医师对多点执业政策的认知情况研究
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摘要
背景医师多点执业政策有利于促进优质医师资源的合理流动,缓解居民"看病难"的问题,但目前医师多点执业注册情况并不十分理想。目的探讨江苏省医师对医师多点执业政策的认知情况。方法采用目的抽样法,在苏南、苏中、苏北3个地区分别选取3家不同等级(三级、二级、一级)的医疗机构,然后采取方便抽样法,在9家医疗机构选取符合本研究标准的医师为调查对象。于2017年7—8月,采用自行设计的调查问卷对纳入的医师进行调查。问卷的主要内容包括:医师的基本情况,对医师多点执业的认知情况(包括了解程度、是否赞成、意愿、对多点执业政策前景的看法、认为医师多点执业可能带来的好处、关心的因素、存在的顾虑及愿意采用的多点执业工作形式)。共发放问卷204份,回收有效问卷194份,问卷的有效回收率为95.1%。结果 194例医师中,非常了解/了解/一般了解医师多点执业政策者占93.3%(181/194);赞成多点执业政策者占78.4%(152/194);愿意进行多点执业者占70.1%(136/194);非常看好医师多点执业者占47.4%(92/194);认为医师多点执业有助于实现自我价值、增加收入来源者分别占80.9%(157/194)、75.3%(146/194);关心的因素为薪酬、尊重度、工作环境者分别占65.5%(127/194)、62.4%(121/194)、60.8%(118/194);参加多点执业的顾虑为医疗事故及纠纷难以处理、工作环境的差异者分别占62.4%(121/194)、60.3%(117/194)。选择医生工作室、医联体内部的对口帮扶、注册多点执业单位作为多点执业形式者分别占61.9%(120/194)、53.6%(104/194)、47.9%(93/194)。不同性别、职称、所在医疗机构区域的医师对多点执业了解程度的比较,差异有统计学意义(P<0.05);不同职称、所在医疗机构区域、所在医疗机构等级的医师对多点执业的赞成情况比较,差异有统计学意义(P<0.05);不同工龄、职称、所在医疗机构区域的医师对多点执业的意愿比较,差异有统计学意义(P<0.05);不同性别、学历、职称、所在医疗机构区域的医师对多点执业前景的看法比较,差异有统计学意义(P<0.05)。结论多数医师了解、赞成并愿意进行多点执业,但仍有顾虑。不同基本情况的医师对多点执业政策的认知情况有差异。
Background Physician multi-site practice is conducive to promoting the rational flow of high-quality doctor resources and alleviating the problem of "difficulty in seeing a doctor".However, the current registration of doctors is not very satisfactory. Objective To explore the perceptions of multi-site practice policies among physicians from Jiangsu Province.Methods From July to August 2017,this study was conducted in a convenience sample of physicians who met the criteria from 9 medical institutions purposively sampled from southern,central and northern Jiangsu(1 primary,1 secondary,and 1 tertiary medical institutions from each of these three regions).They were surveyed with a self-designed questionnaire for collecting the data concerning demographic characteristics,and perceptions of multi-site practice(including the understanding level of multisite practice policies,level of support for multi-site practice,intention to practice in multiple sites,opinions of the prospect of multi-site practice,possible benefits gained from practicing in multiple sites,concerns and misgivings of practicing in multiple sites,preferred patterns for practicing in multiple sites.Of the 204 questionnaires distributed,194 were returned,yielding a 95.1% response rate.Results Of the 194 respondents,93.3%(181/194)were well/good/fair aware of multi-site practice policies;78.4%(152/194)approved of multi-site practice policies;70.1%(136/194)were willing to practice in multiple sites;47.4%(92/194)thought that multi-site practice was very promising;80.9%(157/194)hold that multi-site practice contributed to reach self-actualization;75.3%(146/194)considered that multi-site practice helped increase incomes;65.5%(127/194),62.4%(121/194),60.8%(118/194)showed particular concerns about payment,social esteem and working environment,respectively;62.4%(121/194)felt ill equipped to manage medical accidents and disputes brought by multi-site practice and 60.3%(117/194)worried that the environments in multiple sites would be too diversified to adapt;61.9%(120/194)preferred doctors studio,53.6%(104/194)preferred the institutions within a medical consortium(for providing needed services) and 47.9%(93/194)preferred a registered practice site when it comes to the patterns of multi-site practice.Among the respondents,the level of awareness of multi-site practice policies differed significantly by sex,professional and technical title,location area of the medical institution(P<0.05);the level of support for multi-site practice varied obviously by professional and technical title,location area and level of the medical institution(P<0.05);the intentions to practice in multiple sites changed substantially according to years of working,professional and technical title,and location area of the medical institution(P<0.05);the views of the development prospect of multi-site practice diversified by sex,educational level,professional and technical title,and location area of the medical institution(P<0.05).Conclusion Most of the physicians understood multi-site practice policies,showed support for multi-site practice and intended to practice in multiple sites.However,they also demonstrated misgivings.The understanding level of multi-site practice policies diversified according to demographic factors.
