantitative methods. We used descriptive statistics and econometrics model (such as Gini coefficient, Lorenz curve, Theil index and Data Envelop Analysis) to analyzed the natural and economical situation in Chongqing, the health service need and demand of people, health resources supply and utilization. We also used SD methods, system thinking, expert consultation, regression analysis, statistical prediction and econometrics model to established the SD model of Chongqing’s health service system sustainable development, and then we used the model by simulating runs. At last, we used the methods of systematical analysis, literature concluding, expert consultation and SD methods to made a series of policy intervention experiments to evaluate the effect of the model.
The main results of this study included:
1. The chronic non-infectious diseases have been the main causations harming people’s health. The change of disease spectrum and population aging bring the increase of health service need and demand. The health service need and demand in rural are more than those in urban. The too fast growth of medical care expenditure has been one of the severest obstacles preventing people, especially people in rural, from using the health service. The demand of public health has been increased. The problem of infectious diseases has been still serious because some infectious diseases which had been controlled revive. Especially, the prevention of AIDS has been very urgent.
2. At present, the medical service system of urban and rural, public health service system and medical security system have been established which are accordant with the development of social economy. However, to speak with the allocation and utilization of health resources, there are lots of problems such as the low total quantity and quality of health resources, the low equity and utility efficiency, the unreasonable structure of THE financing, the low level of the government investment, the imbalance of the development among health service institutions, the too fast growth of medical expenditure, the low coverage and level of medical security etc, which are seriously obstructing the development of health enterprise.
3. In the study we established SD model which had 114 variables and equations, and the effect of it was passable. The results showed that the main cause of Chongqing health service system were the low government investment and the unreasonable allocation of it, which brought the imbalance of the development among health service institutions and aim dislocation. According to current status, the increasing tendency of the percentage of personal health expenditure to THE would be controlled, but still high. The problem of high medical expenditure paid by people would not be solved radically. The maternal and child health status would be better, but the infectious diseases status would still austere. The health human resources would be optimized but still far from the national criterion. The structural illogicality would be improved but still serious.
4. In our study three policy intervention experiments were conducted under different government investment increase and different distribution projects. The results showed that with the precondition of THE’s benign increase, government health expenditure would increase 80%~100%, the priority would be given to health service system development, and the urban medical service system would be controlled properly. The distribution proportion of increased government investment to public service system, urban medical system and rural health service system might be 1.8:1.2:3:4. With the forgoing framework, the problem exposed during sustain development of health service system in Chongqing would be greatly improved.
Policy suggestion: The target should be located on preferential guarantee of people’s basic medical need. The emphases of policy intervention should firstly be public health service. Secondly, the medical resources should be allocated on the basic clinical services with low cost and high efficiency. Thirdly, those clinical services with good treatment effect but high cost should be developed restrainedly. Fourthly, those clinical services with bad effect and thigh cost should be given up. Fifthly, more attention should be put into the improvement of medical technique. The government function should be strong in the sustainable development of health service system, which means to strong the ability of government financing and distribution and to make comprehensive intervention on the constructing and development of health service system. The policy framework in the future is to establish a medical service system covering all people with no limit between urban and rural, to increase the government investment on public health and basic medical institutions, to increase the coverage and level of medical security system and to separate pharmacy from medical service.
引文
1.王小燕.卫生可持续发展模式.卫生经济研究,2002.8:13-14
2.张鹭鹭,陈群平,张义,等.军队卫生资源配置系统性分析.解放军医院管理杂志,2003,10(6):506-508
3.杨祖兴.我国城市医疗卫生服务系统结构研究.第二军医大学学位论文,2005
4.张爱胜,李锋瑞,康玲芬.系统动力学及其在区域可持续发展研究中的应用.干旱气象,2005,23(2):70-74
5.孟凯中,王斌.系统动力学在我国可持续发展战略中的研究进展.资源开发与市场,2007,23(1):78-80
6.王其藩.高级系统动力学[M].北京:清华大学出版社, 1995:3-5
7.宋世涛,魏一鸣,范英.中国可持续发展问题的系统动力学研究进展.中国人口、资源与环境,2004,14(2):42-48
8.曾国平,曹跃群.重庆市第三产业整体结构与内部结构变动分析.重庆工商大学学报,2004,4:64:66
9.胡联善.卫生经济学.上海:复旦大学出版社,2003
10.程晓明.卫生经济学[M].北京:人民卫生出版社,2003
11.陈德育,饶克勤.国家卫生服务调查结果对卫生资源调整与合理配置的启示.中国卫生事业管理,1999,10(9):465-466
12.申一帆.广州市医疗配置研究.上海:复旦大学博士学位论文,2004
13.重庆市卫生局.2003年重庆市卫生服务调查分析报告.
