内 容 简 介
本书采取单因素与多因素统计推断分析、专家咨询与层次分析法、战略
管理理论与方法、利益相关者理论与方法、新制度经济学理论与方法等定性
与定量方法，阐述国内外医疗服务体系发展状况，进行城市医疗服务体系整
合的理论分析，并结合典型案例调查，分析整合的环境及有关动力、阻力，
分析城市医疗服务体系整合的利益相关者影响，评估城市医疗服务体系整合
的协作服务效果。本书还尝试用新制度经济分析法来解析医疗服务体系整合
的交易费用、产权问题、制度安排与变迁，最后进行了讨论分析，并在此基
础上提出总体性政策建议与研究展望。
样章试读
目录
- 目录
第一章绪论 ······································································· 1
一、研究背景 ··············································································· 1 二、研究意义 ··············································································· 5 三、研究目的和内容安排 ································································ 6 （一）研究目的 ······································································ 6 （二）研究内容 ······································································ 7 （三）结构安排 ······································································ 9 四、核心概念界定 ······································································· 10五、小结···················································································· 13
第二章城市医疗服务体系整合的研究进展 ·······························15
一、医疗服务体系及其整合 ··························································· 15（一）整合的概念 ································································· 15（二）医疗服务体系整合的概念 ··············································· 17二、国外城市医疗服务体系整合研究进展 ········································· 21三、国内城市医疗服务体系整合研究进展 ········································· 27四、国内外研究进展的启示 ··························································· 29五、小结 ··················································································· 30
第三章城市医疗服务体系整合的理论基础和研究方法 ················34
一、城市医疗服务体系整合的理论基础 ············································ 34（一）系统论 ······································································· 34（二）战略分析 ···································································· 35（三）新制度经济学理论 ························································ 36（四）患者就医选择和行为理论 ··············································· 39二、理论框架和技术路线 ······························································ 43（一）理论框架 ···································································· 43
（二）技术路线 ···································································· 44
三、资料和方法 ·········································································· 44（一）研究现场和资料来源 ····················································· 44（二）抽样方法 ···································································· 45（三）调查工具和方法 ··························································· 46（四）研究分析方法 ······························································ 46（五）质量控制方法 ······························································ 47
四、小结···················································································· 48
第四章城市医疗服务体系发展现状及有关就医流向分析 ·············50
一、国外医疗服务体系及其内部协作的比较研究 ································ 50（一）英国 ·········································································· 50（二）美国 ·········································································· 51（三）澳大利亚 ···································································· 51（四）加拿大 ······································································· 52（五）德国 ·········································································· 53（六）古巴 ·········································································· 53（七）新西兰 ······································································· 53
二、国内城市医疗服务体系发展现状及其就医流向 ····························· 54（一）国内城市医疗服务体系发展现状 ······································ 54（二）国内城市医疗服务体系发展背景下的患者就医流向分析 ········ 55（三）就医流向分析结果的讨论 ··············································· 69
三、国内城市医疗服务体系整合发展历程 ········································· 71（一）国内城市医疗服务体系整合发展阶段 ································ 71（二）国内城市医疗服务体系整合模式 ······································ 74
四、医疗服务体系整合后有关业务量与次均费用变化的案例分析 ··········· 91（一）镇江市、扬州市基本情况比较 ········································· 92（二）城市医疗机构业务量变化分析 ········································· 93（三）城市医疗机构次均费用分析 ············································ 94
五、城市医疗服务体系发展现状及有关就医流向分析的讨论与建议 ········ 96
六、小结···················································································· 99
第五章城市医疗服务体系整合的战略分析 ····························· 102
一、战略分析的基本内容 ····························································· 102（一）PEST分析模型及其应用情况介绍 ··································· 102 （二）SWOT分析法介绍及应用情况 ········································ 103
二、城市医疗服务体系整合的 PEST分析 ········································· 104（一）政治环境分析 ····························································· 104（二）经济环境分析 ····························································· 107（三）社会文化因素 ····························································· 108（四）技术因素 ··································································· 109
