职业病防治绩效评价及分析研究

发布时间：2018-05-29 23:39

本文选题：职业病防治 + 绩效评价　；参考：《山东大学》2014年博士论文

【摘要】：研究背景职业健康问题是全球所面临的严重问题之一,是经济发展,特别是工业化进程的产物,但因其外部性、公共产品的特征,仅仅依靠市场机制这只“无形的手”无法有效解决这一难题,因此作为公共服务的提供者,政府在职业病防治领域负有高度的责任,职业病防治工作是政府公共服务的重要组成部分。但片面的发展观和以经济增长为核心的政绩考核机制,均制约了我国职业病防治工作的开展。因此,在职业病防治领域,政府失灵与市场失灵并存,而前者突出表现在管理不力和效率低下。目前我国已处于职业病的高发期和矛盾凸显期,职业病患者人数、死亡人数均位居世界首位,职业病已成为重大的公共卫生问题和社会问题。职业病防治形势日益严峻的现实,迫使我们产生以下疑惑“我国职业病防治工作是否有效,绩效几何”,因此,以何标准衡量我国职业病防治工作所取得的成绩,如何客观、公正的对我国职业病防治投入、产出以及结果进行综合评价,成为各级政府关注的问题,也是职业病防治领域理论研究者以及实践工作者亟待解决的问题。但目前国内外关于职业病防治绩效评价的研究极少,而职业病防治绩效评价的实施对强化责任、监控进程、界定成败影响因素和提供实证依据有着十分重要的意义,因此本研究致力于解决这一难题,通过绩效评价提高职业病防治资源的利用效率,改善职业病防治的服务质量,切实维护劳动者的健康权益。研究目的基于上述背景,本研究以职业病防治绩效评价为主题,旨在通过构建职业病防治绩效评价体系,对我国职业病防治的绩效做出科学、公正的评价,并确定关键制约因素以及其内在根源,从而为相关部门采取针对性的改进措施提供客观依据。具体目标为： 1、构建以行政区域为对象的职业病防治绩效评价体系,包括指标体系的构建、基础数据集的建立、评价模型的确定以及评价标准的形成等。 2、通过对样本地区的实证研究,对构建的评价体系进行检验,并对样本地区进行诊断缺陷,发现薄弱环节,为针对性改进措施的实施提供依据。 3、确定制约我国职业病防治绩效的内在根源。研究方法针对以上研究目的,本研究按照一般与特殊相结合,理论与实证相结合,系统与局部相结合,内在与外在相结合的方法论原则,采用理论方法与实证方法两大类手法,通过对行政区域职业病防治绩效进行评价,提出进一步完善和发展我国职业病防治体系的政策建议,以供决策者参考。本研究所采用的对应研究方法如下： 1、首先通过相关政策分析、文献复习和专题访谈确定了职业病防治绩效概念模型； 2、通过小组研讨、专家访谈和现场调研对指标进行初选,然后通过两轮Delphi专家咨询和离散趋势分析筛选出最终指标,进而采用主客观赋权法确定各指标的权重,然后经过专家咨询和论证,确定指标的标准值和收集方式等； 3、在文献复习的基础上,通过专家咨询确定职业病防治绩效不可控因素,然后利用偏最小二乘回归法构建这些因素与职业病防治绩效指数的回归模型,然后,通过建立样本地区内部影响因素矩阵,计算出“环境有利度”； 4、选择山东省九个地级市为样本,将构建的职业病防治绩效评价体系运用于实证研究,利用从样本地区收集的资料,分别应用克朗巴赫α系数、主成分分析和聚类分析,检验指标体系的信度、效度和区分度,采用综合指数法评价样本地区的职业病防治绩效； 5、采用规范分析的方法,借鉴经典的委托代理模型以及成本收益模型,对我国职业病防治绩效不佳的内在根源进行探讨。主要研究结果本研究的主要研究结果包括： 1、建立了职业病防治绩效的概念模型,包括投入、活动、产出、结果、影响及环境等维度。 2、构建了职业病防治绩效评价指标体系,包括投入、产出和结果三个一级指标,其中投入维度包括有形投入和无形投入两个二级指标,产出维度包括服务提供、行业自律和依法行政三个二级指标,结果维度包括健康促进和社会影响两个二级指标,共计22个三级指标,并确定了各指标的权重和标准值。与之相对应,基础数据集、评价模型以及评价标准的形成,最终形成职业病防治绩效评价体系。 3、为了确保职业病防治绩效评价结果的横向可比性,本研究构建了职业病防治绩效不可控因素模型,包括政治、经济、社会和技术等维度,共计十个指标,其中,人均GDP、规模以上工业万元增加值能耗、财政赤字率、第二产业比重、城镇登记失业率以及职业病危害因素接触率与职业病防治绩效呈负相关,RD投入占GDP的比例、规模以上工业产值中高新技术产业比重、卫生技术人员千人拥有量、大专以上文凭所占比重与职业病防治绩效呈正相关。并在此基础上计算出这些不可控因素对样本地区的“环境有利度”。 4、建立了职业病防治绩效评价指标体系使用指南,针对三级指标制定了具体的测量公式、数据收集方式以及评价的标准值。 5、利用构建的职业病防治绩效评价体系对山东省9个地级市职业病防治的现状进行了综合评价,评价结果显示：按照绩效从高到低依次排序为济南市、潍坊市、聊城市、烟台市、莱芜市、济宁市、威海市、枣庄市和菏泽市。本研究将绩效分为好、较好、一般、较差和差五类,按照分类标准,前七个市绩效类别为“一般”,枣庄市和菏泽市绩效类别为“较差”。 6、中央政府与地方政府的信息不对称以及目标函数的不一致,使得其在职业病防治领域存在严重的委托代理问题,主要表现在地方政府倾向于选择放松职业病防治,甚至直接非正当干预职业病防治工作的开展,成为一些企业的保护伞。 7、目前我国职业病防治体系及制度的不完善,使得用人单位缺乏自觉开展职业病防治工作的积极性。结论和建议通过理论分析和实证研究,结合我国相关政策,提出如下政策建议： 1、落实各级政府和相关部门的责任,加强组织领导是前提 2、加强职业病防治能力建设是基础 3、加强对用人单位的监管,强化其责任主体的地位是重点 4、加强政策引导,提高职业病防治各相关责任体的内在动力是关键 (1)制定有利于职业健康的产业政策,充分发挥产业政策导向和市场机制的作用,鼓励和引导用人单位采用先进的技术、装备和工艺。 (2)完善中央政府与地方政府之间的转移支付机制,建立中央政府-地方政府安全健康生产基金,中央政府根据地方政府的政策执行情况,按照一定比例从税收中返还给地方政府。 (3)完善我国工伤保险制度,对工伤保险金的使用范围进行相应的改革,建立弹性工伤保险金制度。 (4)实行更为严格的考核和责任追究制度,严格落实职业病防治目标考核制度,对各级政府、相关职能部门以及用人单位完成年度职业病防治指标情况进行严格考核,并建立相应的奖惩制度。 (5)实施用人单位职业健康公示和承诺制度,用人单位必须定期公示本单位职业健康的基本信息。创新与不足本研究的创新有以下几个方面: 1、理论创新目前关于我国职业病防治绩效不佳的原因的探讨众多,但大都浮于表面,本研究借鉴经典的经济学原理,从委托代理以及成本-收益两个方面,分别对政府和用人单位开展职业病防治工作的内在动力进行探讨,从而确定了我国职业病防治绩效不佳的内在根源,那就是无论是地方政府还是用人单位都是“经济人”,它们均缺乏自觉开展职业病防治活动的积极性。 2、实践创新目前的研究多集中在对用人单位职业卫生管理效果的评价上,本文的研究目标定位于区域性的职业病防治绩效评价,构建了一套科学、合理的职业病防治绩效评价体系,并进行了实证研究,对于强化责任、监控进程、界定成败影响因素和提供实证依据有着十分重要的实践意义。 3、方法创新如何剔除不可控因素的干扰一直是评价领域的一个难题,本研究通过PLS模型构建了不可控因素与职业病防治绩效的回归方程,并结合内部影响因素模型,定量测量职业病防治绩效不可控因素的作用,计算出每个评价区域的“环境有利度”,从而可以剔除这些不可控的环境因素的影响,实现了区域之间的横向比较。但是职业病防治绩效评价是一个复杂的系统工程,同时,由于作者能力和精力所限,本研究尚存在一些不足之处： (1)由于职业病是一个笼统的概念,它包含很多种疾病,不同的职业病危害需要采取的防治措施不同,因此所需要的资源也相应不同。本研究没有对其进行细分,因此,需要进一步的完善。 (2)本研究利用“环境有利度”对职业病防治绩效进行校正,但也仅限于综合绩效指数,而没有对三级指标进行校正。 (3)本研究虽然剔除了一些不可控因素的干扰,但由于本研究以行政区域为评价对象,因此,不能采取实验或准实验研究的方法(因为没有那个区域完全不采取职业病防治措施),进行严格的因果论证,虽然是条件所限,但仍是缺憾之处。 (4)目前我国职业健康形势不佳是受到政治、经济、社会、文化等多方面制约引起的,本研究仅从经济学角度对其进行探讨。
[Abstract]:Research background
The problem of occupational health is one of the serious problems facing the world. It is the product of economic development, especially the process of industrialization, but because of its externality and the characteristics of the public products, only the "invisible hand" of the market mechanism can not solve this problem effectively. Therefore, as a provider of public service, the government is negative in the field of occupational disease control. The occupational disease prevention and control work is an important part of the government's public service. However, the one-sided view of development and the performance assessment mechanism at the core of economic growth have restricted the development of occupational disease prevention and control in China. Therefore, in the field of occupational disease prevention, the government failure and market failure coexist, and the former is highlighted in the management. Inefficiency and inefficiency.
At present, our country has been in the period of high incidence of occupational disease and the period of contradiction, the number of patients and the number of deaths are in the first place in the world, and occupational disease has become a major public health and social problem. The increasingly serious reality of the occupational disease prevention and control forces us to produce