14.王小丽白丽萍.卫生服务需求与供给的现实思考.卫生经济研究.2000,8:17-18
15.杜乐勋,赵郁馨,高广颖.漫谈如何利用卫生总费用数据进行政策分析[J].卫生经济研究,2000.6:5-8
16.郭清,王小合,李晓惠,马海燕,汪胜,许亮文,李宇阳.Lorenz曲线和Gini系数在社区卫生服务资源配置公平性评价中的应用.中国卫生经济[J].2006,25(1):50-53
17.李晓惠.社区卫生服务资源配置评价方法研究.中国卫生统计.2006,23(3):215-217
18.龚向光,胡善联.卫生资源配置的公平性分析.中华医院管理杂志.2005,21(2):73-77
19.刘志伟.收入分配不公平程度测度方法综述.统计与信息论坛.2003,18(5):28-32
20.冯星光,张晓静.基于广义熵指数的地区差距测度与分解:1978～2003.统计信息与论坛.2005,20(4):24-29
21.林宏,陈广汉.居民收入差距测度的方法与指标.市场与人口分析.2004,10(4):63-71
22.李聪睿.计算基尼系数的算法研究及其应用.广东工业大学学报.2005,22(2):125-129
23.戴建林.基尼系数是如何计算的.浙江统计[J].2000,3:37
24.李杰,徐凌忠,邱亭林,袁勤德,伍向平,侯广军,张新林.东营市卫生资源公平性研究.现代预防医学[J].2003,30(6):799-801
25.邓苏,张晓.山东省区域经济差距的变动趋势与内部构成.东岳论丛.2006,27(4):70-75
26.史健,魏权龄. DEA方法在卫生经济学中的应用.数学的实践与认识, 2004, 34 (4) : 59-66
27.刘宏韬,房耘耘.应用DEA方法评价医院效率的研究进展.中华医院管理杂志, 2004, 20(7): 420-422
28.吴文江,刘亚俊. DEA中确定指标是输入(出)的根据及其应用.运筹与管理.2000,9(4):67-70
29.吴文江.数据包络分析及其应用[M].北京:中国统计出版社, 2002
30. Tim Goelli. A guide to DEAP version 2.1: a data envelopment analysis (computer) program.http://www.une.edu.au/econometrics/cepa.htm
31.严高剑,马添翼.关于DEA方法.科学管理研究.2005,23(2):54-56
32.郝模.我国的医疗改革还有希望吗.中国卫生经济,2006,9(2):51-52
33.刘继同.统筹城乡卫生事业发展与全民医疗保险制度建设的核心理论政策议题.人文杂志,2007,2
34.尹爱田,王丽华,钱东福.国内外卫生总费用及结构比较研究[J].中国卫生经济,2005,24(8):5-8
35.重庆市卫生局.2003年重庆市卫生服务调查分析报告.卫生部统计信息中心.中国西部地区卫生服务调查研究.北京:中国协和医科大学出版社.2004,161
36.庞瑞芝.我国城市医院经营效率实证研究.南开经济研究.2004,6:71-81
37.卫生部卫生经济研究所.2005中国卫生总费用研究报告.2005年12月
38.贡森.中国西部地区卫生服务利用状况分析.卫生部统计信息中心.《中国西部地区卫生服务调查研究》.中国协和医科大学出版社.2004:31-48
39.朱薇.重庆“新农合”三年内取消家庭账户.中央政府门户网站. http://202.123.110.5/fwxx/jk/2008-03/28/content_930812.htm
40.钱学森.论系统工程.长沙:湖南科学技术出版社,1982
41.成思危:《复杂科学与管理》,民主与建设出版社,1999
42.吴彤.复杂性研究的若干哲学问题.自然辩证法研究,2000(1):7
43.郑国基.论复杂性研究.系统辨证学学报,1996,4 (2):13-16
44.李锐锋.复杂性是系统内在的基本属性.系统辨证学学报,2002,10(4):8
45.欧崇阳,张鹭鹭,杨祖兴,李凌,于军,卢杨.卫生服务系统的复杂系统特征研究.解放军医院管理杂志2005,12(3):243-244
46.杨祖兴.我国城市医疗卫生服务系统结构研究.第二军医大学硕士论文
47.白思俊.系统工程.北京:电子工业出版社,2006.7
48.程叶青,李同升,张平宇. SD模型在区域可持续发展规划中的应用.系统工程理论与实践,2004,12:13-18
49.彼得·圣吉.第五项修炼——学习型组织的艺术与实务.上海:上海三联书店,1998
50.张文,刘家金,王明旭.中国卫生事业可持续发展研究.北京:军事医学科学出版社,2000.2
51.贺建勋.系统建模与数学模型.福建:福建科学技术出版社,1995
52.李凌.我国潜在医疗服务需求转化模型构建与机制研究.第二军医大学硕士学位论文.2006
53.谢伟斌,李炜.基于柯布-道格拉斯生产函数的我国卫生资源实证分析.中华医院管理杂志. 2006,26(4)
54.许光清,邹骥.可持续发展与系统动力学.经济理论与经济管理, 2005 (1) : 69 - 72.