三、城市医疗服务体系整合中的 SWOT分析 ···································· 110（一）镇江市医疗服务体系整合的优势 ····································· 111（二）镇江市医疗服务体系整合的劣势 ····································· 112（三）镇江市医疗服务体系整合的机会 ····································· 112（四）镇江市医疗服务体系整合的外部威胁 ······························· 113
四、城市医疗服务体系整合的战略分析讨论 ····································· 113（一）管理体制方面 ····························································· 113（二）医疗保障制度方面 ······················································· 114（三）社区卫生服务机构能力方面 ··········································· 114（四）大医院动力与积极性 ···················································· 115
五、小结··················································································· 115
第六章城市医疗服务体系整合的利益相关者定量与定性分析 ····· 116
一、城市医疗服务体系整合的利益相关者定量模型分析 ······················ 116（一）利益相关者分析理论及其在卫生领域中的应用 ··················· 116（二）医疗服务纵向整合的利益相关者分析模型 ························· 118（三）医疗服务纵向整合的利益相关者案例分析 ························· 119（四）医疗服务纵向整合的利益协调策略 ·································· 122
二、城市医疗服务体系整合的定性访谈分析 ····································· 123（一）定性访谈实施情况 ······················································· 123（二）医疗服务体系整合障碍因素的案例分析 ···························· 124（三）定性访谈的讨论与建议 ················································· 129
三、小结··················································································· 132
第七章城市医疗服务体系整合的认知评价研究 ·························· 134
一、城市医疗服务体系整合的“结构 -过程-结果”评价研究 ···················· 134（一）“结构-过程-结果”模型介绍 ··········································· 134（二）镇江市医疗服务体系整合的“结构-过程-结果”评价分析 ········ 135（三）“结构-过程-结果”评价的讨论与建议 ······························· 146
二、城市医疗服务体系整合的认知评价研究 ····································· 150（一）认知评价研究实施情况 ················································· 150（二）医务人员对镇江市医疗服务体系整合的认知评价分析 ·········· 151（三）患者对镇江市医疗服务体系整合的认知评价分析 ················ 155（四）认知评价研究的讨论与建议 ··········································· 157三、小结··················································································· 162
第八章城市医疗服务体系整合的障碍因素分析 ·························· 164
一、咨询专家构成情况 ································································ 164二、影响因素指标体系的筛选 ······················································· 167（一）影响因素指标体系初稿的设计与筛选 ······························· 167（二）第一轮影响因素指标筛选与结果汇总 ······························· 167（三）第二轮影响因素指标筛选与结果汇总 ······························· 172（四）指标认同度分析 ·························································· 175三、影响因素指标权重的研究 ······················································· 176（一）层次分析法 ································································ 176（二）求判断矩阵 ································································ 178（三）最终指标与权重表 ······················································· 180四、讨论与建议 ········································································· 182（一）结果讨论 ··································································· 182（二）建议 ········································································· 183五、小结··················································································· 184
第九章医疗服务体系整合的新制度经济学分析 ·························· 186
一、医疗服务体系整合的交易费用分析 ··········································· 187（一）交易费用理论 ····························································· 187（二）医疗服务体系整合的交易费用分析 ·································· 189二、医疗服务体系整合的产权理论分析 ··········································· 197（一）产权与产权理论 ·························································· 197（二）产权制度 ··································································· 198（三）医疗服务体系整合的产权问题分析 ·································· 199三、医疗服务体系整合的制度变迁分析 ··········································· 200（一）制度与制度变迁 ·························································· 200（二）以制度变迁视角分析医疗服务体系整合 ···························· 203四、小结··················································································· 212
第十章总体结论和政策建议 ··············································· 214
一、总体讨论 ············································································ 214（一）方法学讨论 ································································ 214（二）内容分析讨论 ····························································· 216（三）研究的创新和不足 ······················································· 224（四）总体结论 ··································································· 224二、总体政策建议 ······································································ 225（一）服务整合 ··································································· 225（二）医师团队整合 ····························································· 226（三）信息整合 ··································································· 227（四）学科整合 ··································································· 228三、研究展望 ············································································ 228四、小结··················································································· 230
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