Background Physician multi-site practice is conducive to promoting the rational flow of high-quality doctor resources and alleviating the problem of "difficulty in seeing a doctor".However, the current registration of doctors is not very satisfactory. Objective To explore the perceptions of multi-site practice policies among physicians from Jiangsu Province.Methods From July to August 2017,this study was conducted in a convenience sample of physicians who met the criteria from 9 medical institutions purposively sampled from southern,central and northern Jiangsu(1 primary,1 secondary,and 1 tertiary medical institutions from each of these three regions).They were surveyed with a self-designed questionnaire for collecting the data concerning demographic characteristics,and perceptions of multi-site practice(including the understanding level of multisite practice policies,level of support for multi-site practice,intention to practice in multiple sites,opinions of the prospect of multi-site practice,possible benefits gained from practicing in multiple sites,concerns and misgivings of practicing in multiple sites,preferred patterns for practicing in multiple sites.Of the 204 questionnaires distributed,194 were returned,yielding a 95.1% response rate.Results Of the 194 respondents,93.3%(181/194)were well/good/fair aware of multi-site practice policies;78.4%(152/194)approved of multi-site practice policies;70.1%(136/194)were willing to practice in multiple sites;47.4%(92/194)thought that multi-site practice was very promising;80.9%(157/194)hold that multi-site practice contributed to reach self-actualization;75.3%(146/194)considered that multi-site practice helped increase incomes;65.5%(127/194),62.4%(121/194),60.8%(118/194)showed particular concerns about payment,social esteem and working environment,respectively;62.4%(121/194)felt ill equipped to manage medical accidents and disputes brought by multi-site practice and 60.3%(117/194)worried that the environments in multiple sites would be too diversified to adapt;61.9%(120/194)preferred doctors studio,53.6%(104/194)preferred the institutions within a medical consortium(for providing needed services) and 47.9%(93/194)preferred a registered practice site when it comes to the patterns of multi-site practice.Among the respondents,the level of awareness of multi-site practice policies differed significantly by sex,professional and technical title,location area of the medical institution(P<0.05);the level of support for multi-site practice varied obviously by professional and technical title,location area and level of the medical institution(P<0.05);the intentions to practice in multiple sites changed substantially according to years of working,professional and technical title,and location area of the medical institution(P<0.05);the views of the development prospect of multi-site practice diversified by sex,educational level,professional and technical title,and location area of the medical institution(P<0.05).Conclusion Most of the physicians understood multi-site practice policies,showed support for multi-site practice and intended to practice in multiple sites.However,they also demonstrated misgivings.The understanding level of multi-site practice policies diversified according to demographic factors.
引文
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[8]马文建.从医疗损害赔偿责任层面破解我国医师多点执业困境[J].中国医院管理,2014,34(10):54-56.MA W J.Solving the dilemma of physician multi practice in China from the perspective of liability for medical damage compensation[J].Chinese Hospital Management,2014,34(10):54-56.
[9]魏洪娟,张淑娥.医师多点执业实施困境的多级递阶结构模型构建研究[J].中国医院管理,2017,37(5):11-13.WEI H J,ZHANG S E.The construction of multi-level hierarchical structure model for the implementation of dilemma in physician multi practice[J].Chinese Hospital Management,2017,37(5):11-13.
[10]林凯程,陈俊畅,耿仁文.公立医院医师群体对医师多点执业的认知分析[J].医学与哲学,2014,35(5):60-63.LIN K C,CHEN J C,GENG R W.Cognitive analysis of physicians'multi practice in public hospitals[J].Medicine&Philosophy,2014,35(5):60-63.
[11]杜兆建,马亚会,袭燕.济南市公立医院医师多点执业现状调查[J].医学与社会,2017,30(3):16-18.DOI:10.13723/j.yxysh.2017.03.005.DU Z J,MA Y H,XI Y.Investigation of current situation of public hospitals'multi-point physician practice in Jinan City[J].Medicine and Society,2017,30(3):16-18.DOI:10.13723/j.yxysh.2017.03.005.
