深圳市某三甲医院医师多点执业现状及影响因素的分析

发布时间：2018-05-25 02:40

本文选题：医师多点执业 + 深圳市　；参考：《广州中医药大学》2017年硕士论文

【摘要】：目的:深圳市作为广东省的重要试点城市,在政策的推行和配套措施的建设方面都具有较成熟的经验,本文通过分析深圳市地区政策实施的成效和不足,为深圳政策调整和其他地区的政策推广提供参考意见。通过对深圳市某三甲公立医院的利益相关方医师和医院管理者的多点执业政策实施效果主观态度和认知进行调查研究,运用数据分析找出地区现阶段的政策实施效果和不足,及主要阻碍因素和影响因素,为现阶段政策实施提供现实可行方案,更好的推动深圳市地区多点执业政策环境的健康发展,通过引导政策顺利实施形成优质的地区服务品牌。方法:运用文献分析法,收集国内多点执业政策条例、国内外相关的理论、综述、实证研究和实施现状报告等资料进行总结分析,分析目前国内外多点执业问题研究现状、前沿理论及有参考价值经验,并进行国内外研究的对比分析。通过文献研究初步选定调查维度,对相关调查维度进行筛选,通过预调查对问卷进行修改并对问卷进行信度和效度检验形成有效问卷。通过运用问卷调查法和访谈法对政策利益相关方进行调查,对调查结果运用方差分析和显著性分析进行分析整理,根据分析结果得出结论提出建议。结果:通过运用问卷法和访谈法对政策利益相关分进行调查得出调查结果包括,以对多点执业态度为因变量,阻碍因素为自变量进行方差分析,得出的有统计学意义(p0.05)的阻碍因素按平均分排名依次为:经济收入、学术成果分配不明晰,医师个人意愿,医师的工作量超负荷;对政策实施优缺点进行调查显示,最大优点为增加医师的收入,最大缺点为产生薪酬支付问题;对政策受益和损益方进行调查,统计结果显示最大受益者为患者,损益者为医院,医师对自身的投票中受益者排第四,损益者排第二;以政策相关性总分为因变量,调查医师个人情况为自变量进行方差分析,得出年龄,职称和执业年限与相关性总分有统计学意义(p0.05),其中小于30岁,职称为主治医师,执业年限10-20年的医师群体与政策相关性较高;通过对影响因素进行分类统计,发现现阶段与政策相关度最高的影响因素来自第二执业单位的相关因素;通过对医院管理者访谈内容进行编码整理,应用显著性指数计算公式计算访谈内容中涉及的影响因素,研究结论显示现阶段更好政策效益的体现是地区政策推广的主要驱动力。结论:深圳市多点执业政策实施效果明显,普遍认为的医院人事制度、责任风险、注册管理等相关制度因素不利于政策的推广的问题,在深圳市现行政策推广模式下得到了有效解决,这些政策推广经验值得其他地区的借鉴;通过调查得出医师对政策的态度主要与主观经济因素相关,医师在政策实施过程中未感受利益的明显改善,多点执业更多被认为医师的逐利行为,而未充分体现其政策公益性,可通过出台配套薪酬制度对政策进行管理;医师与管理者对政策影响因素分析结果较一致,认为政策驱动力不足,需要通过更多的政策实施福利的体现来驱动政策进一步的落实;通过调查研究分析认为健全的初级卫生服务网络是多点执业政策得以有效实施的必要条件,为促进多点执业政策更好落实需重视基层卫生服务能力的建设,积极引导患者的分流。
[Abstract]:Objective: Shenzhen City, as an important pilot city in Guangdong Province, has more mature experience in the implementation of policy and the construction of supporting measures. Through the analysis of the effectiveness and deficiency of the implementation of Shenzhen's regional policy, this paper provides a reference for the adjustment of the policy of Shenzhen and the promotion of policy in other regions. The subjective attitude and cognition of the implementation effect of multi-point practice policy of the stakeholders and hospital managers in the hospital are investigated, and data analysis is used to find out the effect and deficiency of the policy implementation at the present stage, and the main obstacles and influencing factors to provide practical and feasible plans for the implementation of the current policy and to promote the Shenzhen city better. The healthy development of the multi-point practice policy environment in the region, through guiding the smooth implementation of the policy to form a high quality regional service brand. Methods: using the literature analysis method, collecting domestic multi point practice policy and regulations, domestic and foreign related theories, summary, empirical research and implementation of the status report and other data to analyze and analyze the current domestic and foreign multi point implementation. The research status of the industry, the frontier theory and the reference value experience, and the comparative analysis of the domestic and foreign research. Through the literature study, the preliminary selection of investigation dimension is selected, the related investigation dimensions are screened, the questionnaire is modified and the reliability and validity of the questionnaire is formed to form an effective questionnaire. The questionnaire survey method is used. And interview method to investigate the stakeholder of policy, analyze and analyze the result of variance analysis and significance analysis, and draw some suggestions according to the result of the analysis. The obstacle factors are the variance analysis of the independent variables, and the statistical significance (P0.05) is ranked as the economic income, the academic achievement is not clear, the physician's personal will and the workload of the doctor are overloaded; the best advantage is to increase the doctor's income and the biggest shortage. The point is the issue of pay and payment; the policy benefit and the profit and loss party are investigated. The statistical results show that the biggest beneficiaries are patients, the profit and loss are the hospitals, the doctors have fourth of the beneficiaries in their own voting and second of the profit and loss. Age, professional title and practice years and correlation total score has statistical significance (P0.05), which is less than 30 years old, the professional title is the chief physician, and the physician group with 10-20 years of practice has a higher correlation. By classifying the influencing factors, it is found that the most influential factors of the current stage with the policy are related to the related causes of the second practice units. By coding the interview contents of the hospital managers and calculating the influence factors involved in the interview, the conclusion shows that the embodiment of the better policy benefit at the present stage is the main driving force of the regional policy promotion. Conclusion: the implementation effect of the multi point practice policy in Shenzhen is obvious and generally believed. Hospital personnel system, responsibility risk, registration management and other related institutional factors are not conducive to the promotion of policy. It is effectively solved in the current policy promotion mode of Shenzhen. These policies are worthy of reference in other areas. Through investigation, the attitude of doctors to the policy is mainly related to the subjective economic factors. In the process of implementing the policy, there is no obvious improvement in the benefit of the policy, and more practice is considered to be more beneficial to the doctor, but not fully reflected in the public welfare of the policy. It can manage the policy through the introduction of the supporting compensation system; the results of the analysis of the factors influencing the policy factors are more consistent, and the lack of policy driving force needs to pass through more. Many policies to implement the welfare of the embodiment to drive the implementation of the policy further; through investigation and analysis, a sound primary health service network is the necessary condition for the effective implementation of the multi point practice policy. In order to promote the better implementation of the multi point practice policy, we should attach importance to the construction of the basic health service capacity and actively guide the shunt of the patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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