55.屈谦.精心谋划“十一五”发展规划,加快重庆市卫生事业改革与发展步伐. 2006,http://www.moh.gov.cn/newshtml/16585.htm
56.国务院发展研究中心课题组.中国医疗卫生体制改革的评价与建议调研报告.国务院发展研究中心《中国发展评论》,2005年增刊1期
57.马进.卫生系统问题诊断与改革政策建议.中国卫生资源,2006,9(3):55
58.曲相艳,潘志峰,杨广伟.基本公共社区卫生服务项目界定原则的研究.中国卫生事业管理,2006,9:569-570
59.张鹭鹭,李凌,欧崇阳.基于人群健康的国家医疗卫生服务系统建模设计.第二军医大学学报. 2005 ,26( 11):1209-1212
60.许光清,邹骥.系统动力学方法:原理、特点与最新进展.哈尔滨工业大学学报(社会科学版),2006,8(4):72:77
61. Jack B. Homer, PhD. and Gary B. Hirsch, SM. System Dynamics Modeling for Public Health: Background and Opportunities. American Journal of Public Health,, 2006,96( 3):452-458
62. Homer JB. Why we iterate: scientific modeling in theory and practice. System Dynamics Rev. 1996,12:l-19.
63. Homer J. Hirsch G, Minniti M, Pierson M. Models for collaboration: how system dynamics helped a community organize cost-effective care for chronic illness. System Dynamics Rev. 2004,20:199-222
64. Homer JB, Hirsch GB. System dynamics modeling for public health: background and opportunities.
65. American Journal of Public Health 2006;96(3):452-458.
66. Dangerfield B, Fang Y. Roberts C. Model based scenarios for the epidemiology of HIV/AIDS: the consequences of highly active antiretroviral therapy. System Dynamics Rev. 2001,17:119-150
67. Royston G. Dost A, Ibwnshend J, Turner H Using system dynamics to help develop and implement policies and programmes in health care in England. System Dynamics Rev. 1999;15;293-313
68. Scblessinger L, Bddy DM. Archimedes: a new model for simulating health care systems—the mathematical formulation. J Biomed Inf 2002,35:37-50
69. G. McDonnell, M. Heffernan , A. Faulkner. Using System Dynamics to analyse Health System Performance within the WHO Framework. http://www.decisionmodelling.com/PDF/Health%20System%20Performance.pdf
70. Jones, Homer, Murphy et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation. American Journal of Public Health, March 2006.
71. Chris Benjamin. Systems Thinking: A Practical Application Participant Exercises. http://www.eval.org/SummerInstitute/06SIHandouts/SI06.Jones.BO1.Final.pdf
72. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston, MA: Irwin McGraw-Hill, 2000.
73. Sterman JD. System dynamics modeling: tools for learning in a complex world. California Management Review 2001;43(4):8-25.
74. Dangerfield B, Roberts C. Foreword to the special issue on health and health care dynamics. System Dynamics Review 1999;15(3):197-9.
75.罗乐宣,姚岚,陈渊清,陈子敏,陈启鸿,舒展.我国城市社区卫生服务机构与医院的卫生资源利用效率比较.中国医院管理,2005,25(6):63-64
76.谢小平,刘国祥,李斌,郭斌,赵郁馨.卫生服务利用公平性方法学研究.中国卫生经济,2007,26(5):74-76
77. Wagstaff A, Doorslaer AE. Measuring and Testing for Inequity in the Delivery of Health Care. Journal of Human Resurces, 2000,35 (4): 716- 733.