[12]刘永军,孟凡超,胡琼.我国公立医院注册医师多点执业的多方博弈研究[J].中国卫生质量管理,2016,23(1):110-113.DOI:10.13912/j.cnki.chqm.2016.23.1.34.LIU Y J,MENG F C,HU Q.Multi-game research on registered physician multi-site practice in public hospitals in China[J].Chinese Health Quality Management,2016,23(1):110-113.DOI:10.13912/j.cnki.chqm.2016.23.1.34.
[2]林凯程.从公立医院角度探讨注册医师多点执业[J].中国医院管理,2011,31(12):4-5.DOI:10.3969/j.issn.1001-5329.2011.12.002.LIN K C.Discussion on multi point practice of registered doctors from the perspective of public hospitals[J].Chinese Hospital Management,2011,31(12):4-5.DOI:10.3969/j.issn.1001-5329.2011.12.002.
[3]刘国恩.让医生自由执业才能从根本上抑制大处方[J].中国医疗保险,2012,5(6):34.LIU G E.Allowing doctors to practice more can fundamentally curb the prescription[J].China Health Insurance,2012,5(6):34.
[4]刘文生.多维度迈向医生多点执业[J].中国医院院长,2015,11(23):64-67.LIU W S.Multi dimensional approach to physician multi practice[J].China Hospital CEO,2015,11(23):64-67.
[5]左建生,吉琳,林茂.医师多点执业制度实施的思考[J].中华医院管理杂志,2013,29(12):885-887.DOI:10.3760/cma.j.issn.1000-6672.2013.12.002.ZUO J S,JI L,LIN M.Insights for multi-site physician practice[J].Chinese Journal of Hospital Administration,2013,29(12):885-887.DOI:10.3760/cma.j.issn.1000-6672.2013.12.002.
[6]谢宇,杨顺心,鲁雅,等.深圳市医师多点执业的政策困境与制度障碍分析[J].中国医院管理,2015,35(4):3-5.XIE Y,YANG S X,LU Y,et al.Policy dilemma and institutional obstacles of doctor multi-sited license in Shenzhen[J].Chinese Hospital Management,2015,35(4):3-5.
[7]陈红艺,张光鹏.我国医师多点执业现状分析及政策建议[J].中国医院管理,2016,36(6):9-10.CHEN H Y,ZHANG G P.Status analysis and policy recommendations of physician multi-sited practice in China[J].Chinese Hospital Management,2016,36(6):9-10.
[8]马文建.从医疗损害赔偿责任层面破解我国医师多点执业困境[J].中国医院管理,2014,34(10):54-56.MA W J.Solving the dilemma of physician multi practice in China from the perspective of liability for medical damage compensation[J].Chinese Hospital Management,2014,34(10):54-56.
[9]魏洪娟,张淑娥.医师多点执业实施困境的多级递阶结构模型构建研究[J].中国医院管理,2017,37(5):11-13.WEI H J,ZHANG S E.The construction of multi-level hierarchical structure model for the implementation of dilemma in physician multi practice[J].Chinese Hospital Management,2017,37(5):11-13.
[10]林凯程,陈俊畅,耿仁文.公立医院医师群体对医师多点执业的认知分析[J].医学与哲学,2014,35(5):60-63.LIN K C,CHEN J C,GENG R W.Cognitive analysis of physicians'multi practice in public hospitals[J].Medicine&Philosophy,2014,35(5):60-63.
[11]杜兆建,马亚会,袭燕.济南市公立医院医师多点执业现状调查[J].医学与社会,2017,30(3):16-18.DOI:10.13723/j.yxysh.2017.03.005.DU Z J,MA Y H,XI Y.Investigation of current situation of public hospitals'multi-point physician practice in Jinan City[J].Medicine and Society,2017,30(3):16-18.DOI:10.13723/j.yxysh.2017.03.005.
[12]刘永军,孟凡超,胡琼.我国公立医院注册医师多点执业的多方博弈研究[J].中国卫生质量管理,2016,23(1):110-113.DOI:10.13912/j.cnki.chqm.2016.23.1.34.LIU Y J,MENG F C,HU Q.Multi-game research on registered physician multi-site practice in public hospitals in China[J].Chinese Health Quality Management,2016,23(1):110-113.DOI:10.13912/j.cnki.chqm.2016.23.1.34.