【作者】 张强；

【导师】 王丽亚；

【作者基本信息】 上海交通大学 ， 工业工程， 2018， 硕士

【摘要】 实施医院间的医疗信息共享能够缓解我国“看病难、看病贵”的社会问题,促进医疗资源的有效利用,同时是推进医疗改革的必须基础,也是医疗服务现代化的必然要求。我国政府近年来大力推进医院间信息共享,然而医院考虑到自身收益、成本、风险等因素,往往难以自发进行信息共享。针对这一问题,本文将从医院间信息共享的影响因素、医院参与信息共享的演化过程以及信息共享的激励机制三个方面进行研究。首先,本文结合我国医疗机构的特点及医疗信息共享的现状,对医院间信息共享的影响因素进行了实证研究。通过文献总结与半结构化访谈的方式归纳出了五类影响因素,并提出了假设模型;而后通过基于情景角色扮演实验的试验设计,以问卷为载体进行实验,并采用自助重抽样法对数据进行处理和分析,对假设模型进行了验证、修正和解释。研究得到医院在参与共享中受到的外部强制力、医院参与共享的效益-风险比以及医院对信息共享的认知水平的提高均能提升医院的信息共享意愿。随后,本文分析了在政府奖惩政策作用下,医院群体参与信息共享的演化过程及均衡结果。结合我国当前正在推行的医联体医院间信息共享运作模式,引入梅特卡夫定律并考虑患者评价的影响,分析了政府部门与医院各自的利益组成,建立了政府部门与医院两者之间的演化博弈模型,并采用复制动态方程研究了不同情形下医院间信息共享的演化博弈轨迹。研究表明,降低医院主体信息共享的风险成本、规范提高医院共享信息的质量、引导患者增强对医院信息共享的关注、制定有吸引力和威慑力的奖惩政策,是促进医院医疗信息共享的关键。研究结果可为政府监管部门预测医院间的信息共享趋势和制定精准化政策以促进信息共享提供参考。最后,本文研究了政府如何为不同医院设计最有效的激励机制,从而提高医院参与信息共享的努力程度。基于医联体模式下医疗信息共享的过程与特征引入信息“互补性”和“可用性”的概念,综合考虑医疗信息共享过程中医院的信息贡献和使用行为,基于委托代理理论为政府部门构建了对称信息和不对称信息两种条件下,医院分别为风险中性和风险规避时的多阶段医疗信息共享激励机制模型。研究结果表明,当信息不对称且医院为风险规避时,最优激励系数与信息存量、信息互补性、可用性以及单位信息预期效益正相关,与医院的努力成本系数、风险成本系数、风险规避系数以及随机因素方差负相关。更多还原

【Abstract】 Implementing medical information sharing among hospitals can alleviate the social problems of “difficulties and high expense in medical care” and promote the effective use of medical resources.At the same time,it is a necessary basis for medical reforms and an inevitable requirement for the modernization of medical services.In recent years,the Chinese government has been promoting medical information sharing among hospitals.However,hospitals do not spontaneously participate in the information sharing process in consideration of their own benefits,costs,and risks.To deal with this problem,we carried out our study in three aspects of information sharing among hospitals: the influencing factors,the evolution process,and the incentive mechanism.Firstly,based on the characteristics of medical institutions in China and the current status of medical information sharing,we conduct an empirical study of the influencing factors of information sharing among hospitals.Through literature review and serval semi-structed interview,we summed up 5 kinds of factors.Followed by a scenario-based experiment,we find that the increase of external force,hospitals’ benefit-risk ratio and recognition can significantly promote information sharing between hospitals.Afterwards,we analyzed the evolution process and equilibrium results of hospital group participate in information sharing under the government’s policy.Based on the information sharing process of the Medical Consortium in China,we introduced the Metcalfe’s law and patients’ supervision,the interests of the governments and hospitals are analyzed.An evolutionary game model between hospitals and governments is established and the equilibrium state under different conditions are studied by solving the replicator dynamic equations.The results showed that reducing the risk cost of information sharing,standardizing and improving the quality of information sharing in the hospital,encouraging patients to supervise hospitals behavior of information sharing,making attractive reward and proper punishment policy are the key factors to promote the medical information sharing.The results can provide a reference for governments to evaluate the information sharing trend of the hospital and to establish incentive and punishment mechanism to stimulate medical information sharing.Finally,we studied how to design the most effective incentive mechanism for different hospitals.We constructed a multi-stage healthcare information-sharing incentive model with consider of symmetric and asymmetric information backgrounds,and risk neutral and risk aversion hospitals.The modeling progress is based on principal-agent theory in consideration of the features of the Medical Consortium,and in which we proposed the concepts of information “complementarity” and “usability” to measure the using and sharing behaviors of the hospital.The results showed that when the regulatory authorities have asymmetric information of the risk averse hospitals’ sharing efforts,the optimal incentive coefficient has a positive correlation with the information inventory,the information complementarity or usability as well as the expected benefits of unit information,but has a negative correlation with the hospitals’ cost coefficient,the risk cost factor,risk aversion ratio and variance of random factors.更多还原