县乡医生医疗服务提供决定因素分析——基于中部地区两个县的调查
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摘要
目的:了解医生为患者进行诊疗时决策因素的实际变化,为引导合理医疗服务提供依据。方法:采用典型整群抽样方法开展问卷调查,描述性分析决策因素变化,并进行方差分析。结果:疾病情况(26.9%)、纠纷风险(22. 8%)、政策要求(19.4%)、便捷程度(18. 0%)、个人收入(12. 9%)五个因素对服务提供影响的权重依次下降;疾病情况权重随年龄增长由23.6%增长到33. 0%,同时在收入占家庭收入比重较高的医生中的差异具有显著性;纠纷风险权重更高的是男医生(23. 7±8.0);个人收入权重随医生年龄增大而减小(P<0.01)。结论:现实中的医生并非"完全健康代理人";医生提供诊疗服务时仍以疾病情况为首要因素,但其他因素的影响不容忽视;医生的个人特征及家庭背景对服务决策存在影响。
Objective: This paper aims to understand the actual changes in the decision-making factors when doctors provide medical services to patients, and to guide the provision of reasonable medical services. Methods: In this study, a typical cluster sampling method is used to conduct a questionnaire survey. The descriptive analysis and analysis of variance methods are then used to interpret the data. Results : The average weights of the five decisionmaking factors while providing medical services, namely type of disease, risk of disputes, policy requirements, degree of convenience and personal income, decrease successively. Compared with the control group, the weight of disease type is higher among the elderly doctors and county-level doctors. Those with higher weight of dispute risk are male doctors and doctors with a higher proportion of family income. The weight of individual income is higher for female doctors and young doctors; while township doctors and female doctors are given higher convenience ratings.Conclusions : In reality,doctors are not "fully health agents". When doctors are providing medical services, the state of illness is still the primary decision-making factor, but the influence of other factors cannot be ignored. The personal characteristics and family background have a significant impact on the decision-making of doctors.
Objective: This paper aims to understand the actual changes in the decision-making factors when doctors provide medical services to patients, and to guide the provision of reasonable medical services. Methods: In this study, a typical cluster sampling method is used to conduct a questionnaire survey. The descriptive analysis and analysis of variance methods are then used to interpret the data. Results : The average weights of the five decisionmaking factors while providing medical services, namely type of disease, risk of disputes, policy requirements, degree of convenience and personal income, decrease successively. Compared with the control group, the weight of disease type is higher among the elderly doctors and county-level doctors. Those with higher weight of dispute risk are male doctors and doctors with a higher proportion of family income. The weight of individual income is higher for female doctors and young doctors; while township doctors and female doctors are given higher convenience ratings.Conclusions : In reality,doctors are not "fully health agents". When doctors are providing medical services, the state of illness is still the primary decision-making factor, but the influence of other factors cannot be ignored. The personal characteristics and family background have a significant impact on the decision-making of doctors.
引文
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[9]刘航宇,段利忠,殷丽丽,等.非医疗技术服务影响因素认知的性别差异及改善对策[J].公共卫生与预防医学,2017(4):143-145.
[10]董香书,ProochistaAriana,肖翔.中国农村医生离职倾向研究——基于工作收入、医院管理与医患关系的实证分析[J].经济评论,2013(2):30-39.
[11]苏岱,陈迎春,李浩淼,等.安徽省阜南县医疗服务共同体模式下分级诊疗效果分析[J].中华医院管理杂志,2017, 33(7):493-496.
[2]苗豫东,张亮.县乡两级医生对分级诊疗中医疗服务提供联动的认知调查[J].中华医院管理杂志,2016,32(11):849-852.
[3]夏云,邹宗峰,曾晓静,等.医务人员对医患冲突的认知与态度[J].中国卫生事业管理,2013(6):413-415.
[4]潘传德,王建华.医患双方对医患关系认知差异性的调查分析[J].医学与哲学,2005(15):63-64.
[5]端木云霄.诱导需求化解路径研究——基于中西方诱导需求差异的原因分析[J].劳动保障世界,2015(S1):160-162.
[6]国务院.中共中央国务院关于深化医药卫生体制改革的意见[J].中华人民共和国卫生部公报,2009(5):1-10.
[7]周良荣.医生诱导需求的经济学分析[J].广东社会科学,2007(6):11-15.
[8]张翠华,贺加.基于医生处方行为的影响因素及约束机制分析[J].中国社会医学杂志,2011(4):246-248.
[9]刘航宇,段利忠,殷丽丽,等.非医疗技术服务影响因素认知的性别差异及改善对策[J].公共卫生与预防医学,2017(4):143-145.
[10]董香书,ProochistaAriana,肖翔.中国农村医生离职倾向研究——基于工作收入、医院管理与医患关系的实证分析[J].经济评论,2013(2):30-39.
[11]苏岱,陈迎春,李浩淼,等.安徽省阜南县医疗服务共同体模式下分级诊疗效果分析[J].中华医院管理杂志,2017, 33(7):493-496.