78.魏权龄.数据包络分析[M ].科学出版社, 2004.
79.高广颖,赵郁馨,万泉,杜乐勋.全国卫生总费用实际使用法研究.中国卫生资源,2002,5 (5):195-198
80.何平平.中国卫生总费用增长因素研究.统计与信息论坛,2006,21(1):37-41
1.张文,刘家金,王明旭.中国卫生事业可持续发展研究.北京:军事医学科学出版社,2000
2.许光清,邹骥.可持续发展与系统动力学.经济理论与经济管理2005,1:69-71
3.陈来成.论医药卫生系统的可持续发展.系统辩证学报,2001,9(3):89-91
4.成刚,王成岗,孟庆跃.应用层次分析法建立卫生技术综合评价指标体系.中国卫生资源,2006,9(5):231-232
5.徐天和.中国医学统计百科全书·统计管理与健康统计分册.北京:人民卫生出版社,2004
6.刘丽.层次分析加权法在评价医院综合效益中的应用.中国医院统计,1995 ,2 (3) :1361
7.汤少开,罗权,张锡宝.层次分析法评价广州市性病防治工作质量.中国医院统计.2005,12(2):132-134
8. Tzeng GH. Compromise solution by MCDM methods: A comparative analysis of VIKOR and TOPSIS[ J ]. Eur J Operat Res, 2004, 156(2) : 4452455.
9.史子春.综合指数法评价工业卫生工作的探讨.中国卫生统计, 2002, 9 (3) : 872188.
10.刘莉.应用综合指数法对病房医疗质量的综合评价. 2007,14(3):267-268
11.浦金辉,王蜀燕,周民伟.综合指数法评价医院科研绩效2007,14 (4):261-262
12.王一任,孙振球.医用综合评价方法研究进展.中南大学学报(医学版), 2005, 30 (2):228-232
13.李贤相,洪倩.卫生综合评价方法研究进展.实用预防医学,2003,10(6):1035-1038
14.杨永利,何钦成.我国医院综合效益评价方法的探讨.现代医院管理,2006,3:6-8
15.贺建勋.系统建模与数学模型.福建:福建科学技术出版社,1995
16.张艳娥,刘国义,孙建平,纪爱兵.医院管理决策中的运筹学思想.2006,21(2):66-67
17.吴文江.数据包络分析及其应用.北京:中国统计出版社,2002
18.蔡金文编.医用运筹学基础.上海:上海科学技术文献出版社,1987.
19.胡联善.卫生经济学.上海:复旦大学出版社,2003
20.许光清,邹骥.系统动力学方法:原理、特点与最新进展.哈尔滨工业大学学报(社会科学版),20068(4):72-77
21.谢伟斌,李炜.基于柯布-道格拉斯生产函数的我国卫生资源实证分析.中华医院管理杂志,2006,22(4):272-274
22.房俊涌,龚幼龙.疾病控制措施的经济学评价.国外医学卫生经济分册,1999,1:1-7
23.王其藩.高级系统动力学.北京:清华大学出版社, 1995:3-5
24.杨祖兴,张鹭鹭,李凌,谢长勇,马玉琴.城市医疗卫生服务系统宏观模型构建. 2005,26(11):1217-1219
25. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston, MA: Irwin McGraw-Hill, 2000.
26. Sterman JD. System dynamics modeling: tools for learning in a complex world. California Management Review 2001;43(4):8-25
27. Dangerfield B, Roberts C. Foreword to the special issue on health and health care dynamics. System Dynamics Review 1999;15(3):197-9
28. G. McDonnell, M. Heffernan , A. Faulkner. Using System Dynamics to analyse Health System Performance within the WHO Framework. http://www.decisionmodelling. com/PDF/Health%20System%20Performance.pdf
2.张鹭鹭,陈群平,张义,等.军队卫生资源配置系统性分析.解放军医院管理杂志,2003,10(6):506-508
3.杨祖兴.我国城市医疗卫生服务系统结构研究.第二军医大学学位论文,2005
4.张爱胜,李锋瑞,康玲芬.系统动力学及其在区域可持续发展研究中的应用.干旱气象,2005,23(2):70-74
5.孟凯中,王斌.系统动力学在我国可持续发展战略中的研究进展.资源开发与市场,2007,23(1):78-80
6.王其藩.高级系统动力学[M].北京:清华大学出版社, 1995:3-5
7.宋世涛,魏一鸣,范英.中国可持续发展问题的系统动力学研究进展.中国人口、资源与环境,2004,14(2):42-48
8.曾国平,曹跃群.重庆市第三产业整体结构与内部结构变动分析.重庆工商大学学报,2004,4:64:66
9.胡联善.卫生经济学.上海:复旦大学出版社,2003
10.程晓明.卫生经济学[M].北京:人民卫生出版社,2003
11.陈德育,饶克勤.国家卫生服务调查结果对卫生资源调整与合理配置的启示.中国卫生事业管理,1999,10(9):465-466
12.申一帆.广州市医疗配置研究.上海:复旦大学博士学位论文,2004
13.重庆市卫生局.2003年重庆市卫生服务调查分析报告.