the following doubts, "whether the work of prevention and control of occupational diseases in China is effective, and the performance of the occupational disease prevention and control is effective." Therefore, how to measure the achievements of the occupational disease prevention and control work in China, how to objectively and impartially evaluate the input, output and results of occupational disease prevention and control in China has become the concern of the governments at all levels, and also the urgent problems to be solved by the theoretical researchers and the practice workers in the field of occupational disease control. There are few studies on the performance evaluation of occupational disease prevention and treatment at home and abroad, and the implementation of occupational disease prevention and control performance evaluation is of great significance to strengthening responsibility, monitoring process, defining the influencing factors of success or failure and providing empirical evidence. Therefore, this study aims to solve this problem and improve the utilization of occupational disease prevention and control resources through performance evaluation. Efficiency, improve the service quality of occupational disease prevention and control, and earnestly safeguard workers' health rights and interests.
research objective
Based on the above background, this study focuses on the performance evaluation of occupational disease prevention and control, and aims to make a scientific and impartial evaluation of the performance of occupational disease prevention and control in China through the construction of the performance evaluation system of occupational disease prevention and control, and to determine the key constraints and its internal root causes, thus providing objective dependence for the relevant departments to take pertinent improvement measures. The specific objectives are:
1, constructing the evaluation system of occupational disease prevention and control based on the administrative region, including the construction of the index system, the establishment of the basic data set, the determination of the evaluation model and the formation of the evaluation standard.
2, through the empirical study of the sample area, the evaluation system is tested, and the diagnostic defects are found in the sample area, and the weak link is found, which provides the basis for the implementation of the targeted improvement measures.