14.王小丽白丽萍.卫生服务需求与供给的现实思考.卫生经济研究.2000,8:17-18
15.杜乐勋,赵郁馨,高广颖.漫谈如何利用卫生总费用数据进行政策分析[J].卫生经济研究,2000.6:5-8
16.郭清,王小合,李晓惠,马海燕,汪胜,许亮文,李宇阳.Lorenz曲线和Gini系数在社区卫生服务资源配置公平性评价中的应用.中国卫生经济[J].2006,25(1):50-53
17.李晓惠.社区卫生服务资源配置评价方法研究.中国卫生统计.2006,23(3):215-217
18.龚向光,胡善联.卫生资源配置的公平性分析.中华医院管理杂志.2005,21(2):73-77
19.刘志伟.收入分配不公平程度测度方法综述.统计与信息论坛.2003,18(5):28-32
20.冯星光,张晓静.基于广义熵指数的地区差距测度与分解:1978～2003.统计信息与论坛.2005,20(4):24-29
21.林宏,陈广汉.居民收入差距测度的方法与指标.市场与人口分析.2004,10(4):63-71
22.李聪睿.计算基尼系数的算法研究及其应用.广东工业大学学报.2005,22(2):125-129
23.戴建林.基尼系数是如何计算的.浙江统计[J].2000,3:37
24.李杰,徐凌忠,邱亭林,袁勤德,伍向平,侯广军,张新林.东营市卫生资源公平性研究.现代预防医学[J].2003,30(6):799-801
25.邓苏,张晓.山东省区域经济差距的变动趋势与内部构成.东岳论丛.2006,27(4):70-75
26.史健,魏权龄. DEA方法在卫生经济学中的应用.数学的实践与认识, 2004, 34 (4) : 59-66
27.刘宏韬,房耘耘.应用DEA方法评价医院效率的研究进展.中华医院管理杂志, 2004, 20(7): 420-422
28.吴文江,刘亚俊. DEA中确定指标是输入(出)的根据及其应用.运筹与管理.2000,9(4):67-70
29.吴文江.数据包络分析及其应用[M].北京:中国统计出版社, 2002
30. Tim Goelli. A guide to DEAP version 2.1: a data envelopment analysis (computer) program.http://www.une.edu.au/econometrics/cepa.htm
31.严高剑,马添翼.关于DEA方法.科学管理研究.2005,23(2):54-56
32.郝模.我国的医疗改革还有希望吗.中国卫生经济,2006,9(2):51-52
33.刘继同.统筹城乡卫生事业发展与全民医疗保险制度建设的核心理论政策议题.人文杂志,2007,2
34.尹爱田,王丽华,钱东福.国内外卫生总费用及结构比较研究[J].中国卫生经济,2005,24(8):5-8
35.重庆市卫生局.2003年重庆市卫生服务调查分析报告.卫生部统计信息中心.中国西部地区卫生服务调查研究.北京:中国协和医科大学出版社.2004,161
36.庞瑞芝.我国城市医院经营效率实证研究.南开经济研究.2004,6:71-81
37.卫生部卫生经济研究所.2005中国卫生总费用研究报告.2005年12月
38.贡森.中国西部地区卫生服务利用状况分析.卫生部统计信息中心.《中国西部地区卫生服务调查研究》.中国协和医科大学出版社.2004:31-48
39.朱薇.重庆“新农合”三年内取消家庭账户.中央政府门户网站. http://202.123.110.5/fwxx/jk/2008-03/28/content_930812.htm
40.钱学森.论系统工程.长沙:湖南科学技术出版社,1982
41.成思危:《复杂科学与管理》,民主与建设出版社,1999
42.吴彤.复杂性研究的若干哲学问题.自然辩证法研究,2000(1):7
43.郑国基.论复杂性研究.系统辨证学学报,1996,4 (2):13-16
44.李锐锋.复杂性是系统内在的基本属性.系统辨证学学报,2002,10(4):8
45.欧崇阳,张鹭鹭,杨祖兴,李凌,于军,卢杨.卫生服务系统的复杂系统特征研究.解放军医院管理杂志2005,12(3):243-244
46.杨祖兴.我国城市医疗卫生服务系统结构研究.第二军医大学硕士论文
47.白思俊.系统工程.北京:电子工业出版社,2006.7
48.程叶青,李同升,张平宇. SD模型在区域可持续发展规划中的应用.系统工程理论与实践,2004,12:13-18
49.彼得·圣吉.第五项修炼——学习型组织的艺术与实务.上海:上海三联书店,1998
50.张文,刘家金,王明旭.中国卫生事业可持续发展研究.北京:军事医学科学出版社,2000.2
51.贺建勋.系统建模与数学模型.福建:福建科学技术出版社,1995
52.李凌.我国潜在医疗服务需求转化模型构建与机制研究.第二军医大学硕士学位论文.2006
53.谢伟斌,李炜.基于柯布-道格拉斯生产函数的我国卫生资源实证分析.中华医院管理杂志. 2006,26(4)
54.许光清,邹骥.可持续发展与系统动力学.经济理论与经济管理, 2005 (1) : 69 - 72.