3, identify the internal causes that restrict the performance of occupational disease prevention and control in China.
research method
In view of the above research purposes, this study is based on the combination of general and special, combining theory with demonstration, the combination of the system and the local, the principle of combining the internal and external methods, using two kinds of methods, both theoretical and empirical, through the evaluation of the performance of occupational disease prevention and control in administrative regions, and to further improve and develop our country. Policy recommendations for occupational disease prevention and control system are provided for decision makers.
The corresponding research methods used in this study are as follows:
1, first, through relevant policy analysis, literature review and special interview, the concept model of occupational disease prevention and control performance is established.
2, through group discussion, expert interview and field investigation, the index is selected, then the final index is selected through two rounds of Delphi expert consultation and discrete trend analysis, then the weight of each index is determined by the subjective and objective empowerment method, and then the standard value and collection method of the index are determined by expert consultation and demonstration.
3, on the basis of literature review, the uncontrollable factors of occupational disease prevention and control are determined by expert consultation. Then the regression model of these factors and occupational disease prevention performance index is constructed by using partial least squares regression method. Then, the "environment advantage" is calculated by establishing the matrix of the internal influence factors in the sample area.
4, nine cities in Shandong province are selected as samples, and the construction of occupational disease prevention and control performance evaluation system is applied to the empirical study. Using the data collected from the sample area, the Krone Bach alpha coefficient, principal component analysis and cluster analysis are applied to test the reliability, efficiency and division of the index system, and the comprehensive index method is used to evaluate the sample area. Performance of occupational disease prevention and treatment;
5, using the standard analysis method and using the classic principal-agent model and the cost income model, this paper discusses the internal root cause of the poor performance of occupational disease control in China.
Main research results
The main findings of this study include:
1, we set up a conceptual model of occupational disease prevention and control performance, including input, activity, output, results, impact and environment.
2, the performance evaluation index system of occupational disease prevention and control is constructed, including three first level indicators of input, output and result. The input dimension includes two two levels of tangible input and intangible input. The output dimension includes service provision, industry self-discipline and three two level indicators of administration according to law, and the result dimension includes two two of health promotion and social impact. Level index, a total of 22 three level indicators, and determine the weight and standard value of each index. Corresponding to it, the formation of the basic data set, evaluation model and evaluation standard, and finally form the performance evaluation system of occupational disease prevention and control.
3, in order to ensure the lateral comparability of the results of occupational disease prevention and control performance evaluation, this study constructs an uncontrollable factor model of occupational disease prevention and control, including ten indicators, including political, economic, social and technical dimensions, including the per capita GDP, the increase in energy consumption, the fiscal deficit rate, the second industry proportion, and the loss of urban registration. The ratio of occupational disease risk factors and occupational disease risk factors is negatively related to the performance of occupational disease control, the proportion of RD investment in GDP, the proportion of high and new technology industry in the industrial output value above the scale of the scale, the number of thousands of health technicians, the proportion of Higher Education and above and the performance of occupational disease prevention and control, and the uncontrollable calculation on this basis. The "environmental benefits" of the factors to the sample area.
4, we set up a guide for the performance evaluation index system of occupational disease prevention and control, and set up a specific measurement formula, data collection method and the standard value of evaluation for the three level indicators.
5, we evaluated the current situation of occupational disease prevention in 9 prefecture level cities of Shandong province by using the performance evaluation system of occupational disease prevention and control.
According to the performance from high to low ranking in order of Ji'nan, Weifang, Liaocheng, Yantai, Laiwu, Jining, Weihai, Zaozhuang and Heze. The performance is divided into good, good, general, poor and poor five categories, according to the classification standard, the first seven city performance categories are "general", Zaozhuang city and Heze city performance category is "poor".
6, the information asymmetry between the central government and the local government and the inconsistency of the target function make it have serious principal-agent problems in the field of occupational disease prevention and control, which is mainly manifested in the tendency of local governments to choose the prevention and control of occupational diseases, even the direct and non legitimate intervention of occupational disease prevention and control, and become the protection umbrella of some enterprises.