55.屈谦.精心谋划“十一五”发展规划,加快重庆市卫生事业改革与发展步伐. 2006,http://www.moh.gov.cn/newshtml/16585.htm
56.国务院发展研究中心课题组.中国医疗卫生体制改革的评价与建议调研报告.国务院发展研究中心《中国发展评论》,2005年增刊1期
57.马进.卫生系统问题诊断与改革政策建议.中国卫生资源,2006,9(3):55
58.曲相艳,潘志峰,杨广伟.基本公共社区卫生服务项目界定原则的研究.中国卫生事业管理,2006,9:569-570
59.张鹭鹭,李凌,欧崇阳.基于人群健康的国家医疗卫生服务系统建模设计.第二军医大学学报. 2005 ,26( 11):1209-1212
60.许光清,邹骥.系统动力学方法:原理、特点与最新进展.哈尔滨工业大学学报(社会科学版),2006,8(4):72:77
61. Jack B. Homer, PhD. and Gary B. Hirsch, SM. System Dynamics Modeling for Public Health: Background and Opportunities. American Journal of Public Health,, 2006,96( 3):452-458
62. Homer JB. Why we iterate: scientific modeling in theory and practice. System Dynamics Rev. 1996,12:l-19.
63. Homer J. Hirsch G, Minniti M, Pierson M. Models for collaboration: how system dynamics helped a community organize cost-effective care for chronic illness. System Dynamics Rev. 2004,20:199-222
64. Homer JB, Hirsch GB. System dynamics modeling for public health: background and opportunities.
65. American Journal of Public Health 2006;96(3):452-458.
66. Dangerfield B, Fang Y. Roberts C. Model based scenarios for the epidemiology of HIV/AIDS: the consequences of highly active antiretroviral therapy. System Dynamics Rev. 2001,17:119-150
67. Royston G. Dost A, Ibwnshend J, Turner H Using system dynamics to help develop and implement policies and programmes in health care in England. System Dynamics Rev. 1999;15;293-313
68. Scblessinger L, Bddy DM. Archimedes: a new model for simulating health care systems—the mathematical formulation. J Biomed Inf 2002,35:37-50
69. G. McDonnell, M. Heffernan , A. Faulkner. Using System Dynamics to analyse Health System Performance within the WHO Framework. http://www.decisionmodelling.com/PDF/Health%20System%20Performance.pdf
70. Jones, Homer, Murphy et al. Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation. American Journal of Public Health, March 2006.
71. Chris Benjamin. Systems Thinking: A Practical Application Participant Exercises. http://www.eval.org/SummerInstitute/06SIHandouts/SI06.Jones.BO1.Final.pdf
72. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston, MA: Irwin McGraw-Hill, 2000.
73. Sterman JD. System dynamics modeling: tools for learning in a complex world. California Management Review 2001;43(4):8-25.
74. Dangerfield B, Roberts C. Foreword to the special issue on health and health care dynamics. System Dynamics Review 1999;15(3):197-9.
75.罗乐宣,姚岚,陈渊清,陈子敏,陈启鸿,舒展.我国城市社区卫生服务机构与医院的卫生资源利用效率比较.中国医院管理,2005,25(6):63-64
76.谢小平,刘国祥,李斌,郭斌,赵郁馨.卫生服务利用公平性方法学研究.中国卫生经济,2007,26(5):74-76
77. Wagstaff A, Doorslaer AE. Measuring and Testing for Inequity in the Delivery of Health Care. Journal of Human Resurces, 2000,35 (4): 716- 733.
78.魏权龄.数据包络分析[M ].科学出版社, 2004.
79.高广颖,赵郁馨,万泉,杜乐勋.全国卫生总费用实际使用法研究.中国卫生资源,2002,5 (5):195-198
80.何平平.中国卫生总费用增长因素研究.统计与信息论坛,2006,21(1):37-41
1.张文,刘家金,王明旭.中国卫生事业可持续发展研究.北京:军事医学科学出版社,2000
2.许光清,邹骥.可持续发展与系统动力学.经济理论与经济管理2005,1:69-71
3.陈来成.论医药卫生系统的可持续发展.系统辩证学报,2001,9(3):89-91
4.成刚,王成岗,孟庆跃.应用层次分析法建立卫生技术综合评价指标体系.中国卫生资源,2006,9(5):231-232
5.徐天和.中国医学统计百科全书·统计管理与健康统计分册.北京:人民卫生出版社,2004
6.刘丽.层次分析加权法在评价医院综合效益中的应用.中国医院统计,1995 ,2 (3) :1361
7.汤少开,罗权,张锡宝.层次分析法评价广州市性病防治工作质量.中国医院统计.2005,12(2):132-134
8. Tzeng GH. Compromise solution by MCDM methods: A comparative analysis of VIKOR and TOPSIS[ J ]. Eur J Operat Res, 2004, 156(2) : 4452455.
9.史子春.综合指数法评价工业卫生工作的探讨.中国卫生统计, 2002, 9 (3) : 872188.
10.刘莉.应用综合指数法对病房医疗质量的综合评价. 2007,14(3):267-268
11.浦金辉,王蜀燕,周民伟.综合指数法评价医院科研绩效2007,14 (4):261-262
12.王一任,孙振球.医用综合评价方法研究进展.中南大学学报(医学版), 2005, 30 (2):228-232
13.李贤相,洪倩.卫生综合评价方法研究进展.实用预防医学,2003,10(6):1035-1038
14.杨永利,何钦成.我国医院综合效益评价方法的探讨.现代医院管理,2006,3:6-8
15.贺建勋.系统建模与数学模型.福建:福建科学技术出版社,1995
16.张艳娥,刘国义,孙建平,纪爱兵.医院管理决策中的运筹学思想.2006,21(2):66-67
17.吴文江.数据包络分析及其应用.北京:中国统计出版社,2002
18.蔡金文编.医用运筹学基础.上海:上海科学技术文献出版社,1987.
19.胡联善.卫生经济学.上海:复旦大学出版社,2003
20.许光清,邹骥.系统动力学方法:原理、特点与最新进展.哈尔滨工业大学学报(社会科学版),20068(4):72-77
21.谢伟斌,李炜.基于柯布-道格拉斯生产函数的我国卫生资源实证分析.中华医院管理杂志,2006,22(4):272-274
22.房俊涌,龚幼龙.疾病控制措施的经济学评价.国外医学卫生经济分册,1999,1:1-7
23.王其藩.高级系统动力学.北京:清华大学出版社, 1995:3-5
24.杨祖兴,张鹭鹭,李凌,谢长勇,马玉琴.城市医疗卫生服务系统宏观模型构建. 2005,26(11):1217-1219
25. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston, MA: Irwin McGraw-Hill, 2000.
26. Sterman JD. System dynamics modeling: tools for learning in a complex world. California Management Review 2001;43(4):8-25
27. Dangerfield B, Roberts C. Foreword to the special issue on health and health care dynamics. System Dynamics Review 1999;15(3):197-9
28. G. McDonnell, M. Heffernan , A. Faulkner. Using System Dynamics to analyse Health System Performance within the WHO Framework. http://www.decisionmodelling. com/PDF/Health%20System%20Performance.pdf
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