7, the current system of occupational disease prevention and control in China is imperfect, which makes employers lack the initiative to carry out occupational disease prevention and control.
Conclusions and suggestions
Through theoretical analysis and empirical research, combined with China's relevant policies, the following policy recommendations are put forward:
1, it is a prerequisite to implement the responsibilities of governments at all levels and related departments and strengthen organizational leadership.
2, strengthening the construction of occupational disease prevention and control is the basis
3, it is the key to strengthen the supervision of employers and strengthen the status of their responsibilities.
4, to strengthen policy guidance and improve the internal motivation of various responsible bodies of occupational disease prevention is the key.
(1) to formulate industrial policies conducive to occupational health, to give full play to the role of industrial policy guidance and market mechanism, to encourage and guide employers to adopt advanced technology, equipment and technology.
(2) improve the transfer payment mechanism between the central government and the local government, establish the central government - local government safe and healthy production fund, the central government, according to the implementation of local government policy, return to the local government from the tax revenue in a certain proportion.
(3) improve the industrial injury insurance system in China, reform the scope of work injury insurance premium, and establish a flexible industrial injury insurance system.
(4) to implement a more stringent system of assessment and accountability, strictly implement the system of assessment of occupational disease prevention and prevention, to carry out a strict assessment of the annual occupational disease prevention and control indicators for governments at all levels, relevant functional departments and employers, and to establish a corresponding reward and punishment system.
(5) implementation of the employer's occupational health publicity and commitment system, the employer must regularly publicized the basic information of occupational health of the unit.
Innovation and deficiency
The innovation of this research has the following aspects:
1, theoretical innovation
At present, there are many reasons for the poor performance of occupational disease prevention and treatment in China, but most of them float on the surface. This study, referring to the classic economic principles, discusses the internal motivation of the government and the employing units in the two aspects of the principal and the cost and income, so as to determine the occupational disease prevention in China. The internal root of poor governance is that both local governments and employers are "economic people", and they are all lack of initiative to carry out occupational disease prevention and control activities.
2, practical innovation
The current research focuses on the evaluation of the effectiveness of occupational health management for employers. The aim of this study is to evaluate the performance evaluation of regional occupational disease prevention and control. A set of scientific and reasonable performance evaluation system for occupational disease prevention and control is constructed, and an empirical study is carried out to strengthen the responsibility, monitor the process, and define the factors affecting the success or failure of the disease. It is of great practical significance to provide empirical evidence.
3, method innovation
How to eliminate the disturbance of uncontrollable factors is a difficult problem in the field of evaluation. In this study, the regression equation of uncontrollable factors and occupational disease prevention and control performance is constructed by PLS model, and combined with the internal influence factor model, the quantitative measurement of the uncontrollable factors of occupational disease prevention and control is used to calculate the "environment favorable" in each evaluation area. It can eliminate the influence of these uncontrollable environmental factors and achieve a horizontal comparison between regions.
However, occupational disease prevention and control performance evaluation is a complex systematic project. At the same time, due to the limitations of the author's ability and energy, there are still some shortcomings in this study.
(1) because occupational disease is a general concept, it contains many kinds of diseases, different occupational hazards need to take different prevention and control measures, so the required resources are also different. This study does not subdivide it, so it needs further improvement.
(2) this study used the "environmental advantages" to correct the performance of occupational disease prevention, but it was also limited to the comprehensive performance index, but did not correct the three level indicators.
(3) although some uncontrollable factors have been eliminated in this study, the study is based on the administrative region as the evaluation object. Therefore, the method of experimental or quasi experimental study (because there is no area without occupational disease prevention and control measures) is not adopted, and the strict causality argument is carried out, although it is limited, it is still a defect.
(4) at present, the poor occupational health situation in China is caused by many aspects such as political, economic, social and cultural constraints. This study is only discussed from the perspective of economics.
【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R135

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